If OCD is chronic, why should I start therapy?

The word “chronic” is often used to describe anything that can have a lasting connotation in an individual’s life. For some, the word may evoke fear and discouragement. These same feelings are often at the forefront for people with OCD when faced with the news that OCD is indeed a chronic and often debilitating mental illness.  

The good news is that there is hope. Many people live with chronic conditions throughout their lifetimes. You can live with OCD and thrive. It is possible. I have seen it many times. I have also experienced it myself. 

An OCD diagnosis

It is true that there is no “cure” for OCD. If this illness is left untreated, the likelihood is that it will only get worse over time. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) language indicates that for someone to meet the diagnostic criteria for OCD, a person’s symptoms must be time-consuming and cause significant distress and difficulty in their functioning, or for example that they must experience OCD symptoms for at least 1 hour per day. These symptoms include obsessions and compulsions; obsessions are described as unwanted, uncontrollable, and intrusive thoughts, images, or urges that cause anxiety or distress. Compulsions are physical or mental actions done in an attempt to neutralize this discomfort or in an attempt to prevent a feared outcome. 

Though OCD is more common than was once thought, many people go for long periods of time before they are properly diagnosed and treated. This is because a diagnosis of OCD is made upon observation by a medical or mental health professional who is trained to recognize the symptoms of this disorder. But unfortunately, even when practitioners have sufficient education, they may not be sufficiently trained in OCD. Often this is due to the fact that OCD can present in so many distinct ways. It wears many masks and each person may look strikingly different. This being said, a professional who has the proper training in the treatment of OCD should be able to diagnose the condition accurately, regardless of the theme. 

When I am assessing a person to see if they meet the criteria for OCD, I look for some key components. These can include things like persistent and severe doubt, an inflated sense of responsibility for the well-being of others, mistrust of oneself, as well as compulsions performed either mentally or physically to reduce feelings of anxiety. I will explore whether these thoughts or behaviors have a significant impact on the individual’s ability to function. In other words, are they doing the things they want to be doing? If they are, are they having difficulty? Do the obsessions and compulsions take up a significant period of their time each day?

Symptoms that come and go

This is where things sometimes get tricky: If you ask almost anyone who has experienced OCD, they will tell you that the symptoms of OCD can come and go throughout their lifetime. They will often be amazed at how well they have done for several days, weeks, or even months. I have met with people convinced that their OCD was gone for good, only to have it come back later. Some people will report the same OCD themes over time, while others will report that theirs change frequently. I have heard it described as a shapeshifter—even as OCD shifts over time, it is important to remember that the underlying components often remain the same, continuing as long as OCD goes untreated.

One question I am often asked is, “If I am not experiencing currently significant symptoms, do I still have OCD? Is it really chronic?” The answer is complicated. Yes, you are someone who chronically struggles with symptoms of OCD and will likely experience some periods where symptoms increase somewhat. But no, you may not always meet the criteria for a diagnosis of OCD at any given moment. When OCD is properly treated and you learn to manage OCD successfully, it’s actually possible to not meet the diagnostic criteria. 

It is important to remind ourselves a diagnosis is nothing more than a set of symptoms that we label. We label it for the purpose of effective treatment. We do this to recognize what we are up against in treatment—we want to know that we are utilizing the correct tools to help manage the symptoms of the disorder. 

There are a few different avenues of treatment for people with OCD. Exposure and response prevention (ERP) therapy, the gold-standard treatment for OCD, was developed specifically to treat OCD, and decades of research have shown it to be the most effective form of therapy. For some, medication may also provide significant relief from symptoms, especially when administered in tandem with ERP.

Since OCD is considered chronic, you may ask yourself, “will I always have to be in ERP? Is this a lifelong therapy?” No, of course not. You can get to a place where you know how to respond to OCD’s symptoms, and confidently manage it day to day. You can experience a “remission” of symptoms of sorts. You can also still experience symptoms sometimes without them significantly impacting your life. Your symptoms can become less time-consuming, and your intrusive thoughts can become much quieter. 

This is not “just the way it is”

When people ask me if treatment for OCD is worth it, I ask them about their quality of life. What does it look like when they think of what they value and want out of their life? Does OCD get in the way of that? If it does, then I ask the next question: Are you okay with that? If that answer is no, then we get to work. 

Effective treatment is life-changing for most people, and I’ve seen this firsthand as someone who both treats people with OCD and who has the condition myself. It may be the first time they have ever felt heard and seen, and knowing that they are not alone in dealing with OCD can change the way they see themselves. For the first time, they may find relief from symptoms that have tormented them for years. Many people experience a freedom that they never thought possible. Unfortunately, too many people have gone years and years with improper treatment, and by the time they find the correct treatment, they may have already resigned themselves to a lifetime of thinking “this is just the way it is.”

They couldn’t be more wrong. A person who has been diagnosed with OCD can live a happy, fulfilling life with the right tools. You can live a life without OCD controlling your actions. You can live a life “unstuck.” You can tolerate distress and anxiety. You can learn not to attach meaning to thoughts, images, and urges. It is possible. I know because I have experienced it myself, along with so many people I have had the pleasure of working with. 

It will take perseverance. ERP is hard, but living with OCD is harder. ERP uses temporary difficulty in order to achieve long-term freedom. ERP can give hope to those who are tired and exhausted from OCD. 

Getting the right treatment can lessen the impact of OCD symptoms long term

Though OCD is chronic, ERP therapy can help people improve their quality of life, manage OCD, and reduce their OCD symptoms as well as symptoms of anxiety and depression. ERP  is an active form of treatment and requires intentional buy-in from the therapy member through participation in exposures, a willingness to feel discomfort, and honesty with their therapist about their obsessions and compulsions (even if they believe they are shameful or taboo). 

ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. If you have questions or think that you may need ERP therapy for your OCD, speak to someone on our care team on a free 15-minute call.

If you’re worried or uncomfortable about discussing your symptoms and thoughts with anyone else, keep in mind that a therapist won’t judge you, and a trained OCD specialist (like the ones at NOCD) will deeply understand all themes of OCD. You don’t have to suffer in silence or live with debilitating OCD symptoms forever, and many people find relief in sharing their experiences. Over time, you can learn how to manage OCD and regain your life, too.