If you live with obsessive-compulsive disorder (OCD), sometimes, obsessions and compulsions can feel all-consuming, making it difficult to function. Obsessions can make it hard to concentrate, and compulsions can become extremely time-consuming, interfering with work or school, and disrupting relationships.
Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) doesn’t recognize an official scale of severity for OCD, the impact of OCD on someone’s life can vary greatly. How intense your symptoms feel, and how frequently they show up can be related to a number of factors—from hormonal changes, to how much stress you’re dealing with.
For those with more severe-feeling symptoms, exposure and response prevention (ERP) therapy is often supplemented by medications—though alternative interventions can also sometimes be helpful. Read on to learn more about severe OCD, its causes, symptoms, and how to get help.
What is severe OCD?
While some people may feel that their symptoms are worse or more intense than others, according to Tracie Ibrahim, MA, LMFT, CST there is no clinical distinction between “mild” or “severe” OCD. “But, some people can suffer more,” she says.
Dr. Patrick McGrath, Chief Clinical Officer at NOCD, further explains: “It is all OCD, but the level of impairment it causes is different from person to person.”
If the term “severe OCD” feels helpful to you, it’s perfectly fine to describe yourself this way. Just know that some people prefer not to use this language. Ibrahim says that sometimes feeling like you have the “worst” form of OCD can keep people from seeking help, out of fear that treatment won’t be as effective.
Regardless of how intense or frequent your OCD symptoms are, they still follow the same basic pattern:
- Obsessions, which are recurrent and intrusive thoughts, feelings, urges, images, and sensations, cause significant anxiety.
- In response, you perform compulsions, which are repetitive behaviors or mental acts meant to decrease distress.
What’s key is how much these symptoms interfere with your routine, relationships, and overall quality of life.
Signs of severe OCD
The following experiences may indicate that your symptoms are more intense and persistent:
- Time-consuming rituals: Your rituals take up to several hours a day. For example, you may spend significant amounts of time checking locks, cleaning, or performing other repetitive tasks, leaving little time for daily routines and activities.
- Distress and impairment in daily life: The severity of your symptoms causes significant emotional distress, impaired functioning in relationships, work, or school. The cycle of obsessions and compulsions is physically and emotionally exhausting, and feels inescapable.
- Symptoms don’t improve with treatment: Treatment-resistant OCD refers to cases that do not respond well to standard treatments like ERP therapy and medications.
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Treatment-resistent OCD vs. severe OCD
Treatment-resistant OCD is not necessarily the same as severe OCD, but these experiences can overlap. Treatment-resistant OCD refers specifically to cases where a person does not experience improvement from ERP therapy and selective serotonin reuptake inhibitors (SSRIs).
According to Ibrahim, it’s important to note that improvement from ERP can be slow—especially if you’re struggling to fully commit to the exercises your therapist has given you. She cautions that it’s crucial to distinguish between these cases and people who are doing everything they can, but still aren’t seeing progress.
People with treatment-resistant OCD and severe OCD are often recommended supplemental treatment options, in addition to ERP therapy. These include:
- Increasing the dosage of SSRIs
- Adding medications like antipsychotics or mood stabilizers
- Transcranial Magnetic Stimulation (TMS)
- Deep Brain Stimulation (DBS)
In some cases, your symptoms may be more intense and persistent and resistant to treatment. But, remember—treatment-resistant OCD can occur in people with a wide range of symptom severities, including “mild” cases.
What causes severe OCD?
OCD symptoms may be more severe or persistent as a result of:
- Co-occurring conditions: Depression and anxiety can sometimes increase the intensity of OCD symptoms, as these conditions often amplify feelings of distress and uncertainty. These conditions can also make it harder to engage in ERP, as they may reduce motivation or increase feelings of anxiety.
- Higher levels of stress: Extreme stress can trigger a flare-up of OCD symptoms. Stress increases the body’s cortisol levels, which can heighten anxiety.
- Significant life changes: Major life transitions, such as moving to a new place, starting a new job, or experiencing the loss of a loved one, can trigger or worsen OCD symptoms. These changes often bring about feelings of uncertainty, which can exacerbate a perceived need for control.
- Changes in routine: Disruptions to your usual routine, whether due to travel, illness, or changes in sleep, can make OCD symptoms worse.
Identifying these potential triggers can help you gain a deeper understanding of yourself and how to better care for your well-being.
How is severe OCD treated?
Treatment for OCD looks different for everyone. It’s important that you talk to a mental health professional who specializes in OCD to find the approach that works best for you. A therapist can help assess your specific symptoms and create a personalized treatment plan, which may include a combination of ERP therapy, medications, and/or lifestyle changes.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Exposure and response prevention (ERP) therapy
The most effective form of treatment for severe OCD (and every form of OCD) is ERP, a specialized form of cognitive behavioral therapy (CBT).
ERP involves working with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, while resisting the urge to do compulsions. The goal is to help you build tolerance to the anxiety these thoughts trigger, and reduce the need to engage in rituals to alleviate that anxiety. ERP helps you gradually build tolerance to anxiety, helping to weaken the cycle of OCD.
Medication
Depending on the frequency and severity of your OCD symptoms, medications such as SSRIs or antipsychotics may help you manage the condition. SSRIs are commonly used to regulate serotonin levels in the brain, which helps to balance mood and can help you engage in ERP more effectively. When SSRIs alone are not effective, antipsychotics may be added to enhance treatment outcomes.
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive treatment option for OCD that uses electromagnetic pulses to stimulate nerve cells in the brain to target specific areas of the brain associated with OCD symptoms. It helps to regulate brain activity and alleviate distress.
TMS is typically considered when other treatments, such as medications and therapy, have not been effective in managing OCD symptoms. Like other forms of treatment, TMS is also often most effective when used alongside ERP therapy and medications.
Deep Brain Stimulation (DBS)
DBS is a more invasive treatment option for treatment-resistant OCD. It involves implanting electrodes in specific areas of the brain, which play a role in mood regulation. These electrodes deliver electrical impulses to regulate abnormal brain activity associated with OCD.
Like TMS, DBS is typically reserved for people who have not responded to traditional treatments such as medication and therapy.
Bottom line
OCD symptoms can vary in intensity and frequency, and may seriously impact daily life, physical health and overall wellbeing.
Fortunately, OCD is treatable. ERP therapy, SSRIs, antipsychotics, TMS, and DBS may all be considered for people with more intense symptoms, or who have not found relief through traditional treatment options. In time, you can get your life back from OCD, and learn to live with more confidence and ease.
Key Takeaways
- Severe OCD is a way of describing OCD symptoms that are more intense and frequent.
- Co-occurring mental health conditions, higher levels of stress, significant life changes, or changes in routine can all make OCD symptoms worse.
- ERP therapy helps people with OCD gradually confront their fears and resist compulsions.
- Medications, such as SSRIs or antipsychotics, may be added to support therapy in cases where symptoms are more intense or don’t seem to improve from ERP alone— and options like TMS or DBS may also be considered.