Obsessive-compulsive disorder is a prevalent chronic mental health condition that affects millions of people. The World Health Organization considers anxiety disorders, including OCD, one of the top 10 contributors to non-fatal health loss across the globe. The symptoms of OCD can range from minor disturbances to a person’s daily tasks to obsessive rituals that completely take over a person’s life.
While it’s difficult to predict when or how OCD will worsen, stress, comorbidities and life circumstances can all play a significant role. OCD is generally diagnosed between the ages of 8 and 12 or between the late teenage years and early adulthood, but the condition tends to vary in severity throughout one’s life. It doesn’t necessarily always get worse for everyone; it may get easier to live with or just stay at the same level. However, untreated OCD has the potential to get worse and become unmanageable.
How OCD changes over time
Comorbidities play a significant role in the severity of OCD. Some common OCD comorbidities are depression, social anxiety disorder and generalized anxiety disorder. When these conditions become more severe, OCD may be more likely to get worse, especially when an individual is used to engaging in compulsions as a way to relieve anxiety.
Here’s an example of how this might happen: Sam has recurrent uncued panic attacks, and he’s worried they will get so bad that something horrible will happen. He also has a mild form of religious/scrupulosity OCD that causes him to experience ongoing and intrusive thoughts about something bad happening to him if he doesn’t pray perfectly. To ease this anxiety, he spends a little extra time praying each day. His compulsions take him only a couple of extra minutes per day, so Sam doesn’t feel the need to seek out treatment.
However, because Sam’s panic attacks are so bad, he starts avoiding certain situations and people he’s worried could trigger them. He starts to have obsessive thoughts that these panic attacks are happening because he hasn’t been praying enough and they are a way for God to tell him he’s sinning. As a result, his compulsive prayer increases as Sam begins to view prayer as his only chance to make his panic attacks stop.
While it’s difficult to predict when or how OCD will worsen, stress, comorbidities and life circumstances can all play a significant role.
Here’s another example: Joe has “just right” OCD and needs to make sure his emails are perfect before he sends them. He rereads each email multiple times before clicking send, and sometimes asks a friend to look over them. The process usually takes 10 minutes per message. Joe feels this is inconvenient, but 10 minutes doesn’t impose a huge burden on his day, and since he’s been doing this compulsion for so long, he’s learned to factor in the extra time. Plus, Joe is convinced this is the only way he can write a good email, so he never seeks out an alternative.
Fast forward a few years. Joe now has a new job that requires him to send dozens of emails per day. He can no longer afford to spend 10 minutes per email, because his work and productivity will suffer. His life circumstances have made his condition unmanageable. Joe has reached a point where he needs to manage his OCD or he will be incapable of performing well at his job. Starting therapy can be challenging, and many people with OCD wait to seek treatment until their symptoms become more severe or severely impair their ability to function in their daily life. For others, the cost of treatment or lack of access can be prohibitive and prevent them from getting the help they need.
How OCD subtypes can change over time
Because there are many subtypes of OCD and many different ways the condition can show up in a person’s life, it is common for people to experience their OCD differently throughout their life. A person may experience remission of one OCD subtype but find they have developed a different subtype.
Let’s use another example: Anna has a mild form of contamination OCD. She washes her hands excessively, but so far it has not seriously interfered with her life. No one notices this compulsion, and as a result, Anna doesn’t spend too much time worrying about it as a problem. But a few years later, Anna gets into a romantic relationship for the first time, and it becomes apparent that she has relationship OCD as well — a subtype where people experience excessive and ongoing worry about their partnerships. Her hand-washing compulsion felt manageable, but her ROCD feels overwhelming and compels her to seek treatment.
How to treat OCD
OCD isn’t known to spontaneously resolve without treatment, though depending on the circumstances we discussed above, there are times where it may feel more manageable than others. But you don’t need to wait for your OCD to get worse to seek treatment. If you think you have a mild form of OCD, it’s recommended that you seek help, even if your symptoms feel like they’re manageable. This will help ensure your condition does not get worse.
The best form of treatment is exposure and response prevention therapy, known as ERP. It’s been found to be effective for mild to severe cases of OCD. This form of therapy targets a person’s symptoms by gradually exposing them to the source of their obsessions and then working to withhold the compulsive actions.