In This Article
Comorbidities: A History of Mental Health Conditions
Some conditions, known as comorbidities, can contribute to the severity of OCD symptoms. Individuals with OCD often concurrently struggle with other types of mental health conditions, and these comorbidities are the main factor that causes OCD to get worse.
Up to 60–80% of patients with OCD experience a depressive episode in their lifetime, and at least one-third of patients with OCD have a concurrent major depressive disorder at the time of evaluation (Pallanti et al., 2011).
Other comorbid conditions that can add to the severity of OCD symptoms include anxiety disorders, impulse control disorders, attention deficit hyperactivity disorder (ADHD), mood disorders, social anxiety disorder, tic disorders, and substance abuse disorders.
If these comorbidities are left untreated, they can become more severe, increasing anxiety and distress and causing OCD behaviors to exacerbate.
Giving into the compulsions will typically make OCD worse by fueling the vicious cycle of obsessions and compulsions.
While doing a compulsion may initially provide relief and feel like the only way to ease your anxiety, the more compulsions you do, the more OCD will want from you.
And, the longer you remain in the cycle, the more momentum and strength it gains, making it even more difficult to escape. The entire cycle will repeat itself if you resist the obsessions and give in to the compulsions.
When struggling with OCD, many people will avoid situations they deem to be triggering to gain control over the anxiety.
For example, they might think, “If I don’t leave my home, I will not get contaminated.” While this might relieve anxiety in the short term, it will only reinforce the OCD in the long term.
Avoidance gives the power to the OCD and does not allow sufferers to face and overcome triggering situations.
When we worry or feel anxious, we can often look to others to reassure us. We might ask, “Are you sure I am a good person?” or “Are my hands clean?” or “Did you sanitize the light switch?” to make us feel better and ease our doubts. However, this habit only fuels the OCD by reinforcing their original fears and feeding into the OCD cycle.
It might make you feel better in the moment, but constant reassurance does not allow your brain to learn to tolerate discomfort.
In the long term, reassurance-seeking actually prevents you from disconfirming your fears and only contributes to the maintenance of OCD symptoms. Instead, you must practice sitting with short-term discomfort to see long-term success.
Ruminating is the mental process of overthinking or engaging in repetitive negative thought processes that loop continuously in our brains.
For OCD sufferers, this might include worrying about a future event, trying to think of all the worst-case scenarios, replaying a past scenario, trying to predict how something will play out, or trying to plan something to every last detail.
Ruminating is a type of compulsion – a mental compulsion – that feeds OCD and reinforces the idea that an intrusive thought is dangerous and needs to be controlled.
Stressful Life Events
Stressful life events, such as unemployment, relationship issues, death of a loved one, birth of a child, or financial problems, can provoke and intensify our OCD symptoms.
While the symptoms of OCD will range in severity and duration from person to person, they tend to increase during particularly stressful times, making the condition more difficult to manage.
Like with most other anxiety disorders, periods of high stress can bring out symptoms because as you start to feel overwhelmed, you resort to the positive coping mechanisms that you have learned.
This can lead to a return, or a worsening, of OCD symptoms.
Isolation from friends, family and loved ones is common for anyone struggling with mental health challenges. For people with OCD, social events can trigger or seem like a chore.
Over time, this isolation can cause sufferers to feel quite lonely. Anxiety and other OCD symptoms seem to feel the strongest when the sufferer is alone and left with nothing to do but overthink.
While socializing might seem daunting and tiresome, isolation will likely feed and grow the OCD.
“Junk” foods, such as foods high in processed ingredients, sugars, fats, oils, and sodium, can exacerbate your OCD symptoms.
A poor diet can put excess stress on the body, such as fluctuating blood sugar levels, impairing higher cognitive functioning, or causing neuro-inflammation.
By avoiding highly processed and gluten-based foods, OCD patients can slow their obsessions and compulsive behaviors.
Inadequate or Poor Sleep
It is common for individuals with OCD to have a hard time falling and staying asleep due to racing thoughts, nightmares, rumination, intrusive thoughts, and urges.
Severe OCD symptoms are proven to be associated with greater sleep disturbance, and the more severe the OCD, the more severe the sleep disruption.
When you do not get enough sleep, your health and well-being suffer, and consequently, it can worsen your OCD symptoms.
