Can OCD Get Worse Over Time Without Treatment?

If you or a loved one is seeking more information about obsessive-compulsive disorder (OCD), in this article, we provide an overview of the disorder, important things to know, and offer some guidance on when it may be a good idea to seek treatment.

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder is one of several related disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) published by the American Psychiatric Association, including hoarding, body dysmorphic disorder, and disorders related to skin picking and hair pulling. 

It’s estimated that about 2.3% of people experience OCD throughout their lifetime. At any given time, about 1.2% of Americans are living with OCD, with rates dropping with age: 

• 1.5% age 18-29
• 1.4% age 30-44
• 1.1% age 45-59
• 0.5% age 60+

There is a gender difference in the prevalence of the disorder, with more women experiencing OCD than men:

• 1.8% women
• 0.5% men

The timing of when symptoms begin is called “onset,” and this can vary from person to person. Symptoms of obsessive-compulsive disorder often start in childhood and adolescence and can progress into adulthood. More on the progression of the disorder is discussed below.

People living with OCD can experience symptoms that are classified as obsessions and compulsions. 

Obsessions: Internal Experiences

Obsessions can include thoughts, urges, and mental images that are unwanted and cause distress. According to the NIMH, obsessions can include:

• Fears related to contamination, illness, or germs
• Being afraid of forgetting, losing, or misplacing something
• Feelings of fear related to losing control over one’s behavior
• Thoughts toward others or oneself that are aggressive or violent
• Thoughts with themes of sex, religion, or harm that are unwanted, and may be forbidden or taboo to the person, and violate their cultural norms
• A strong desire for things to be in a perfect order or symmetrical 

Compulsions: Behaviors

Compulsions are behaviors that are essentially an effort to help reduce one’s distress and suppress obsessions with thoughts or actions, for example, by doing a behavior like handwashing to alleviate feelings of dirtiness. These are called compulsions because people feel compelled to do these actions even if they don’t really want to. The NIMH outlines some examples of compulsions, including:

• Cleaning or handwashing that is excessive
• Arranging things in a particular, precise way or order
• Checking things repeatedly, for example, going to make sure the oven is off or the door is locked
• Counting in a way that is compulsive
• Silently repeating words or praying

Additionally, the obsessions and compulsions are very time-consuming, taking up an hour or more each day. They also cause problems in important areas of someone’s life, such as work, school, and relationships.

People can experience a cycle of feelings and behaviors:

1. Having an obsessive thought or obsession
2. This builds up to experiencing overwhelming anxiety and distress
3. This distress leads to the person trying to satisfy the obsession through some action, also called compulsions
4. The person experiences relief, albeit this relief is brief
5. The obsessive thoughts or obsessions resume 

No two people experience OCD the same way, and how it plays out is unique to each individual. 

How OCD Differs from Normal Anxiety and Perfectionism

It is important to note that there is a distinction between OCD and preferences and personality traits. You may hear people say, “I’m so OCD,” when referencing their preferences for cleanliness, order, or perfection. In reality, many people prefer to have their environment ordered and clean, or to have certain things “just so.”

Being a high achiever and having perfectionist tendencies are common traits that many people share. However, having these traits and preferences doesn’t mean that one is experiencing OCD.

OCD can be debilitating, causes many people extreme suffering, and interferes with people’s ability to function in their daily lives.

We highly encourage people to avoid using a mental health diagnosis as a joke or to describe normal experiences. Using stigmatizing language and making light of a serious disorder adds to the stigma of a serious and legitimate health condition and can be hurtful for people living with OCD.

Does OCD Worsen Without Treatment?

The natural course of OCD, if left untreated, can be devastating. Since more researchers are starting to consider it a “progressive disorder,” this means that it does tend to get worse over time, making intervention as early as possible key. Unfortunately, it’s estimated that people go 17 years living with the condition before seeing treatment. 

The progression occurs in phases: 

• Subclinical OCD symptoms: This can include symptoms of depression, anxiety, and concerns related to order and symmetry. 
• Full-blown OCD: This phase is when people meet the full criteria for a diagnosis, and that their symptoms are so severe that they warrant prompt clinical attention.

Many people who experience “subclinical OCD” symptoms do not go on to develop the disorder.

It’s not uncommon to have concerns about OCD getting worse with age, but the statistics referenced earlier in this article seem to indicate that the condition’s severity isn’t correlated with older ages.

Rather, this progression of severity seems to be that it increases from childhood into adulthood. On average, the full-blown phase of the disorder begins between ages 22 and 36.

What Causes OCD?

Numerous factors are likely associated with the development of obsessive-compulsive disorder.

• Genetics: Current research demonstrates that the genetic heritability of OCD is indisputable. Having a genetic predisposition to the disorder remains one of the most salient factors that increase someone’s chance of developing the disorder. 
• Biology: Structural characteristics of the brain have been correlated with the development of OCD.
• Trauma and stress: Many people with OCD report that their disorder seemed to have developed after experiencing a traumatic event, or that the exposure to significant stress or a traumatic event worsened the person’s overall mental health, making their experience of OCD worse as well. Some aspects of OCD seem to be made worse by exposure to traumatic events and experiences, and are particularly impactful if the traumatic events are experienced in childhood.

