What Causes OCD to Get Worse?

Obsessive-compulsive disorder (OCD) is a common mental health condition that affects more than 1% of the population, according to the American Psychiatric Association (APA). It can alter lives by causing unwanted thoughts and obsessions that are repetitive in nature and difficult to manage. Trauma, stress, and abuse all can be a cause of OCD getting worse. 

OCD causes intense urges to complete a task or perform a ritual. For those who have the condition, obsessions and compulsions can begin to rule their life. Some common rituals might include repeated hand washing, checking (and rechecking) that doors are locked, or uncontrollably repeating a phrase or prayer. OCD symptoms tend to come on gradually and often become more difficult to deal with over time. Understanding how to deal with OCD and the different types of OCD can help prevent the condition from worsening. 

In this article, we’ll review some of the complications if OCD isn’t addressed sooner than later and provide ways you can prevent it from getting worse.

Does OCD Get Worse Over Time?

Obsessive-compulsive disorder symptoms can intensify and worsen over the years. Symptoms can range in severity and how often you experience them, and you might notice them increase during particularly stressful times in your life. For most people, even if symptoms begin early in life, as OCD compulsions and obsessions become more intense, the condition can become more difficult to manage. Urges or compulsions can look like any of the following:

A need to keep things very orderlyA need for things to be symmetricalIntense fear of contamination or dirtHorrifying images or thoughts of self-harm or harming othersUnwelcome thoughts of aggressionUnintentional and very unwanted thoughts of sexual aggression or subjects

Symptoms that could worsen OCD

What makes OCD worse? There are several things that can trigger an OCD episode and conditions — known as comorbidities — that may contribute to how severe your OCD is as well. 

In fact, comorbidities are the main source of what causes OCD to get worse. It’s estimated that about 90% of people who have OCD also have other mental health conditions. These additional related conditions can add to how severe OCD might be. Some of them include: 

Types of anxiety disordersImpulse control disordersAttention deficit hyperactivity disorder (ADHA)Mood disordersMajor depression disorder (MDD)Social anxiety disorderTic disorderSubstance abuse disordersHypochondriasis

As comorbidities and conditions become more severe, it’s very common for untreated OCD to also worsen. This can be especially true if someone acts on compulsive behavior in hopes of relieving some of their anxiety. 

Because everyone’s symptoms are different and OCD is very individualized, it’s difficult to say exactly when, how, or even if OCD symptoms will become more prevalent. Adding to the challenge is the fact that OCD has many unofficial subtypes (ways OCD shows in your life). Contamination OCD, just-right OCD, harm OCD, counting OCD, and more are some of the various ways that OCD can be seen. 

However, one thing that is clear is that comorbidities, stress, anxiety, and major life changes or circumstances can all play a significant role in how much worse OCD might become.

As symptoms increase or intensify, people with OCD may also experience the following: 

Failure at work and/or schoolDifficulty focusingDepressionIsolationIncreased panic attacksPhysical, emotional, and mental exhaustionThoughts of self-harm or suicide

How to Prevent OCD From Getting Worse

With treatment and coping skills, you can manage your OCD. With a comprehensive understanding of the condition and what causes OCD to get worse, you can prevent it from taking over any more of your life. 

Therapy or medication

OCD can improve, or at least not get any worse, through management and treatment. OCD therapy and medication, or a combination of the two, are often successful. It’s important to recognize that you don’t need to wait for symptoms of your OCD to worsen before you reach out for help. Even if you just have a mild form of OCD, seeking therapy and/or OCD medication can help you reduce symptoms so they become more manageable.

“You may notice OCD symptoms getting worse if you go through a difficult transition such as the death of a loved one or making a big change like moving or starting a new school.”

Talkspace therapist Elizabeth Kelly, LICSW

Exposure and response prevention (ERP) therapy has been found to be extremely effective in helping mild to severe cases of OCD. By targeting symptoms and gradually exposing you to the root of your obsession, ERP helps you work toward resisting the compulsive reactions that you may once have had difficulty controlling.

Managing triggers

Knowing what makes OCD flare up can help you avoid, or at least be aware of, things before you encounter them. 

