One day, you’re going about your life; the next, you find yourself racked with anxiety that can only be relieved by performing repetitive behaviors or mental rituals.
Aside from these obsessions and compulsions taking up a fair amount of your day, you’re in a near-constant state of anxiety, your work and relationships suffer, and your risk of developing a slew of other mental health disorders has skyrocketed. While this is not the typical way that Obsessive-Compulsive Disorder (OCD) first appears, some people open their eyes one morning and find themselves in this frightening new reality.
This article will offer some insight into the more usual way OCD manifests in contrast to sudden onset OCD. We’ll then look at a group of common infections that may sometimes lead to the condition’s sudden onset and describe an evidence-based treatment approach that is highly effective at helping people manage the disorder—regardless of how they started experiencing symptoms—and regain control over their lives.
What is OCD?
Before we get into the ways that OCD can appear in people’s lives, let’s take a step back and get a feel for what this often misunderstood and misdiagnosed disorder is all about.
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive, and distressing mental triggers (obsessions) and repetitive behaviors or mental acts (compulsions). These obsessions and compulsions can consume a significant amount of time and energy, causing significant distress and impairment in daily life.
Obsessions often center around themes like contamination, orderliness, symmetry, harm, or even taboo fears around their sexuality or religious beliefs. They may feel irrational, and people with OCD can usually recognize them as excessive or unreasonable. It’s important to understand that these obsessions are ego-dystonic, meaning they are out of line—and often opposed—to a sufferer’s true thoughts and feelings. A loving parent with OCD might have recurring thoughts about grievously harming their child, for example, while a faithful and committed partner might be inundated with mental images of cheating with a stranger. OCD is adept at attacking the things we most care about and creating extreme anxiety in the process.
Compulsions, the “C” in OCD, are repetitive behaviors or mental rituals a person feels compelled to perform in response to their obsessions. These actions are often aimed at reducing the discomfort or fear that comes from their obsessions, or preventing something they’re worried might happen. For instance, someone with contamination obsessions may engage in excessive hand washing, while someone who has pedophilic intrusive thoughts may avoid being around children, which could mean avoiding family events or changing their entire commute to avoid a school zone.
It’s important to understand that OCD is not simply a preference for cleanliness or an occasional need for order, which is how it’s often portrayed in the media. OCD is a serious, potentially debilitating mental illness, and it can significantly impact various aspects of life, including work, relationships, and overall quality of life.
How OCD usually appears
Obsessive-Compulsive Disorder (OCD) affects approximately 2.5% of the global population, and while it can manifest at any age, there are two peak periods of onset.
“The first typically occurs in late childhood to early adolescence, around the ages of 10 to 12, and the second peak emerges in early adulthood, around the ages of 18 to 24,” explains NOCD’s Chief Clinical Officer Dr. Patrick McGrath. “However, it’s important to note that OCD can develop at any stage of life, and onset can occur later in adulthood.”
The causes of OCD are believed to be multifaceted, involving a combination of genetic, neurological, behavioral, cognitive, and environmental factors. People with a family history of OCD or related disorders may be at a higher risk. Additionally, certain life events, chronic stress, or trauma may contribute to a more rapid onset or exacerbation of OCD symptoms. In the case of traumatic or highly stressful events, for example, people very often develop OCD symptoms over the next 6 months—but that’s not the same as a “sudden onset.”
“Typically, OCD symptoms do not come on suddenly,” Dr. McGrath says. “It’s usually a gradual process with intrusive thoughts, obsessions, anxiety, and compulsions growing in intensity over weeks, months, or years. Sometimes, however, people wake up with it, and when they do, it’s often the result of a very common infection.”
Another potential cause for OCD
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a rare but significant condition in which children and adolescents develop sudden and severe obsessive-compulsive symptoms and/or tics following a streptococcal infection, such as strep throat. This condition is believed to be an autoimmune response, where the body’s immune system mistakenly attacks the basal ganglia, a part of the brain responsible for regulating movement and behavior.
Streptococcal infections are not the only ones that can lead to the development of mental illnesses. HIV, toxoplasmosis, Lyme disease, and flu are just some of the well-known infections that cause changes in people’s moods and behavior. Only streptococcal infections are associated with OCD, however.
The link between strep and sudden onset OCD was first proposed by Dr. Susan Swedo and her colleagues at the National Institute of Mental Health. They observed that some children who had strep infections went on to develop OCD symptoms, seemingly out of the blue. This led to the recognition of PANDAS as a distinct clinical phenomenon.
Symptoms of sudden onset OCD in PANDAS can be severe and debilitating, often manifesting as obsessive thoughts, compulsive behaviors, and, in some cases, motor or vocal tics. These symptoms can interfere with a child’s daily life, including school performance, social interactions, and overall well-being.
Treatment for PANDAS typically involves a two-pronged approach: addressing the underlying streptococcal infection with antibiotics and managing the neuropsychiatric symptoms with exposure and response prevention therapy (ERP), which we’ll discuss in just a moment.
It’s important to note that while PANDAS is a recognized condition, there is ongoing debate and research within the medical community about its diagnosis and treatment. “Not all sudden onset OCD cases can be attributed to PANDAS, and other factors, such as stress, trauma, or genetic predisposition, may also play a role in somewhat rapid development of OCD,” says Dr. McGrath.
If you suspect PANDAS may be a factor in the symptoms affecting someone you love, consulting with a qualified healthcare professional for a comprehensive evaluation and appropriate treatment plan is crucial.
Is OCD always treated the same way?
In short, yes. No matter what causes it, OCD is best treated with Exposure and Response Prevention (ERP) therapy, often complemented by a variety of pharmaceutical medications.
ERP was developed specifically for OCD treatment, designed to help people confront and manage their obsessive thoughts and resist compulsive behaviors in a controlled and supportive environment. By intentionally exposing people to their feared situations and guiding them in resisting their typical compulsive responses, ERP helps retrain the brain’s response to one’s obsessive triggers.
ERP involves much more than simply facing your fears and hoping for the best. Rather, a specially trained therapist guides you through an intentional, personalized, and structured process, working collaboratively with you to design a treatment plan that targets your specific obsessions and compulsions. The duration of ERP therapy varies for each person, but positive results can often be observed within a few months—and sometimes just weeks—of therapy exercises done during sessions and on your own.
It’s important to note that ERP is more accessible than ever before, as more insurance providers cover this evidence-based treatment. Additionally, studies have shown that ERP administered remotely via video sessions is just as effective as in-person sessions, making this therapy option even more convenient and accessible for anyone seeking relief from OCD.
Start getting better today
If you think you or someone you know might have OCD and you’re interested in learning how it’s treated, please know that help is available for you.
Here at NOCD, all of our therapists specialize in OCD and receive intensive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered. I encourage you to learn more about NOCD’s evidence-based approach to OCD treatment.