Literature review summary: Yes, no, maybe, sometimes.
Helpful I know.
Instead I will write what I think, from my experience and understanding, what the answer to this question could be. I might be wrong, but since this seems to be an important unanswered question with OCD, I don’t see the harm in speculation.
So, can you recover from OCD or be “cured”?
In simple terms, yes, you can. We know this because some people claim to have recovered and I see no reason not to believe them. In fact my own therapist once suffered from severe OCD and hasn’t had symptoms for over 10 years.
So why do a lucky few achieve complete recovery whilst most of us, at best, have to go a life guarding against potential relapse?
Personally, I think there are 5 aspects that come into play with OCD: personality; genetics and biology; environment; learnt behaviours, and; philosophy.
I suppose personality is shaped also partly by the other 4 aspects, but I still think it’s important to highlight just how it can play a serious role in OCD development and potential recovery. I wrote here about 5 personality traits I have that have made OCD recovery difficult for me. They included: creativity, perfectionism, high empathy and sensitivity, deep thinking, and being guilt prone.
Now, I am not saying that these traits are bad, far from it, in fact they can all be seen in a positive light, especially creativity, empathy/sensitivity and deep thinking. Perfectionism and being prone to guilt are more often than not unhelpful for me, and because of that these have actually been the easiest for me to tackle as I’ve aged.
The other 3 aspects, despite making me skilled in many other areas of life, are an excellent weapon for OCD to use against me. I’m not sure if any research has been done on this, but I would imagine it is much harder to recovery from OCD the higher your levels of creative thinking. Furthermore, as OCD largely involves concern about harm coming to others, sensitivity and empathy levels will almost certainly need to be addressing in some form or another. The weight of [excessive] responsibility a person with OCD can feel is immense, and this will surely have a proportionate impact on recovery potential also.
For the people who I’ve come across who have “completely recovered” most seem to have one or both of the following; first, they are generally involved in delivering OCD awareness, training, or therapy and/or they are confident, assertive people who have managed to taper their sensitivity levels. This makes a difference because active involvement in OCD education can remind us of therapy tools and keep them fresh for ourselves. On the second point, developing confidence, assertiveness, and reducing sensitivity (to “normal” levels) will prevent reoccurance of OCD for many reasons, some more obvious than others. For example, if we struggle to be assertive in our every day lives (say, a work problem), it is surely much harder to stand up to the OCD bully.
2. Genetics and biology
I don’t think it’s controversial to say that there is a consensus amongst most OCD experts that genetics and biology play at least a part with OCD. I think the disagreement comes mainly from those who argue whether the brain changes after behaviour, or whether the malfunctioning part occurs before the behaviour – a chicken and egg problem if you will. This also causes disagreement between those who think recovery is almost always possible if the correct approach is followed (as the brain can “rewire” itself once new behavioural patterns set in) and those who think OCD is chronic for most and will always be there in the background.
My guess would be that pre-existing biological factors can and do play a major role with many, whilst others have a weaker set of pre-existing malfunctioning brain structures. Those in the latter group would then find it much easier to rewire their brains than the former.
If biology didn’t play a significant role with OCD, medication would not be effective in helping to reduce symptoms. Furthermore, relapse rates following discontinuation of meds would not be as widely recorded as it is. Obviously medication is specific for each person – some benefit greatly, others partially, some not at all. Again, this could be because biological causation is stronger in some people than others.
Another example to show that biology (rather than learnt behaviours) can play a strong role with OCD is when children develop sudden severe OCD following strep throat infection. Symptoms occur almost out of nowhere – which means something has caused the OCD from a biological perspective.
As I’ve alluded to already people can rewire their brains, there is plenty of evidence demonstrating this – neuroplasticity is a fascinating area. That said, I recently read an interesting study referred to in Sally Winston and Martin Seif’s book Overcoming Unwanted Intrusive Thoughts who highlight that whilst people can rewire their brains with new patterns, the older wiring isn’t erased, but rather new pathways are created next to the old ones. Thus, if this is the case, sometimes the train of thought can veer onto the wrong track if we’re not careful. From personal experience, I think this is absolutely spot on (at least for me) because it’s almost as if I can feel the OCD controller switching the track sending the train on a path to destruction.
I am also convinced that OCD can be so traumatic for many of us that certain obsessions can become imprinted on our brains. Certain triggers can then bring the fear and anxiety back almost instantaneously. For example, I have been without symptoms for weeks before and then BANG! a certain trigger (even a small one) can throw me into severe OCD almost within seconds and without any overt compulsions.
There is also the question of comorbidities and how they influence OCD. If someone struggles with depression, this will surely make OCD worse (and vice versa). I would imagine that those who have OCD as their “main” disorder would find it much harder to recover than those who develop OCD as a lesser problem to another “main” disorder.
