If you have obsessive-compulsive disorder (OCD), you probably already know that it can choose to rear its head at all kinds of moments, from the extremely important to the totally mundane. Even if your OCD has been relatively quiet, and you’ve been feeling alright, your symptoms can still pop up, sometimes seemingly out of nowhere, and begin to escalate.
One moment you’re in a perfectly fine mood and running into the grocery store after work as you’ve done many times before, and the next you start to feel anxiety and panic in the produce section, because the moral OCD themes that you haven’t experienced in a year are suddenly convincing you again that you’re a bad person if you can’t confirm that the veggies you buy were grown as ethically and sustainably as possible. This symptom spike can then continue to intensify.
This experience is called an OCD flare-up. It can be severe and debilitating, and can happen even if you’ve been making progress in OCD treatment, especially after a disruption like a string of sleepless nights, a stressful work week, or a major life transition. These flares can be extremely frightening and deeply frustrating, especially if they come just when you thought you were getting a handle on things. What can be even more frustrating is if, in days, months, or years after an OCD flare-up, the lingering memory of that flare-up continues to derail you. Maybe you find yourself worrying you’ll start spiraling every time you start to drive to the grocery store, even though your OCD hasn’t seized on the produce aisle in months. Or, maybe after a couple of sleepless nights, you begin to grow exceedingly concerned that lack of sleep could contribute to another debilitating OCD flare-up, even though nothing has changed yet.
If you’ve experienced fears like these, you’re not alone; some people with OCD feel avoidant or afraid of places, people, events, objects, or even times of year that they associate with bad periods in their OCD journeys, even if their symptoms don’t actually automatically get worse when confronted with those things. If you’re experiencing anxiety, fear, and avoidance around things you associate with OCD flare-ups, here’s what to know—and how specialized treatment can help.
OCD can ebb and flow
OCD is not a linear disorder. Often, people find that the severity of their symptoms shifts over time. These fluctuations can be in response to major life changes or world events, or they can happen without any clear cause. But some common factors that can worsen OCD symptoms include:
- Stress and change – OCD can get worse during times of extreme stress or drastic change, even if those changes aren’t traumatic. As counterintuitive and unfair as it may seem, even positive changes, like the beginning of a new dream job or a move to an exciting new city, can worsen symptoms if OCD hasn’t been managed.
- Trauma – OCD tries to present itself to you as a means of keeping you safe, so it makes sense that it can flare in response to traumatic situations. Research suggests that people with PTSD are around 10 times more likely than members of the general population to have OCD.
- Other, co-occurring mental health conditions – OCD often occurs alongside other mental health conditions, especially major depressive disorder (MDD) and generalized anxiety disorder (GAD), which can interact with OCD symptoms to create more complex experiences. If you’re managing other mental health disorders in addition to OCD, it’s important to receive ongoing treatment for these conditions from a professional who knows how to navigate treatment for these conditions in conjunction with OCD treatment.
It’s also helpful to understand that while your anxiety might spike around certain people, events, and so on because you’re worried they could cause an OCD flare-up, one thing is known to worsen OCD symptoms, and that’s engaging in compulsions. This seems especially unfair, because OCD is so insistent that compulsions will help assuage your intrusive thoughts, urges, and fears. But while compulsions may quiet these things in the short-term, they ultimately serve to reinforce the belief that the focuses of your obsessions are truly a danger to you and your loved ones, and that compulsions are the only way of protecting yourself—no matter how much distress and harm they cause.
OCD’s impacts are far-reaching
Avoiding people, places, contexts, and other things that remind you of a bad OCD flare-up can have far-reaching negative consequences. This is one of the ways in which OCD can be deeply isolating, causing you to miss out on hobbies, relationships, career opportunities, and other meaningful life experiences.
For example, if you experienced an especially bad OCD flare-up while you were applying to college, the idea of applying to graduate school may spark fear for you—even if pursuing a graduate degree is the next step toward securing your dream job. This might lead you to put off applying, delaying the steps you want to take to grow and pursue your goals.
Or, maybe you experienced the onset of your OCD after giving birth, and while you’ve since worked through those symptoms the idea of getting pregnant again feels incredibly frightening. Postpartum OCD, or OCD that focuses on your newborn, can be a recurrence of previous symptoms or a new onset that’s triggered by pregnancy or giving birth. Either way, it’s harrowing to go through the absolute overwhelm of caring for a newborn while also being barraged by OCD symptoms. This experience can make you feel scared of becoming pregnant again, even if you know you want to have more children, giving OCD an unfair and unwanted stake in your family planning.
