Obsessive compulsive disorder - OCD treatment and therapy from NOCD

OCD Flare-ups: What causes them & how long they last

May 10, 20247 minute read

It can be scary and discouraging for obsessive-compulsive disorder (OCD) to flare up all of a sudden, especially if your symptoms have been getting better for a while. You should know that it’s completely normal for OCD symptoms to fluctuate over time, because it’s considered a chronic condition. Even though the majority of people who go through specialized OCD treatment experience a long-term, drastic reduction in symptoms, that doesn’t mean your symptoms won’t spike now and then.

“Having flare-ups is just part of how OCD works,” says Tracie Zinman-Ibrahim, LMFT, CST, an OCD specialist at NOCD, the leading telehealth provider of specialized OCD treatment. In fact, one study on OCD flare-ups found that 60% of people with OCD who successfully went through treatment experienced some kind of flare-up in the next five years. And they’re not always predictable: sometimes flare-ups come out of nowhere, while other times they have specific triggers. 

Let’s get into common OCD triggers that lead to flare-ups, how long they can last, and how you can effectively manage OCD symptoms whenever they arise—including the occasional flare-up.

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What is an OCD flare-up?

Any uptick in OCD symptoms can be referred to as a flare-up. When symptoms spike, you may notice an increase in intrusive thoughts, an increase in the distress they cause, and an increased urge to engage in compulsions. You likely find an increased difficulty in consistently managing those symptoms, too, even if you’ve previously been able to, and worries like “What if I’m losing all my progress?” are common. 

Even if your OCD treatment journey has been smooth so far, it’s important to recognize that you can handle setbacks, too—just like you learned to manage your symptoms in the first place, you can get better at recognizing and responding to future flare-ups. 

What causes OCD flare-ups?

“We’re all different,” says Zinman-Ibrahim, “so OCD flare-ups get triggered differently and at different paces. They’re not always predictable, but we can often learn some of the things that tend to trigger them.” Some of those reasons may be obvious, while others are subtle and unexpected. Zinman-Ibrahim says that the triggers she sees most often include:

1. Major life changes.

These could include moving, getting married, or starting a new job, for example. A change in routine, even if it’s a positive change, can lead to an increase in stress. Research on OCD triggers indicates that stress can be a major trigger.

2. A lack of sleep or other lifestyle changes.

Physical and mental health are intimately connected—a change in your physical wellness, like a lack of sleep, not eating enough, or not moving your body as much as you used to, for example, can trigger a flare-up of OCD symptoms.

3. You’re engaging in compulsions.

In the OCD cycle, obsessions lead to compulsions, compulsions reinforce obsessions, and together they tighten OCD’s grip on your life. What may start off as seeming like one trivial, harmless compulsion can trigger a larger OCD episode. But the reverse is also true: resisting compulsions is the best way to manage a flare-up—more on this later.

4. Trauma.

Sometimes, trauma triggers obsessions and compulsions. For example, if you get in a car accident, you might develop new debilitating fears about driving or being in a car. A body of trauma research has found a link between trauma and OCD.

5. Co-occurring mental health conditions.

OCD has high comorbidity rates, meaning that it often occurs at the same time as other conditions, including anxiety, depression, body-focused repetitive behaviors (BFRBs), and post-traumatic stress disorder (PTSD). If these conditions are left untreated, they can leave you more vulnerable to falling back into the OCD cycle.

If you have no idea what triggered your flare-up, don’t worry. Working with a therapist who specializes in treating OCD can help you develop an awareness of what tends to trigger your flare-ups, so you learn what to watch out for in the future. “It usually takes some time to develop this awareness,” Zinman-Ibrahim says. 

And sometimes, you just can’t know all your potential triggers. “Sometimes you will get triggered unexpectedly. Maybe you’re driving down the street and you see something on a billboard or maybe someone says a word. Maybe you see a store and that reminds you of an obsession,” Zinman-Ibrahim explains.

