What causes OCD to get worse and what you can do

Obsessive-compulsive disorder (OCD) is a life-long condition that requires that those affected pay extra attention to life’s stressors. OCD is highly treatable, but not curable, which is why symptoms can come and go, periodically worsening depending on a variety of factors. Some people learn to manage their symptoms only to have them return without warning. Others get control of one obsessive-compulsive bond and then develop a new one. 

This article discusses what causes OCD to get worse and the steps needed to manage it. 

If OCD is leading to an increase in anxiety for you or someone you know, the providers on the Klarity platform can help. On Klarity, you can hand-pick your own mental health therapist who’s trained and experienced in OCD treatment.

What is obsessive-compulsive disorder (OCD)?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines OCD as a combination of obsessions and compulsions “that cause major distress or disruption to daily living.” Obsessions are intrusive thoughts, feelings, urges, and doubts, while compulsions are repetitive physical or mental actions performed to reduce anxiety. 

Symptoms of OCD include obsessions primarily based in doubt and fear. 

• Did I leave the stove on? 
• Are my hands free of germs? 
• Did I complete that task perfectly? 
• Is something bad going to happen to my brother? 

While fear and doubt are a normal part of life, the person with OCD becomes obsessed with uncertainty, to the point of rumination. This leads to an increase in anxiety that can be crippling. 

Compulsions or rituals are developed to relieve the anxiety that can include:

• Repeatedly checking appliances before leaving the house.
• Constant hand washing or organizing items so they’re symmetrical.
• Continually reciting a prayer or mantra.

While compulsions reduce anxiety in the short term, they also re-emphasize the obsession. A person with OCD is trapped in a closed-loop cycle that’s extremely intense and builds on itself so that it continues intensifying.

Causes of OCD

What causes someone to develop OCD is unclear but is likely due to a combination of family history and a deficit in the brain’s chemical messengers or neurotransmitters, specifically serotonin. Some imaging studies on how disease and medication shape the brain of people with OCD have shown differences in the frontal cortex and thalamus regions of the brain. 

What causes OCD to get worse?

While symptoms of OCD come and go and aren’t predictable, some things make OCD worse. These include stress (both “good” and bad), trauma, sleep deprivation, other mental health conditions, hormones, and avoidance.

Stress, good and bad

Increases in stress can lead to increases in OCD symptoms. When we’re struggling with finances, work, or a relationship, it takes a toll on us mentally and physically. With higher levels of stress hormones such as cortisol in the body, a person with OCD may experience an increase in intrusive thoughts, feelings, doubts, and urges.

Even “good” stressors, such as a move to a nicer apartment or a job promotion, can change the amount of stress hormones in our bodies and lead to an increase in OCD symptoms that were previously well-managed.

Trauma

Traumas, such as significant loss or death, serious injury, or sexual abuse, can worsen OCD symptoms. An immediate and high level of distress creates a need for safety and control and triggers the OCD cycle. Remember, the compulsions in OCD offer the illusion of control and alleviate anxiety for a short time. Thus, the OCD cycle can act as a form of coping as our bodies psychologically process the trauma.  

Sleep deprivation

Sleep is one of the most important medicines we have but is often given the least importance in our lives. With OCD, like other anxiety disorders, a lack of sleep, known as sleep deprivation, can heighten symptoms. Ironically, feelings of anxiety brought on by OCD often disrupt our ability to sleep, igniting another negative spiral. 

Other mental health conditions

The rate of comorbidity with OCD is high. Comorbidity means that a person has more than one mental health condition. According to Stanford Medicine, depression is the most commonly diagnosed comorbid condition of OCD, followed by other anxiety disorders and personality disorders. There is also a correlation between OCD and ADHD, eating disorders, and phobias. Any of these conditions can cause OCD symptoms to get worse. 

Hormones

Like the stress hormone cortisol, other hormonal changes can increase OCD symptoms. This can happen at pivotal stages in life, such as adolescence or mid-life, but can also be impacted by events such as pregnancy or menopause. Some cisgender women find their symptoms worsen as their hormones fluctuate each month. 

But cisgender women aren’t the only ones susceptible to hormonal changes. Like cisgender women, cisgender men have estrogen and progesterone, which impact serotonin, the brain’s chemical messenger linked to OCD.

Avoidance

Avoidance can take a variety of forms, from avoiding uncomfortable feelings to avoiding treatment to avoiding situations that make OCD worse. In some instances, avoidance can be a coping skill, but it can also reinforce triggers and make OCD symptoms worse. 

Similar to other anxiety disorders, the more we avoid, or try to avoid, the worse the symptoms become. In some people with OCD, avoidance becomes a compulsion (the repetitive physical or mental actions used to relieve anxiety).

How to manage OCD 

OCD is highly treatable. And, depending on the severity of symptoms, treatment may include a combination of therapy, mindfulness techniques, social support, self-care, and/or medication. 

OCD therapy

The most common therapy for treating OCD is cognitive behavioral therapy (CBT). With this treatment modality, a therapist helps you reframe negative thoughts (obsessions) and adjust your maladaptive behaviors or reactions (compulsions). The therapist works with you to develop coping skills that let you change how you react to your intrusive thoughts. 

Under the umbrella of CBT is exposure and response prevention (ERP). In ERP, a trained therapist helps you tolerate exposure to the obsession in a safe environment without responding to it. With repeated exposure over time, the anxiety decreases, eliminating the need for the compulsion and thereby breaking the obsession-compulsion bond.

Mindfulness

Practicing mindfulness involves focusing on acceptance, instead of avoidance, increasing our brain’s ability to regulate stress. Mindfulness techniques, such as deep breathing exercises and meditation, help calm anxiety, which can reduce the frequency and severity of the OCD cycle. 

Group therapy

Group therapy or support groups let people with OCD feel supported by others with similar diagnoses. Groups can make people with OCD feel less alone and give them insight into how others cope and manage their OCD symptoms. 

Self-care

Self-care, such as eating right, developing a good sleep routine, exercising regularly, connecting with your support system, and making time for hobbies, can create a healthy framework for managing stress and calming anxiety. By taking care of your physical self and knowing how to manage your anxiety, you can more effectively manage OCD symptoms. 

Medication

Medication may also be a part of a treatment plan for OCD. The most common prescription medications used for OCD are antidepressants, and include Prozac, Luvox, Paxil, Zoloft, and Anafranil. 

When to seek help for OCD

Because OCD is generally a lifelong condition, it can come and go. People with OCD benefit by paying close attention to changes in stress levels. And people who seek and maintain treatment can improve their quality of life. Those who put off treatment run the risk of strengthening the structural brain changes that occur as the cycle of obsessions and compulsions continues.

If you find your symptoms increasing in frequency or intensity and impacting your ability to function, it’s time to seek professional help. A healthcare provider will diagnose OCD by asking you about your symptoms as well as your medical and mental health history.

Get help and take control of ongoing or worsening OCD today

If you or someone you know are ready for relief from OCD symptoms, find a provider today on Klarity. Online platforms, like Klarity, provide a flexible and affordable option for finding a therapist who meets your specific needs and can create a tailored treatment plan just for you. Find a provider today and start taking control of your OCD symptoms.

 If you’re having a mental health crisis or experiencing a psychiatric emergency, it is crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S. 

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