Everything You Need To Know About Severe OCD And How To Deal With It

OCD is a common mental health disorder affecting men, women, and children. It affects approximately 2–3% of the population in the US. The World Health Organization ranks OCD as one of the ten most disabling conditions by lost income and decreased quality of life.¹

If you're reading this and you have OCD, know that it's not your fault, and you don't have to deal with it alone. OCD is treatable, even when it feels severe. Appropriate treatment can improve your ability to function — at school, work, social activities, etc. — and significantly enhance your quality of life.

An OCD diagnosis doesn't have to limit a person's potential. Learn the truth about OCD, how to recognize OCD symptoms, and how to successfully manage and treat severe OCD.

What is OCD? 

While most people have heard of the condition, few understand it. Many believe they know exactly how OCD looks from pop culture representations. They might associate the term “OCD” with people who are unusually organized or wash their hands slightly more than the average person. 

Although some with OCD have rituals that focus on cleanliness, the obsessive thoughts and repetitive behaviors that characterize OCD aren't limited to that. This widespread misrepresentation of OCD can be frustrating for those with the condition. So, what is OCD? 

Obsessive-compulsive disorder (OCD) is a mental condition characterized by a pattern of unwanted thoughts and fears (obsessions) or the urge to perform certain repetitive behaviors (compulsions). When this condition becomes severe, it can significantly interfere with all aspects of life.  

What are the symptoms of severe OCD?

Symptoms of OCD usually start gradually. As a result, OCD severity tends to vary throughout a person's lifetime. Symptoms can be mild in the beginning and become increasingly severe as time goes on. There are two main symptoms attributed to OCD: 

• Obsessions — persistent, unwanted thoughts, impulses, or images that cause distressing emotions

• Compulsions —  certain behaviors, rituals, or routines that a person feels compelled to perform in an attempt to “turn off” these thoughts or relieve the distress 

People with OCD usually struggle with obsessions, compulsions, or both every day. These intrusive thoughts and urges to perform specific actions are often disruptive and disturbing. While “severe OCD” is not an official diagnosis, people with OCD often feel their symptoms are severe.

Obsessions and compulsions relate to several things, referred to as “themes.” Common OCD themes include: 

• Contamination. Your obsessive thoughts and compulsions focus on cleanliness, germs, and the likelihood of falling sick. 

• Order and symmetry. Your OCD causes you to fixate on order and symmetry, and your anxiety goes through the roof when things are out of place.

• Relationships. You experience constant anxiety and doubt about your relationships with others. 

• Scrupulosity (religious or moral OCD). You experience moral or religious obsessions, usually causing you to feel like a terrible person.

• Harm. You have persistent, unwanted thoughts about harming yourself or others. 

Obsession symptoms

Obsessive thoughts may fixate on one or more themes. Here are a few examples of common obsessive thoughts:

• Fear of touching things other people have touched 

• Thoughts or fear of harming yourself or a loved one

• Extreme worry when objects aren't placed a certain way

• Disturbing thoughts or images about a taboo subject

• Constantly worrying you haven't done something such as locking the door, turning off the lights, etc. 

Compulsion symptoms

Compulsions are repetitive behaviors or actions you feel compelled to perform in response to obsessive thoughts. Like obsessions, compulsions may also relate to one or more themes. Examples of compulsions include:

• Excessive or ritualized hand washing, brushing, showering, etc. 

• Refusing to touch objects that other people touch a lot, such as doorknobs, or shake hands

• A strong fixation with checking locks, doors, switches, or appliances 

• Arranging or ordering things in a particular way

• Repeatedly cleaning household items 

• Rituals relating to numbers, such as counting to a specific number, avoiding certain numbers, etc. 

Compulsions may temporarily relieve distress related to an obsession, meaning you're likely to repeat these rituals soon. In the most severe OCD cases, a constant repetition of rituals may fill the day, leaving you unable to function. 

Other signs of OCD

The inability to function due to OCD can significantly affect the quality of life. Here are a few examples of how severe OCD can negatively affect your quality of life: 

• You are suffering from health issues related to OCD, such as dermatitis due to excessive hand washing

• You are constantly late for work or school

• You are unable to enjoy or even attend social events

• Your relationships are strained

• You have feelings of guilt, shame, and self-blame

• You're thinking about self-harm

Severe OCD can be extremely disabling. While some symptoms of OCD may be more commonly discussed, such as handwashing, note that the condition can take many shapes and forms. Every experience is unique. 

Keep in mind that symptoms of OCD will not remain the same. For some people, obsessions and compulsions may change or be replaced by others over time. Symptoms may also fluctuate depending on stress levels or other factors. 

What causes OCD?