She says she once worked with someone who was triggered by hugging their sibling. This client had harm OCD—a type of OCD that causes obsessions about accidentally or purposefully hurting someone else or yourself. “This client suddenly had intrusive thoughts like, ‘What if I’m trying to smother my sister? Maybe I’m going to squeeze her a little tighter and make it hard for her to breathe.’”

We cannot always be aware of our triggers, but we can certainly learn their themes over time. Whether or not you know the exact trigger of your flare-up, you can still use evidence-based strategies to manage your OCD symptoms and get back on the road to relief. 

How long do OCD flare-ups last?

Every person with OCD, and every flare-up, is different. “We do know that OCD tends to get worse the longer it goes untreated,” Zinman-Ibrahim says. Beyond this, your journey may involve any number of ups and downs. 

This underscores something that experts consistently emphasize: the sooner you get treatment, the sooner you’ll learn to manage your flare-ups in the long term. Catherine Schuler, PsyD, a psychologist at the Center for Anxiety & Behavior Therapy, says that no matter how long a flare-up lasts, she reminds her clients, “A flare-up is not a step backward; it is just another opportunity to strengthen your defenses against OCD.”

It’s natural to feel anxious about when an OCD flare-up will end. But as Schuler says, you can view this uncertainty as yet another chance to practice sitting with discomfort—and doing so is just another step on the road to long-term relief from your symptoms.

With specialized treatment, you can tackle OCD flare-ups as soon as they start. Start your journey with a free call.

How to manage OCD flare-ups

On to the good news: there is evidence-based therapy to treat OCD called exposure and response prevention (ERP) therapy, and it can be used throughout your life to effectively manage flare-ups. Note that receiving specialized treatment is key to OCD recovery. If you’re not receiving specialized treatment, you’re likely to be even more prone to flare-ups and lack the tools you need to manage them. 

ERP works by slowly, gradually facing your triggers and resisting compulsions through response prevention techniques. To begin the process, your ERP therapist gathers an in-depth understanding of your unique OCD symptoms. From there, you collaborate on your treatment plan, starting with the least intense triggers and gradually working up to more difficult ones.

Zinman-Ibrahim has not only been treating OCD for 20 years, but has also been doing ERP for her own OCD for decades. When she finds herself engaging in compulsions now and then, she sees it as a learning experience, not a matter of going back to square one: “You don’t drive down the freeway and get all confused and thrown off because you went over a pothole—it’s just a normal part of your journey. It’s the same with OCD.” 

“It’s important to have compassion for yourself and acknowledge that recovery isn’t linear,” says Zinman-Ibrahim. If you’ve stopped specialized therapy for OCD, you can always go back. In fact, it’s common for people to go back to therapy for a refresher, no matter how long they’ve been out—and this isn’t a failure! It’s kind of like going to the gym to maintain the strength of your muscles or develop new ones.

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Other tips for managing OCD flare-ups

1. Practice noticing when you’re triggered.

“If you’re not aware, then you won’t be able to do anything about it,” Ibrahim says. Take note of the when, where, and why of your triggers. Notice how they make you feel. Oftentimes, just being able to name what’s happening can put a little distance between you and your distress. 

2. Don’t try to fight with your thoughts.

Instead, try saying to yourself, “I notice that I’m having this thought right now.” This can allow you to see thoughts as just thoughts, rather than real threats that you have to deal with. Fighting with your intrusive thoughts—or even trying to avoid them—gives them more power. 

3. Practice delaying compulsions.

The ultimate goal of OCD treatment is to eliminate compulsions altogether, since compulsions reinforce the OCD cycle. However, eliminating compulsions takes time, and nobody is perfect. It can be helpful to start by simply delaying them. In the moment of feeling triggered, try saying to yourself, “I will try to figure this out in five minutes.” You can work your way up to 10 minutes, 15 minutes, and so on. Sometimes, you might still do the compulsion after the time is up; other times, you’ll find that the urge has passed.

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