Timeline

Many people have concerns related to how OCD progresses and how it develops over time, and how long milder symptoms take to turn into the diagnosis varies from person to person. 

One study estimated that it takes about 7 years on average for the first signs of OCD to progress towards meeting diagnostic criteria for the disorder, while others estimate it to be 4 years.

Factors That Accelerate OCD Symptom Worsening

Certain factors seem to be associated with the disorder developing more quickly. This means that these factors don’t necessarily cause OCD, but they can play a pivotal role in the development of the disorder and how severe it is. This can include factors such as:

• Having obsessions prior to experiencing compulsions
• Being male
• Symptoms beginning at a young age
• Being in a new romantic relationship
• Symptoms related to religiosity or sexuality
• Hoarding behaviors
• Experiencing co-occurring mental health conditions, in particular, generalized anxiety disorder
• Agorophobia- without panic disorder
• Lack of family history of OCD

When and How to Seek Professional Treatment

As outlined above, OCD symptoms can worsen without treatment. Continue reading to learn about some of the warning signs that someone’s OCD is getting worse, and if so, seeking out a professional evaluation for treatment is advised.

Warning Signs That OCD Symptoms Are Escalating

What happens if OCD goes untreated is that the person experiencing the disorder has symptoms that grow worse and have a progressively greater negative impact on their quality of life and ability to fulfill important responsibilities. 

Some signs to watch out for include:

• Spending more and more time on compulsions
• The impact of functioning at school or work becomes worse
• Relationships start to suffer because of the symptoms
• Exhaustion, physically and emotionally
• Trying to avoid things or situations that seem to cause the symptoms
• Resorting to using drugs or alcohol to cope

Seeking Treatment For OCD

If you or a loved one may be experiencing symptoms of OCD, consult with a healthcare provider who can do an assessment to ensure your symptoms aren’t caused by something else, such as a physical health concern. They can make a referral for specialized treatment if it is indicated. 

Treatment for OCD can include psychotherapy and medications. Many people benefit from a combination of the two. Both talk therapy and medication take time to be effective, and sticking with treatment can help increase your chances of recovery.

For people who don’t improve with psychotherapy and medication, there are other medical interventions that are options as well, such as transcranial magnetic stimulation, electroconvulsive therapy, deep brain stimulation, neurosurgery, and ablative surgery.

Additionally, peer support and support for the loved ones of people with OCD can play vital roles in the healing process. 

• The International OCD Foundation offers educational resources and community events.
• NAMI offers support groups and resources; find a local chapter to get involved.

Hope and Recovery: Treatment Success Rates and Long-Term Outcomes

If you suspect you or a loved one is experiencing OCD, you may be uncertain if seeking treatment is necessary. It’s important to know that although early intervention treatments are still relatively new, emerging research shows that getting the right treatment at the right time can make a big difference. The earlier you get help, the sooner you will feel better. 

The good news is that OCD is treatable. With treatment and support, many people living with OCD can experience relief and a higher quality of life. One study found that amongst people who completed a course of cognitive-behavioral therapy (CBT), 52% achieved remission. Exposure and response prevention therapy (ERP) is a form of CBT and has also been shown to be very effective.

Takeaway

People who are experiencing the symptoms of OCD deserve a chance at a better quality of life. There is no shame in seeking help for a disorder that can have such a profoundly negative impact. Seeking support is a sign of strength. Reaching out shows that you have hope for your future self. 

If you or a loved one is struggling with obsessive-compulsive disorder or is experiencing a mental health crisis, reach out to the team at Willow Health today. We offer same or next business day appointments to ensure people experiencing a mental health crisis get the timely care they need. 

Our patients meet with both a psychotherapist and a psychiatric medication provider for an assessment to create an individualized care plan tailored to meet each person’s needs. We would be honored to support you in your process of healing and recovery. 

Sources and Resources 

International OCD Foundation 

National Alliance on Mental Illness (NAMI) 

Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over - National Institute of Mental Health (NIMH) 

Management and Treatment of Obsessive-Compulsive Disorder (OCD): A Literature Review - PMC 

Diagnostic and Statistical Manual of Mental Disorders | Psychiatry Online

Obsessive-Compulsive Disorder (OCD) - National Institute of Mental Health (NIMH) 

Why I Wish People Would Stop Saying “I’m So OCD” - NAMI Washtenaw County 

The speed of progression towards obsessive-compulsive disorder - ScienceDirect 

Early intervention in obsessive-compulsive disorder: From theory to practice - ScienceDirect 

A Clinical Staging Model for Obsessive–Compulsive Disorder: Is It Ready for Prime Time? 

The genetic epidemiology of obsessive-compulsive disorder: a systematic review and meta-analysis | Translational Psychiatry 

Perceived traumatic and stressful etiology of obsessive-compulsive disorder - ScienceDirect 

Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder | Psychotherapy and Psychosomatics | Karger Publishers