As mentioned earlier in the article, OCD often begins in the teen years or early adulthood. But it can also start in childhood. Researchers aren't sure of the exact cause of OCD.²

However, various factors, including genetics, brain structure, and environmental factors, are associated with an increased chance of developing the condition:

• Genetics. Multiple studies involving relatives of people with OCD suggest that genetics is the most significant factor in someone's risk for developing OCD. While genes contribute to overall risk, they do not completely determine whether a person will develop the condition.³

• Brain structure. Structural and functional abnormalities, typically involving the brain's frontal cortex and subcortical structures, play a significant role in the processing that underlies the emergence of OCD symptoms. However, the relationship between abnormal activity in brain structure and the symptoms of OCD can't help researchers make predictions about a given individual.

• Environmental factors. Research suggests that environmental risk factors, such as stress or experiencing traumatic events, can trigger OCD in people who are already vulnerable to the condition. OCD is often linked to stressful life events, such as divorce.⁴

What other conditions are OCD linked to?

In some cases, people with OCD also get diagnosed with other mental health conditions known as comorbid disorders. The most common other mental health conditions associated with severe symptoms of OCD include: 

• Anxiety disorders

• Mood disorders such as depression

• Impulse control disorders

• Substance use disorders

People with OCD may also experience tics — sudden, repetitive movements or sounds that can be hard to control. These may include clearing their throat, sniffling their nose, grunting, or blinking their eyes. 

How is OCD diagnosed?

There is no single test for OCD. A mental health professional such as a psychiatrist, psychologist, physician, or nurse with special training can make a diagnosis based on an assessment of an individual's behaviors, thoughts, and feelings. The process may involve:

• A physical exam from your primary care provider to check your overall health and rule out any medical problems that may be contributing to your symptoms

• Blood tests for further analysis

• A psychological evaluation to assess an individual's behavior, emotions, and thought patterns

A mental health professional will use the criteria explained in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR) to make the diagnosis. 

The DSM-5-TR outlines very specific criteria for an OCD diagnosis:

• The individual has obsessions, compulsions, or both.

• The obsessions or compulsions take up more than an hour per day.

• The obsessions or compulsions are distressing or impact participation in work responsibilities or social activities. 

• The symptoms are not related to substance use or another medical problem.

• The symptoms aren't explained by another mental health disorder. 

After the diagnosis, mental health professionals can use various tests to assess OCD severity. The Yale-Brown Obsessive Compulsive Scale is considered the gold standard for evaluating the severity of OCD symptoms. 

The semi-structured interview is designed to provide a specific measure of OCD severity that is not influenced by the type of obsessions or compulsions present. The total severity score ranges from 0 to 40. The severity of OCD symptoms is based on the score: 

• 0–7 - Subclinical 

• 8–15 - Mild 

• 16–23 - Moderate 

• 24–31 - Severe 

• 32–40 - Extreme 

What treatment options are available for severe OCD?

According to current research, there's no cure for OCD. However, you may be able to manage the symptoms of severe OCD through a combination of treatments. The two main treatment options for OCD are medications and therapy. 

Medication

When it comes to medications, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) are the established first-line treatment for OCD. These medications increase levels of serotonin. Common examples include: 

• Clomipramine (Anafranil)

• Sertraline (Zoloft)

• Paroxetine (Paxil, Pexeva)

• Fluvoxamine (Luvox)

• Fluoxetine (Prozac)

These medications are usually prescribed in much higher doses for OCD than depression. Your doctor will use the “start low, go slow” approach when starting medications. That simply means your healthcare provider will begin with the lowest available dose and increase it as needed.

Therapy

As a form of treatment for OCD, therapy gives you tools to deal with your unhealthy thoughts, feelings, and behaviors. Cognitive behavioral therapy (CBT) is considered the first-line treatment for OCD. CBT is a talk therapy that can help you manage your symptoms by changing how you think and behave.

Exposure and response prevention (ERP) is a form of CBT that gradually exposes a person with OCD to situations designed to provoke their obsessions in a safe environment. With the right combination of medication and therapy, you can get severe OCD under control and achieve recovery, but it's generally not cured completely.

What happens if OCD is not treated?

Symptoms of OCD tend to begin gradually and get more severe over time. Severe OCD can be crippling as obsessions and rituals get out of control. If left untreated, symptoms can worsen, interfering with all aspects of life, including work, school, and personal relationships.

The lowdown 

OCD is a chronic mental health disorder characterized by frequent obsessive thoughts and compulsive behaviors. These obsessions and compulsions can get in the way of life. Those living with OCD understand how debilitating it can be, but it doesn't have to limit your potential. 

The good news is that OCD is treatable, even when it feels severe. If you have symptoms of OCD that interfere with your daily life, you should talk to a mental health professional. Severe OCD can be managed with a combination of medication and psychotherapy.