What makes OCD symptoms get worse?

If you’re struggling with OCD, you probably know that the symptoms can fluctuate over time. Maybe you’ve observed a pattern and identified things that tend to make OCD worse, and maybe it feels like OCD is impossible to predict. 

It’s impossible to know what might trigger an increase in OCD symptoms for everybody, but there are certain factors that often play a key role in periods of more severe OCD symptoms. This can be valuable to investigate: if we learn what tends to make OCD symptoms worse, we can be proactive in taking care of ourselves and planning for any potential setbacks on our recovery journey. 

Compulsions

Probably the most common cause behind the worsening of OCD symptoms is through compulsions. When we perform compulsions in response to the distress caused by our obsessions, it only serves to provide temporary relief. Over time, performing compulsions reinforces the belief that obsessions pose a real danger, and that compulsions are necessary in order to be safe. This creates a vicious cycle that only gets stronger until it is interrupted. 

Interrupting this cycle is how exposure and response prevention (ERP) therapy works. Considered the gold standard in OCD treatment, ERP works by exposing people with OCD to their fears and obsessions in a controlled environment, providing the opportunity to resist the urge to engage in compulsions for quick relief. Over time, this helps them develop a tolerance for uncertainty and anxiety, allowing them to live life on their own terms, rather than according to OCD’s demands.

The impact of trauma

We know that trauma can exacerbate symptoms associated with any mental health condition, and this is no different with OCD. Trauma and OCD can interact in ways that we don’t always understand—in fact, studies have estimated that 19-31% of people with PTSD also have OCD, around 10 times the rate for the general population.

For people who have experienced trauma, encountering triggers can make OCD symptoms worse. Often, the things that trigger their obsessions are related to their past trauma, and can be very difficult to avoid—moreover, in people with OCD this avoidance can be compulsive, making one’s fears worse and worse over time.

Even without distinct trauma, adverse experiences of varying severity can make OCD symptoms worse. Most of us will not go through life without experiencing some form of event that has a major negative impact on us. Many will endure more than one trauma in their lifetime, and each of these events carries the potential to exacerbate OCD significantly.

The impact of stress and change

In addition to trauma, we all face sources of stress. According to the World Health Organization (WHO), stress can be defined as the response to any type of change that causes emotional, psychological, or physical strain. 

Change of any type, positive or negative, can cause stress. When you think of all of the exciting times in your life, you probably are aware of various stressors. Going off to college, getting married, the birth of a child; all of these may be positive experiences, but they are also common sources of stress.

More often discussed are negative stressors. We live in a fast-paced, high-stress culture. We are often required to work long hours and manage household responsibilities, parenting obligations, financial commitments, relationship issues, and so on. Many people will develop chronic health issues or need to take care of a loved one who does. All of these things impact every part of our mental health, including OCD. People most commonly report spikes in their OCD symptoms occurring during periods of high stress.

Co-occurring mental health conditions

People with OCD are more likely than the general population to experience other comorbid mental health conditions, or conditions that affect a person at the same time. Two of the most common co-occurring mental health conditions are Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), but there are many other conditions that can also go hand in hand with OCD. In addition to these, substance abuse disorders can also severely impact OCD symptoms. 

It is imperative for people with OCD and other co-occurring conditions to receive ongoing treatment and management for their comorbid conditions in conjunction with OCD treatment. Although ERP is the therapy of choice for OCD, one may also need other forms of therapy to help combat other mental health issues, which can often be done alongside ERP treatment. 

How to prevent relapse and continue to live in recovery

How can you manage OCD when so many factors can make it worse? The key is the difficult process of achieving long-term management of these things, as well as proactive preparation—you don’t want intense OCD episodes or relapses to sneak up on you. Living in recovery isn’t about reaching a point in time or a destination, but about building skills that you need to live life on your own terms.You may have heard time and time again that recovery is not linear, and this is certainly true for OCD. Recovery is an ongoing process and will include peaks and valleys. The goal is to have every tool you need to manage OCD when the going gets tough.

Depending on what all you are struggling with, medication management may also be a lifelong practice. You are your own best advocate for your mental health needs. Each person is unique and will need to discuss with their care team what their particular needs are. If you’re living with co-occurring mental health conditions, make sure you’re working with licensed professionals who are trained and experienced with your specific diagnoses, so that you can receive the treatment you need to manage your symptoms simultaneously.

Just like recovery, treatment is not always linear—you may need treatment at various times in your life to fine-tune your skills and continue your progress. But with the right resources, support, and access, learning to manage your mental health long-term is possible.

At NOCD, we have licensed OCD therapists with specialty training in treating OCD with ERP therapy. They will work with you to plan creative ways to gradually face the fears that are holding you back from living the life that you want to live. If you’re experiencing a relapse of OCD symptoms, re-entering treatment can provide the much-needed support and encouragement to help you get through a rough patch stronger than ever. 

If you have any questions about starting ERP therapy or need more information about the treatment, please don’t hesitate to book a free 15-minute call with our care team. On the call, we’ll assist you in either getting started with a licensed therapist at NOCD who has specialty training in OCD and ERP, or connect you to other resources that might be helpful.