Overcoming the impact of an OCD symptom spike
A bad OCD flare-up can seriously impact your life. You might put off major life decisions that matter to you deeply, like applying to school or getting pregnant. You might become so overwhelmed that your work suffers, or you struggle to show up in your relationships the way you want to. Your ability to care for yourself might be impacted, leaving you feeling unwell physically as well as mentally.
If you’re just now beginning to recover, it’s common and normal to feel scared that you could end up back at that low point. The mental and emotional load of OCD is utterly exhausting, and it makes sense that you may need some time before you’re ready to start taking on new challenges. In these moments, it’s important that you’re kind to yourself, and recognize the progress you’ve made. Self-compassion is an essential part of managing both OCD, and everyday existence.
And aversion to things with which you’ve formed a negative association—like the places you went, foods you ate, or people you were spending time with around a bad flare-up—makes sense. But if you start avoiding those things as a result of those fears, that avoidance may become a compulsion that feeds your OCD—ultimately increasing the likelihood of your symptoms worsening. The most important thing to remember is that there are tools that can reduce the severity of OCD flare-ups, and help you to get through them when they do happen.
Strategies for handling an OCD flare-up
There’s no way to be absolutely certain that you’ll never find yourself caught in an OCD flare-up. But there are some strategies that can help you be more prepared:
- Learning how to assess when, where, and why you’re triggered – It can be difficult to have the presence of mind to notice details like these in the midst of a flare-up, but paying attention to the details of your circumstances when symptoms worsen, and how they make you feel, can help you better understand your OCD. This kind of awareness can also help you create distance between yourself and your distress. Because monitoring yourself for triggers can become a compulsion, it’s best to learn this skill by working with a therapist who specializes in treating OCD using exposure and response prevention (ERP) therapy. ERP is the most effective, evidence-based treatment for OCD, and it works by gradually exposing you to feared thoughts and situations while teaching you to resist compulsions.
- Resisting the impulse to fight with your thoughts – Fighting against or trying to mentally avoid intrusive thoughts is an exhausting and ultimately unhelpful form of mental gymnastics. And while it may feel scary to accept that intrusive thoughts could very well arise again in the future, trying to prevent those thoughts from coming into your mind by avoiding certain places, people, or events around which they first appeared will usually only limit your life and may even make the thoughts come back stronger. Rather than imbuing your thoughts with more power by throwing all your energy into trying to avoid and resist them, try noticing them—and then noticing how they’re just thoughts, with no ability to actually impact your reality.
- Delaying compulsions – Compulsions can feel impossible to ignore, but you do have the power to resist them. While the ultimate goal of OCD treatment is to eliminate compulsive behaviors, practicing holding off on compulsions also helps to make you stronger. When you’re dealing with physical compulsions, this can mean waiting five, 10, or 15 minutes between when you get the urge to check that you turned the stove off, and when you actually go to the kitchen to make sure. If you’re dealing with a mental compulsion, like compulsive avoidance, this strategy might not be quite as straightforward, but it can still provide a helpful framework. For instance, maybe you’re afraid to attend your niece’s birthday party this year, because last year’s party created a spike in your POCD (pedophilia OCD), and so you’ve avoided buying a gift. In this situation, you and your therapist might create a plan that calls for taking micro steps over the course of a month to look for a gift and make other preparations for the party. While you may find that this strategy doesn’t eliminate compulsions entirely overnight, the elapsed time proves to you that you’re not in danger, and you may even find that the urge to avoid the party has gone away entirely after you’ve begun slowly engaging with the event over time.
A specialized therapist will work with you to understand your triggers, and help you learn response prevention techniques so that you can lean into self-compassion and away from compulsion. If your most recent flare-up wasn’t your first encounter with OCD, you may already know about ERP and may have even tried it before. If that’s the case, it’s important to know that there’s nothing wrong with returning to therapy if you think it would be helpful. Needs ebb and flow, and your treatment can, too. These techniques can help you go from delaying compulsions to eliminating them altogether. That way, even if you find yourself frightened in the face of a context that’s activated your OCD in the past, you know you have the tools you need.
