My symptoms come and go—is it still OCD?

One of OCD’s many mysteries is its ability for symptoms to morph, become less intense at times, or seemingly come and go throughout a person’s lifetime. As if OCD wasn’t puzzling enough, this waxing and waning may leave you feeling perplexed. 

As a therapist, I have seen many people with OCD who say the same thing: they may have gone weeks, months, or even years without a particular thought, image, or urge bothering them, even when that obsession may have had a major presence in their minds previously—only for it to often return later. They ask why it has come back and what they can do about it. 

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. But what happens when this is not true consistently? 

That is a question many people who have seen OCD symptoms wander in and out of their lives to varying degrees will often ask. There may even be times they doubt whether or not they truly have OCD because of this.  

Can OCD actually be “cured”?

OCD is a chronic disorder—one that requires lifelong awareness and management, as it is debilitating when left untreated. OCD impacts different areas of the brain to varying degrees. Complexities in one’s environment, brain structure, and functioning can contribute to OCD symptoms. 

We know that these symptoms often develop in early childhood and last until adulthood, sometimes not showing up until adulthood. This may also explain why many people who have been diagnosed later in life with OCD are able to look back to their younger selves and see symptoms of OCD that went untreated or often unnoticed. 

What research has consistently shown is that OCD seems to present over a lifetime, often with the intensity of symptoms changing, sometimes even being absent. So in essence, the answer is that no, OCD cannot be “cured” per se, but for most,  it can be managed to the point where it’s no longer debilitating nor significantly interfering with someone’s life; almost as if it were “in remission,” so to speak. 

What specialized treatment works for OCD?

For OCD to become manageable, proper treatment is needed, which might include a combination of exposure and response prevention (ERP) and for some, sometimes medication management. It is very possible to live a very high-functioning life while still meeting the criteria for OCD. It is also possible to no longer technically meet the criteria for OCD at a given point in time and still struggle with the disorder. 

There are a couple of things I always try and point out to individuals that I see in treatment: The first is that a diagnosis simply means you have this set of behaviors or symptoms that impact your life. Typically these symptoms are negative and interfere with your ability to function in the manner you would like to. Secondly, I tell people that I view OCD just as I would any other medical diagnosis. I treat it the same: as a chronic condition that is very manageable. 

If you have diabetes, you can experience symptom-free moments, days, weeks, and months. It is controlled. You are continuing to treat the underlying diagnosis, and it is no longer impacting your life in a meaningful way. It is no longer causing you significant distress. It is still there, but it is being addressed and treated effectively. OCD is similar in that the underlying physiological components may still be at work, but you are managing these with ERP and sometimes medications. There are times when you may experience flare-ups or a worsening of symptoms, then there are times when you may not experience any symptoms at all or have minimal symptoms. With diabetes, when your blood sugar is controlled you don’t say “I no longer have diabetes;” you say that it is managed or under control. That is how I view OCD. 

As a licensed professional who treats OCD and someone with the condition myself, I see managing OCD as a lifelong commitment. Of course, this does not mean you will need therapy forever. It simply means that you can recognize when OCD needs your attention or it can get out of control again. The best way to manage something is to stay on top of it. You will need to be vigilant towards recognizing triggers that may lead up to flare-ups. You will need to actively practice the ERP skills that you learned. When you live in a state of recovery, you’ll understand that certain situations may lead to an increase in symptoms, but you can be prepared. 

Treatment will allow you to have the tools in your toolbox to respond to these OCD episodes. But as with any other health issue, some people may need checkups and maintenance appointments. This doesn’t need to be full-blown therapy, but it can be as simple as a few times per year seeing a therapist or provider to check in and gain extra support. The reason that this is so important is that it can alleviate the likelihood of a sudden relapse of symptoms. It can also decrease the severity of the OCD episode. The more you have prepared and know what to do when faced with OCD, the easier it will be to get back on track towards living in recovery, with minimal symptoms. 

Why do symptoms go and come back in the first place?

It has long since been recognized that OCD symptoms can intensify under times of heightened emotional stress, situational stressors, and major life events. Changes of any sort can lead to increased anxiety; even things considered happy or “good” can be stressors that lead to an increase in symptoms. There are a lot of reasons for this. One way to think of this phenomenon is to imagine something you look forward to, maybe a special vacation or the first day of school. You may be excited and hopeful, yet you still feel stressed, maybe because there are many factors you cannot anticipate. 

Sometimes it can come down to the old adage, what came first the chicken or the egg? What came first, the OCD or the stress? Does the stress magnify the OCD or vice versa? It is hard to decipher where one ends and the other begins. Is it a causal relationship, or do they just exist together? Regardless of which came first, the two often walk hand-in-hand together.

Though it is unclear exactly why many report symptoms of OCD coming and going over a lifetime, what I’d like to re-emphasize is that it can be managed effectively. Through proper treatment, stress reduction, and management, you can decrease the odds of OCD consuming your life. Through therapy, you can learn tools to prevent setbacks and how to live a life of recovery. OCD no longer has to dictate how you live your life.

Getting treatment now can help you manage OCD symptoms, whenever they appear

Even if OCD isn’t currently screaming loudly in your life, that doesn’t mean that you can’t benefit from treatment right now. Often we hold off until we hit rock bottom before seeking treatment. I’d encourage you not to wait until you can barely manage and are struggling with functioning in daily life to seek help. Putting off treatment until it is absolutely necessary will likely only serve to cause you greater distress in the long run. 

This distress may start off small, and so may think it will perhaps go away on its own. Maybe you even think it’s no big deal or that the pain is manageable. And it may be—until it is not. Unfortunately by that time, it will likely have grown, spread out, and encompassed more and more. Now you are faced with more intense pain and discomfort, all of which could have been very preventable. Treatment can help you to treat symptoms before they become unmanageable or severe.

If you’re struggling with OCD and want to be proactive in managing OCD symptoms, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs – and that means the best care for our members. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with our team to get matched with one and get started with OCD treatment.