Does OCD Get Worse With Age?
Obsessive-compulsive disorder (OCD) is a mental illness in which a person experiences recurring and uncontrollable obsessions or thoughts, engages in repetitive compulsions or behaviors, or has a combination of these. Most people develop OCD in childhood or adolescence, but it can start in early adulthood.
Obsessive-compulsive disorder symptoms can cause significant distress and impact quality of life. Generally, symptoms wax and wane. While proper treatment can help people learn to manage these symptoms, relapses are possible, and untreated OCD may get significantly worse in time.
Symptoms of OCD
People with OCD typically have recurring, unwanted thoughts or sensations (obsessions) and feel driven to do something repeatedly to get rid of them (compulsions). These compulsions can interfere with a person’s daily life. Not performing them can cause significant distress. Stopping both obsessive thoughts and compulsive actions can be extremely challenging, but there are treatments available.
Obsessions
Obsessions are persistent thoughts or impulses that cause fear, disgust, or anxiety. Even if the person realizes these thoughts are unreasonable or illogical, they often cannot eliminate them with reasoning. Some common obsessive thoughts include the following:
- Fear of contamination
- Disturbing sexual images
- Fear of being harmed
- Extreme concern with precision, order, or symmetry
- Fear of losing something important
Compulsions
Compulsions are the repetitive behaviors someone with OCD experiences the need to perform in response to obsessive thoughts. They generally reduce or prevent the obsession temporarily but can make a person more likely to perform the same behaviors in the future. Compulsions may be directly related to the obsessions (like hand washing or cleaning in response to a fear of contamination), or they can be completely unrelated. Examples of compulsions include:
- Engaging in excessive hand washing or showering
- Arranging things in a particular order
- Repeatedly checking locks, doors, or switches
- Constantly seeking reassurance
- Counting, repeating, or preferring or avoiding certain numbers
Comorbid mental health conditions
According to Stanford Medicine, people with OCD may be at high risk of having coexisting conditions that may worsen OCD symptoms and affect their treatment. The most common mental health disorders that occur with OCD include major depression, social phobia, eating disorder, phobia, panic disorder, and Tourette’s syndrome. OCD also seems to be associated with an increased risk for alcohol use or dependence.
What causes OCD?
The exact causes of OCD are unknown, but several risk factors can increase the chances of someone developing the disorder, including:
- Genetics. Having a parent or sibling with OCD is associated with an increased chance of someone developing the condition.
- Biology. Brain imaging studies have shown that people with OCD often have structural differences in their brains in areas that influence the ability to control behavior or emotional responses.
- Temperament. Research has also shown that people who demonstrate reserved behaviors or experience negative emotions, depression, or trait anxiety in childhood may be more likely to develop OCD.
The course of obsessive-compulsive disorder
To understand if OCD gets worse with age, it can help to understand the course of the condition.
There are two types of OCD: chronic and episodic. When OCD is episodic, symptoms are typically only present for a short time and can go away, with or without treatment. A chronic course of OCD, though, can have persistent symptoms that wax and wane, going through exacerbation and remission phases without the symptoms ever resolving completely.
This means that OCD can be persistent, but does that necessarily mean the symptoms get worse with age? Not necessarily; one study found that more than 60% of participants with OCD or obsessive-compulsive symptoms achieved remission for three consecutive years, even though only a third received professional treatment.
While these results offer some evidence that people with untreated OCD can recover spontaneously, other research shows that symptoms may return. Studies on untreated OCD performed before effective treatments were available indicated that, while symptoms may improve, late relapses are possible. For example, one study found that a fifth of all patients who reported either improved symptoms or complete remission experienced relapses, even in some who had been symptom-free for nearly 20 years. However, the diagnostic criteria and the definition of relapse have since evolved.
Outcomes of OCD vary across different studies. While symptoms can resolve spontaneously, it is estimated that this only happens in one out of five cases. Research also shows that untreated OCD can cause structural changes in the brain, which can make the condition more challenging to treat.
Treatments for OCD
Studies over the past 20-30 years have shown that treatment can be highly effective for OCD. At least half of people with OCD who seek treatment see remission in symptoms in the long term. Incidents of OCD with low severity and short duration that are treated early and intensely with continued maintenance can have a good outcome.
An effective treatment for OCD is often a combination of medication and therapy, specifically, selective serotonin reuptake inhibitors (SSRIs) and a type of cognitive-behavioral therapy (CBT) known as exposure and response prevention (ERP). About 7 out of 10 people see improvement with either of these treatment options.
SSRIs are prescription medications that help increase the amount of serotonin in the brain. Some research suggests that not enough serotonin can contribute to OCD symptoms. Although SSRIs are not a cure, they can treat OCD by making it easier for people with the condition to manage OCD symptoms. If you are interested in taking an SSRI, consider talking to a doctor. You may need to try a few different medications or doses to find a treatment that works for you.
Therapy can be an essential part of OCD treatment. In exposure and response prevention (ERP) treatment sessions, patients are typically exposed to situations they fear or those that focus on their obsessions. Generally, ERP treatment starts with exposures that lead to only mild or moderate symptoms. Clients are asked to avoid performing their compulsions, which often keeps them in a fearful or anxious state. By staying in this state without anything terrible happening, they can learn that their fears are just thoughts. Eventually, they may learn they can cope with their thoughts without needing ritualistic behaviors, which may decrease their anxiety over time.
If you’re experiencing symptoms of OCD, you may benefit from speaking with a therapist about ERP or other treatments. If your symptoms make it difficult to attend therapy in person, you might consider online therapy.
Online therapy can make mental health treatment more convenient. You can meet with a therapist from the comfort of your home at a time that suits your schedule.
Also, research published in 2022 found that online therapy can be an effective treatment for OCD, especially for people for whom in-person treatment isn’t readily available. This may also be helpful for those who experience difficulty leaving home due to their OCD symptoms.
Takeaway
If you’re experiencing symptoms of OCD, know that you don’t have to face them alone. You may benefit from connecting with a licensed therapist. If your symptoms make it difficult to visit a therapist in person, you might consider online therapy. With BetterHelp, you can be matched with a therapist who has experience treating OCD. Take the first step toward getting support with OCD and contact BetterHelp today.
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