“OCD symptoms can intensify during times of stress or when you feel like life is getting out of control.”

Talkspace therapist Elizabeth Kelly, LICSW

People with OCD regularly experience extreme, yet unnecessary, worry. Obsessive and uncontrollable thoughts can interfere with life to the point of serious disruption. You may find you’re consumed with thoughts like: 

Did I turn off the stove? Will my family be OK? Am I gay because I think that female/male looks good? Are my hands clean?

Even if you are certain you turned off the stove (and you checked multiple times), you’re confident your family is safe, you know you’re straight, and you just washed your hands — you still may not be able to control obsessive thoughts like these. It can add to your normal, daily stresses in life to the point that you’re really unable to manage any longer. 

Luckily, there are coping strategies and techniques you can learn that can help. 

Work with a therapist to develop effective coping skills — The more you practice and develop your coping skills, the better you’ll become at managing known triggers that tend to make OCD worse.Focus on managing your level of stress — Try journaling, doing yoga, eating healthy, working out, or meditating as ways to manage your stress. There’s a definite link between high levels of stress and increased episodes of OCD. The better you can manage your stress, the better your OCD symptoms will tend to be.Don’t try to prevent your thoughts — Spending time trying to prevent your thoughts will often just lead to you having more obsessive thoughts. Try to find other ways to channel your energy.Try not to seek reassurance — It may seem natural to ask for reassurance from others or try to reassure yourself. However, the reality is, reassuring yourself or doing what’s known as reassurance-seeking, is just another compulsion that’s associated with OCD. Try reminding yourself that either the worst is going to happen, is happening right now, or has already happened. You can also ask yourself questions like: Who told you this and How do you know this is true? when you’re having an obsessive thought and feeling the need for reassurance. Questions like this can help you remember that your thoughts are not your reality.It’s OK to sometimes accept help, but remember that your work is your work alone — It can be tempting to involve others in your life. It’s natural to want support in your commitment to healing. However, unless a therapist suggests that you ask friends, family members, or a partner to help you, it’s best for you to try and motivate yourself. The key here is that someone else won’t always be there for you. Learning to self-rely can be extremely helpful, and more beneficial, in the long run.Focus on letting go of perfectionism — Everybody wants to do their best in life, but when you have OCD, perfectionism can be another symptom of your disorder. If you’re obsessing about getting something done perfectly the first time, you run the risk of your perfectionism turning into a compulsion. Remember that no one is perfect, and practice makes progress, not perfection.

When to Seek Treatment

If you’ve seen your OCD symptoms progress, you’re probably wondering why does OCD get worse? It’s a natural question, and the fact that you’re asking it might mean it’s time to seek an OCD treatment. 

You can get help for OCD by: 

Finding a therapistStarting medication (under the guidance and advice of your therapist or doctor)Reaching out to a clinicJoining a support groupLooking for local affiliates who have resources availableResearching online resources that are established to support people with OCD

If you’re worried about what makes OCD worse, there’s a good chance you may be experiencing an increase in symptoms. Early treatment and intervention are the most promising ways you can reduce and manage your OCD. 

Sources:

Colon-Rivera, M.D., CMRO, Hector, and Molly Howland, M.D. “What Is Obsessive-Compulsive Disorder?”. Psychiatry.Org, 2020, https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder. Accessed 13 Sept 2021.“Facts & Statistics | Anxiety And Depression Association Of America, ADAA”. Adaa.Org, 2021, https://adaa.org/understanding-anxiety/facts-statistics. Accessed Sept 2021.Fenske JN, Pettersen K: Obsessive-compulsive disorder: diagnosis and management. Am Fam Physician. 2015, 92:896-903.Penzel, Ph.D., Fred. “International OCD Foundation | 25 Tips For Succeeding In Your OCD Treatment”. International OCD Foundation, 2014, https://iocdf.org/expert-opinions/25-tips-for-ocd-treatment/. Accessed 13 Sept 2021.“International OCD Foundation | How Do I Find Help For OCD?”. International OCD Foundation, https://iocdf.org/ocd-finding-help/. Accessed 13 Sept 2021.