If the body’s internal clock is altered, then your mind’s perception of control and the ability to ward off compulsions may be too. A poor night’s sleep can significantly affect the next day by making OCD symptoms more severe.
OCD Coping Strategies
While there is no official “cure” for OCD, the symptoms can be managed with the proper treatment and coping skills. The International OCD Foundation suggests that 70% of people with OCD will benefit from treatment with ERP, medication, or a combination of the two.
Additionally, becoming more aware of your triggers and learning how to avoid them can also lessen the anxiety associated with OCD.
It is essential to understand that even if your OCD is under control, symptoms can return if you do not actively employ the coping mechanisms that you may have learned in psychotherapy and/or if you stop taking any prescribed medications.
Instead of focusing on blocking your thoughts and thinking of ways to prevent your OCD, try channeling your energy into other activities or relationships.
People who suffer from OCD tend to struggle with perfectionism. Striving always to be the best in life can sometimes become an obsession, feeding your OCD. It is important to remember that perfection does not exist and that being perfect does not always correlate with progress.
There are several treatment options and coping strategies to manage your OCD symptoms and prevent them from progressing further.
You can control your stress levels by engaging in activities that elevate your mood or help manage your stress. These might include yoga, working out, meditating, journaling, or eating your favorite foods.
Cognitive-behavioral therapy (CBT)
One type of psychotherapy often used to treat OCD is Cognitive-behavior therapy. During CBT, your therapist will help you decrease your anxiety by identifying the thought patterns distorting your view of reality and leading to these obsessive thoughts.
The goal of CBT in the context of OCD is to uncover the underlying fear driving the intrusive thoughts, reassess these misguided beliefs, and restructure these thoughts in productive ways.
When undertaking CBT, it is customary to initially experience greater anxiety than you did before you started therapy (Mancebo, 2011).
Dialectical behavior therapy (DBT)
Dialectical behavior therapy is a form of cognitive behavioral therapy that focuses on mindfulness, acceptance, emotion regulation, interpersonal effectiveness, and distress tolerance.
“Dialectical” means combining opposite ideas and finding comfort in contradiction.
DBT is a skill-based treatment that focuses on helping people accept their realities while helping them learn to change their unhelpful behaviors.
One of the most significant differences between DBT and other forms of therapy is the concept of acceptance. With DBT, your thoughts and behaviors are not categorized as good or bad, but instead, they are accepted for what they are.
This step of acceptance and non-judgment is often necessary before people are ready to make measurable changes.
Exposure and response prevention (ERP)
Exposure and response prevention is a sub-type of CBT considered the first-line psychotherapy for OCD (Hezel & Simpson, 2019).
ERP involves deliberately exposing oneself to intrusive thoughts, objects, and situations that make you anxious and then preventing yourself from engaging in compulsive actions in reaction to these thoughts.
The hope is that you will learn that no harm will follow even if you refrain from compulsive behaviors and eventually become less sensitive to the things that once caused you great anxiety.
Deep Brain Stimulation (DBS)
Deep Brain Stimulation is an investigational approach for people with more severe OCD symptoms that do not improve with traditional medications or psychotherapy.
DBS is an investigational surgical treatment that uses electrical impulses to target specific areas of your brain that are contributing to your symptoms.
The goal is that these electrodes produce electrical pulses that will help change your thoughts and behaviors.
Exercise can be another beneficial tool to help ease OCD symptoms. Exercise is a natural reducer of stress and anxiety because when your body is active, your body releases endorphins that decrease tension, lift your mood, and reduce discomfort.
For example, one study by Dr. Ana Abrantes of Butler Hospital in Rhode Island found that 30% of participants who added exercise to their OCD treatment regimen reported decreased depression, anxiety, and OCD symptoms.
Although physical activity is not a substitute for therapy, and the effects may only be temporary, adding exercise to your daily routine can lead to an overall decrease in your OCD-related anxiety.
Mindfulness meditation can be an effective way to manage OCD thoughts or urges and the distress that comes with them.
While it might be overwhelming to sit with your obsessive thoughts, meditation can help you relax, slow down your busy thoughts, and be fully present in the moment.
It can take your mind away from what it is fixated on and help you push out your obsessive thoughts and compulsive tendencies.