Again, I must add here that I am only speculating and thinking aloud. Clearly a lot more research is needed in these areas.
Of course, environment is unique to each individual who develops OCD. I’m not entirely sure which aspects may or may not contribute to OCD development and maintenance. However, there are a few that I think have, or continue, to impact on my OCD, they include:
- Stressful situations
- Tiredness caused by busy life
- Alcohol (I had to quit)
- Prolonged noise
- Illness – especially sinus issues
- Anxiety and worry – i.e. work situation
Anyone who lives will experience some or all of the above. It simply isn’t possible to avoid such environmental situations. I do try my best to minimise such factors, but apparently living in a anti-contamination sound proof bubble with an unlimited (and free) atm machine attached to it is “unrealistic” – bloody government cut backs!
I would posit that those who do fully recover from OCD are more likely to have a good work life balance, limited stress, and/or more control over their environments in general.
4. Learnt behaviours
OCD undoubtedly contains within it an often complex web of learnt patterns of behaviour and thought. Sometimes this web can be so entangled, even hidden, unravelling it makes pulling out the Christmas lights you shoved in the cupboard last year feel like spaghetti.
It’s relatively simple to highlight the main obsessions and compulsions with OCD after some reflection. However, some of us, even a decade after learning we have OCD are still falling into behavioural traps. OCD is so unforgiving, it often only takes a small mistake for it to latch on again and trap you in an OCD cycle.
Not only are there compulsive behaviours with OCD but oftentimes there are many other core beliefs and interrelated aspects that feed in to the process. For example, perfectionism, magical thinking, over-inflated sense of responsibility, low self esteem, low confidence, black and white thinking….there are many othere. These other aspects are often underestimated in my opinion and can have a serious impact on OCD recovery potential.
An example of this could be if someone has fairly deep rooted black and white thinking with regards to the concept of success. They might go 2 months without performing a compulsion, then one day, when tired, they might slip up. For this person those two months are then seen as nothing, the slip up means they are a complete failure, OCD roots itself back into life like the human eating plant it is, and all of a sudden they are left thinking: “What’s the point, I will never get better, I’m going to suffer forever”.
With effort and consistency we can highlight and look to change such behaviours, core beliefs or thought patterns. But this is easier said than done and often requires professional help, the correct type of which is even harder to find at times.
Acceptance Commitment Therapy is so good for OCD because it gives a solid philosophical grounding for approaching recovery. Values can be powerful anchors for keeping us focused in stormy seas. Sometimes we give up on recovery if we forget why we are recovering. It’s too easy to let depression tell us to give up. I think people can underestimate just how much strength is needed to overcome this horrible disorder.
Similarly, self compassion, the present moment, radical acceptance, faith and spirituality can be powerful tools that can help with recovery. I think these concepts are often under-discussed with OCD recovery, but I personally think they are essential. I think in certain cultures we can be quite dismissive of such approaches at times with the only emphasis being on formal medical treatments (which of course are needed). But why not combine approaches if it helps? I have found faith and meditation very important. One of the best OCD books I’ve ever read isn’t even an OCD book – the Power of Now by Eckhart Tolle.
I would find it hard to believe that people who recover fully from OCD don’t have the ability to be self compassionate, accept what is, and be grounded mainly in the present moment. Not that you have to be religious or follow any particular approach, but an understanding and application of such key principles is almost certainly required in my opinion. This could even happen without people meaning to. Like when a point of suffering is reached that is so severe that a massive shift in consciousness occurs almost overnight. More often than not however these are things we all need to practice and work on.
So can OCD be fully recovered from? Yes, but I think it depends on the various factors that caused or maintain the OCD and whether it’s possible to highlight and take action to remedy the said causes.
Regardless of the causes of OCD the fact remains that CBT/ERP and (if required) medication will help the vast majority to manage their symptoms and even allow others to fully recover.
What I would say is, don’t be so hard on yourself. We can only do our best. I get frustrated at some people who argue or insinuate that everyone can fully recover from OCD. Firstly, there is no evidence of that either in the literature or anecdotally. Secondly, it can be very discouraging to those of us that put our heart and soul into recovery and couldn’t try any harder.
If someone can fully recover from OCD, then great, but in my experience this seems to be the exception rather than the norm. I’m not saying this in a defeatist way, but rather to stop people feeling guilty about not “fully” recovering.
We need more research into the causes of OCD and why some people can fully recover and what separates them from the rest. I’m sorry, but I simply don’t believe at this stage that it’s because they followed the recommended treatment approach properly and the rest of us didn’t. It’s almost certainly more complicated than that!