Symptoms of obsessive-compulsive disorder (OCD) can fluctuate over time, but certain factors—such as compulsions, trauma, stress, and co-occurring mental health conditions—are known to worsen them.
Obsessive-compulsive disorder (OCD) is a highly treatable mental health disorder characterized by two symptoms: obsessions (intrusive thoughts, images, urges, feelings and/or sensations that cause fear and anxiety) and compulsions (physical or mental actions performed to cope with the distress from obsessions).
If you have OCD, you probably know that the symptoms ebb and flow. You may have noticed a pattern and identified things that tend to worsen your symptoms. Or, maybe it’s hard to predict your OCD might strike, and that’s completely okay.
While we don’t know what triggers OCD symptoms for everybody, certain factors often play a key role in periods of more severe OCD symptoms. Once we know what makes OCD worse, we can be proactive in taking care of ourselves and planning for any potential setbacks on our recovery journey.
Keep ready to learn what factors can spike your OCD symptoms and how specialized treatment can help you get your symptoms under control.
4 things that can make OCD worse
1. Engaging in compulsions
“The number one thing that makes OCD symptoms worse is doing compulsions (mental or physical),” says Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer. When we perform compulsions in response to the distress caused by our obsessions, it only provides temporary relief. The more you do compulsions, the more they reinforce the belief that obsessions pose a real danger and that compulsions are necessary to protect yourself or loved ones. Ultimately, doing compulsions leads to a vicious cycle that only grows stronger without specialized treatment.
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2. Trauma
We know that trauma can exacerbate symptoms associated with mental health conditions—and this is no different with OCD. Trauma and OCD interact in ways we don’t quite understand, however, studies estimate that 19-31% of people with PTSD also have OCD—around 10 times the rate for the general population.
If you’ve experienced trauma, encountering triggers can worsen OCD symptoms. In many instances, what triggers your obsessions may be related to past trauma and can be very difficult to avoid. Moreover, this avoidance can be compulsive, making your fears worse and worse over time.
Even if you aren’t diagnosed with PTSD and/or haven’t gone through a traumatic event, any unfortunate experience (regardless of the level of severity) can make your OCD symptoms worse. Truth be told, most of us have experienced something that had a negative impact on us. In fact, many people will endure more than one traumatic event in their lifetime, and each of these events could potentially exacerbate OCD symptoms.
3. Stress and change
Aside from trauma, we all deal with some form 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.
Any change—whether positive or negative—can cause stress. When you think of all the exciting times in your life, you can likely identify many stressors—and many of them could trigger your OCD. “OCD symptoms can worsen when there are big changes happening in your life: new job, moving, having a baby, etc.,” says Ibrahim.
What’s often discussed more than positive stressors are the negative ones. We live in a fast-paced, high-stress environment. We often work long hours at our jobs while managing household responsibilities, parenting obligations, financial commitments, relationship problems— the list goes on and on. In addition to these, many people develop chronic health issues or need to care for a loved one who does. Unsurprisingly, all these things affect our mental health—OCD included. Many people with OCD report that their symptoms spike during periods of high stress.
4. Co-occurring mental health conditions
It’s common for OCD to co-occur with another mental health disorder—which is also a factor that could worsen your symptoms. Two of the most common co-occurring mental health conditions are major depressive disorder (MDD) and generalized anxiety disorder (GAD), but there are several other conditions that can occur alongside OCD, such as:
- Attention-deficit hyperactivity disorder (ADHD)
- Eating disorders
- Personality disorders
- Substance use disorders
If you’re managing other mental health disorders alongside OCD, it’s important to receive ongoing treatment and management for these conditions in conjunction with OCD treatment.
How to stop OCD from getting worse
At this point, you might be thinking, “How can I manage my OCD when there are so many factors that can make my symptoms worse?” Well, the key to getting a handle on your symptoms is long-term, ongoing management and preparing for things that might trigger more severe symptoms. Ultimately, the goal is to ensure you have everything in your toolkit to manage your OCD when things get tough.
The first step to getting your OCD symptoms under control is to get the proper treatment. Contrary to popular belief, not all therapy is created equal when it comes to treating various mental health conditions—and this is especially true for OCD.
When it comes to treating OCD, your best bet for managing symptoms is a specialized therapy known as exposure and response prevention (ERP). ERP is an evidence-based treatment supported by decades of research that works by gradually exposing you to your fears. With the help of an ERP therapist, you’ll be guided through two types of exercises: exposures and response prevention techniques. Through these exercises, you’ll learn a new way to respond to your triggers, which, over time, may lead to a reduction in your symptoms.
“With ERP, we learn to be aware of triggers that tend to trick us into performing compulsions so that we can learn to avoid compulsions most of the time, or at least interrupt them as quickly as possible,” says Ibrahim. “This can help with preventing OCD symptoms from getting worse.”
The key to reducing your OCD symptoms with ERP is to stay consistent with your sessions and do your therapy homework. “ERP can prevent OCD symptoms from worsening when done consistently, and the individual is motivated to work to sit with the discomfort,” says MaryBeth Overstreet, MA, LPC, a therapist at NOCD. “OCD is really good at telling patients that if they do the safety-seeking behavior [or compulsion], they will feel better, and sometimes will lie and tell them they can’t get better.”
What if my OCD symptoms continue to get worse?
Maybe you’ve started doing ERP, but you don’t think your symptoms are getting any better. According to Overstreet, it’s normal for your symptoms to worsen, given the challenges that can come with therapy, but this doesn’t mean that your OCD will never improve. “Sometimes, we have to remind patients how ERP is getting them back to living the life they want,” she says.
In some cases, your therapist may suggest supplemental treatments to increase the effectiveness of ERP for severe OCD symptoms. “Specific medications at very specific doses appropriate for treating OCD can be utilized alongside ERP therapy,” says Ibrahim. “Using acceptance and commitment therapy (ACT) therapy principles also help increase motivation to stay on track with ERP and resisting compulsions.”
Bottom line
OCD, like any mental health disorder, can spike at various points in your life for many different reasons. While you may not always be able to predict when your symptoms may worsen, getting treatment like ERP can help you prepare for any potential triggers you might come across in your day-to-day life.
So, if you need help managing your OCD, consider working with an ERP therapist. They can work with you to create a personalized treatment plan that addresses your triggers, obsessions, and compulsions so you can regain control of your life.
Key takeaways:
- Common triggers of OCD symptoms include engaging in compulsions, trauma, stress, major life changes (like moving or having a baby), and co-occurring mental health conditions such as anxiety, depression, or ADHD.
- Exposure and response prevention (ERP) is an evidence-based treatment that can help you face your fears and resist compulsions, offering a long-term way to manage your symptoms.
- Medications and acceptance and commitment therapy (ACT) can enhance the effectiveness of ERP—particularly for severe OCD symptoms.