Instead, you can focus on your breath, a mantra, or specific imagery. Mindfulness is most effective when done in conjunction with a form of CBT.
Certain psychiatric medications, specifically selective serotonin reuptake inhibitors (SSRIs), can help control the obsessions and compulsions of OCD.
Several different SSRIs have been approved by the U.S. Food and Drug Administration (FDA) to treat OCD, including Clomipramine (Anafranil), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Escitalopram (Lexapro), and Sertraline (Zoloft). While medication therapy can be effective, it is essential to be aware of the side effects and understand that it might take time for patients to identify what medication is the most effective for them.
The best treatment for OCD is a combination of CBT and SSRIs, especially if OCD symptoms are severe.
Does OCD Go Away?
One of the first steps to OCD treatment is helping clients accept that an obsessive-compulsive cognitive style generally does not completely disappear; however, the disruptions that obsessive-compulsive behaviors cause can disappear.
So while the “obsessive-compulsive” component of an individual’s personality may remain forever, the disordered component of the obsessions and compulsions can be managed with treatment.
The symptoms of OCD tend to come and go throughout one’s entire life. In some cases, symptoms may go away for long periods, but there is always the possibility that they return, especially if treatment regimes and/or medications are not maintained.
Some people may continue to experience mild OCD symptoms even if they have their disorder under control. Still, most individuals who experience mild-to-moderate symptoms of OCD can learn to live with the inconveniences.
However, even if you think you have a mild form of OCD, it is recommended that you seek help, even if your symptoms feel like they’re manageable.
Does anxiety make OCD worse?
Yes, periods of high anxiety and stress can bring out OCD symptoms. As we start to feel overwhelmed and anxious, we tend to turn to the coping mechanisms we have learned and rely on our compulsions to ease our stress.
When we are in states of heightened anxiety, we have less strength to ignore our OCD thoughts, which can lead to a return or worsening of OCD symptoms.
Can smoking or drinking make OCD worse?
While drinking or smoking might provide a short-lived reprieve from your OCD symptoms, these habits can worsen your symptoms and create more distress in the long run.
In some instances, smoking and drinking are the compulsions used to relieve an individual’s obsessions, so by giving in to these compulsions, you are just fueling the OCD cycle.
While alcohol and drugs might have symptom-relieving qualities, these substances can make OCD symptoms much worse.
Some people who were not experiencing OCD symptoms before drinking report a return of OCD symptoms after drinking.
Does social media make OCD worse?
Notably, aspects of social media and OCD can be pretty similar. While social media can be a precious resource for individuals with OCD and other mental disorders, social media usage can also exacerbate OCD symptoms.
The internet can be an escape and a source of community for some, but for others, it is just another place for OCD to emerge.
It creates new avenues for the disorder to express itself and new ways for people with OCD to find themselves regularly confronted with their symptoms.
Why is my OCD worse at night?
Bedtime is the loneliest part of the day, and OCD likes to attack us when we are at our most vulnerable. When you are alone with your obsessions, this can make them feel more real and powerful.
At night when your mind is meant to be at its quietest, anxious thoughts are most likely to linger and grab control of your mind.
Obsessive thoughts can keep victims of OCD up all night, and one compulsion can disrupt an entire night’s sleep.
Additionally, research has shown a link between OCD and insomnia – people with OCD are more likely to have insomnia than the rest of the population.
Does OCD get progressively worse as we age?
OCD is typically diagnosed between the ages of 8 and 12 or between the late teenage years and early adulthood, but the condition varies in severity throughout one’s life. The average age of onset is 19, with 25% of cases occurring by age 14.
OCD symptoms are known to intensify and worsen as we age. The symptoms tend to come on gradually early in life and become more challenging to manage over time.
However, it is essential to note that OCD does not necessarily get worse for everyone. Most people who experience mild-to-moderate symptoms of OCD will learn to live with the inconveniences of their obsessive thought patterns and compulsive actions.
But when left untreated, the symptoms are more likely to worsen over the years and even become unmanageable.
Because there are many subtypes of OCD, such as checking OCD, counting OCD, or
cleaning OCD, and many different ways the condition can show up in a person’s life, people typically experience their OCD differently throughout their lifetime.
For example, a person might experience remission for one OCD subtype but then develop a different subtype later in life.
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