Does OCD Get Worse Before It Gets Better?

Dear GoodTherapy.org,

I have bad OCD. Fear of germs, obsessive and anxious thoughts, needing things to always be perfect and orderly—you name the symptom, I’m pretty sure I have it.

Before you suggest it, I’m going to contact a therapist. But my question is whether, even with therapy, OCD gets worse before it gets better. Most things I see people dealing with, especially mental health issues, don’t tend to improve as they get older. If anything, their problematic thoughts tend to harden into fully formed habits and they become more difficult to shake. Is that the case with OCD? How quickly can I expect therapy to help? (For that matter, will it help at all? Will it cure me or just give me ways to cope?)

From what I’ve read, obsessive-compulsive disorder isn’t the kind of thing you just “get over.” I want to know what kind of journey I need to buckle in for here, and whether the ride is likely to get bumpier before it smoothens out. Please be brutally honest, if need be. Thank you for your time. —Obsessing Over OCD

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Dear Obsessing,

It sounds like you’re doing the most important thing you can do if you think you have obsessive-compulsive disorder (OCD). You’re investigating what you need to know and looking into seeking help to manage and, ideally, overcome your symptoms. Your instinct to contact a therapist is a good one. If you haven’t already done so, I strongly encourage you to not delay and schedule an appointment.

While I generally caution against self-diagnosing, you may be on to something. If I were to work with you, some things I’d want to know about your symptoms include when you recognized that they are a problem; what, exactly, you mean by “bad OCD”; and what you are already doing to help yourself feel better. I’d also want to know how much your symptoms are interfering in your relationships, job/school, or other daily activities.

I hear your concern about whether symptoms will get better before they get worse; rest assured this fear is unwarranted. It is more likely that symptoms could get worse by not doing anything about them. As you noted, these symptoms are unlikely to resolve on their own without you doing something different.

When you are having symptoms (whether it be for an OCD diagnosis or for something else), the most important thing is that when you recognize you are suffering, you reach out for help. The sooner you seek help, the sooner you will have answers to your questions as they relate to you, and the sooner you’ll learn how to treat your symptoms. Seeking help now also enables you to change your thinking patterns while you are younger, which will have positive implications for your future (countering your anecdotal observation that mental health issues get worse with age, especially when left untreated).

I hear your concern about whether symptoms will get better before they get worse; rest assured this fear is unwarranted. It is more likely that symptoms could get worse by not doing anything about them. As you noted, these symptoms are unlikely to resolve on their own without you doing something different.

Generally, obsessive thoughts and related symptoms are likely to improve when you commit to a course of therapy and not terminate prematurely. This might include cognitive behavioral therapy (CBT), another psychotherapeutic approach, medication, or a combination of the above. One important aspect of treatment effectiveness is learning to recognize what may be triggering your symptoms and how to avoid or prepare for these triggers in the future.

There are no guaranteed “cures” (meaning a promise of no relapses) for anything when it comes to OCD. Treatment will likely take time, and symptoms likely will not subside after just one session. If you start with an approach and it doesn’t seem like a comfortable fit, try to not get discouraged. There are multiple treatment options, and another approach may resonate better with you. Be patient with yourself and your progress.

With many mental health conditions, including OCD and anxiety, some of the most important things we can do are to learn how to build coping skills, increase self-awareness, promote self-compassion, and prevent relapses. In other words, it’s critical to be an active part of your treatment and self-monitor your symptoms.

Sincerely,

Marni Amsellem, PhD

Marni Amsellem

Marni Amsellem, PhD, is a licensed psychologist. She maintains a part-time private practice in New York and Connecticut specializing in clinical health psychology, coping with illness, and adjustment to life transitions. Additionally, she is an interventionist and research consultant with hospitals, organizations, and corporations, both locally and nationally, involved with research investigating the role of behavior, environment, and individual differences in multiple aspects of health and decision-making.