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What is Severe OCD?

June 25, 2023

9 min.

Severe obsessive-compulsive disorder (OCD) is similar to OCD but includes symptoms that are more intense, frequent, and disruptive to daily life.

By: Charlie Health Editorial Team

Clinically Reviewed By: Dr. Don Gasparini

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Table of Contents

Like many mental health conditions, obsessive-compulsive disorder (OCD) exists on a spectrum. The severity and impact of OCD can vary significantly from person to person, ranging from mild to moderate to severe, depending on the intensity of obsessions and compulsions and the level of distress experienced. “Severe OCD” is not an official psychological diagnosis, but mental health professionals use the term to describe when the disorder significantly affects a person’s daily life and functioning. 

How is severe OCD different than OCD?

Severe OCD and OCD are not distinct disorders, but rather varying levels of symptom severity within the same condition. OCD is a mental health condition characterized by the presence of obsessions (intrusive and distressing thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts performed to alleviate anxiety or prevent feared outcomes).

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The distinction between severe OCD and OCD lies in the intensity and impact of the symptoms experienced by an individual. Severe OCD typically refers to cases where the symptoms are significantly more intense, distressing, and disruptive to daily life compared to milder forms of the disorder. Here are some key differences between severe OCD and OCD:

Intensity and frequency of symptoms

In severe OCD, the obsessions and compulsions are more pronounced and intense, causing greater distress and anxiety. They may be pervasive, persistent, and difficult to control, significantly impacting the person’s thoughts, emotions, and behaviors. In contrast, individuals with milder forms of OCD may experience less intense or less frequent symptoms.

Impairment in functioning

Severe OCD can severely impair an individual’s ability to function in work, relationships, and daily activities. Obsessions and compulsions can consume significant time and energy, leading to substantial interference in their ability to carry out everyday tasks. In milder cases, the impact on functioning may be less severe.

Distress and quality of life

Severe OCD is often associated with heightened levels of distress, anxiety, and reduced quality of life. Obsessions and compulsions can cause significant emotional suffering, affecting a person’s overall well-being and social functioning. While OCD in general can be distressing, severe OCD tends to involve more severe and pervasive psychological distress.

Treatment challenges

Severe OCD may be more challenging to treat than milder forms of the disorder. It may require more intensive interventions, such as specialized therapies or a combination of therapies and medication, to effectively manage symptoms.

What are the symptoms of severe OCD?

The symptoms of severe OCD are similar to those of OCD in general but, as discussed, can be more intense, frequent, and disruptive to daily life. Common symptoms of severe OCD may include:


People with severe OCD experience intrusive thoughts, images, or urges that are repetitive and difficult to control. These obsessions can revolve around specific themes, including contamination fears, aggressive or violent thoughts, concerns about order or symmetry, or unwanted thoughts (usually sexual or religious in nature)


Severe OCD is also marked by compulsive behaviors or compulsive rituals that people do to try to ease anxiety. These can include excessive handwashing, checking and rechecking behaviors, counting, repeating words or phrases, or arranging objects in a specific manner.

Anxiety and distress

Intense anxiety and distress are common in severe OCD. The obsessions cause significant emotional discomfort and the intrusive thoughts can be overwhelming. People with severe OCD may fear something terrible will happen if they don’t perform their compulsions, leading to heightened anxiety and distress.

Impaired functioning

Severe OCD has a profound impact on daily functioning. The obsessions and compulsions consume significant time and energy, leading to difficulties at work, school, and in relationships. The impact can be significant, making it difficult to focus, finish tasks, or participate in social activities.

Avoidance behaviors

To cope with the distress caused by obsessions and compulsions, people with severe OCD may engage in avoidance behaviors. They may avoid specific situations, people, or objects that trigger their symptoms. This avoidance can limit people’s experiences and contribute to social isolation.

Emotional and psychological impact

Severe OCD often results in intense emotions, including feelings of shame, guilt, or embarrassment due to the nature of obsessions. Additionally, people with severe OCD may be more prone to developing co-occurring mental health conditions, such as depression or other anxiety disorders.

Everyone’s experience with severe OCD is unique, and symptoms may vary. Talking with a qualified mental health professional is the only way to get an accurate diagnosis and appropriate treatment.

Causes and risk factors of severe OCD 

The causes and risk factors of severe OCD are similar to those of mild or moderate OCD. However, a person may be more likely to develop a severe form of the disorder if faced with more significant risk factors and/or be more vulnerable to those risks. Here are some key causes and risk factors of severe OCD and how they differ from mild or moderate OCD:

Biological factors

In general, OCD is influenced by biological factors, such as genetic predisposition and abnormalities in brain structure and functioning. It is possible that people with severe OCD may have a stronger genetic vulnerability or more pronounced neurobiological abnormalities compared to those with milder forms of OCD.

Environmental factors 

Environmental factors, including life events, trauma, and stress, can contribute to the development of OCD. People with severe OCD may experience more intense and long-lasting environmental stressors compared to those with milder forms of OCD.

Cognitive factors

The way people think and perceive things influences how OCD symptoms develop and persist. People with severe OCD may have more pervasive and deeply ingrained cognitive distortions and beliefs fueling their obsessions and compulsions, leading to a greater impact on their daily lives.

Co-occurring mental health conditions

All forms of OCD can have associations with co-occurring mental health conditions, including anxiety disorders, depression, and certain personality disorders. However, people with severe OCD may have a higher likelihood of experiencing multiple co-occurring conditions, and the severity of these conditions may exacerbate the impact of OCD symptoms.

While these causes and risk factors can contribute to the development of severe OCD, the exact mechanisms of the disorder are still being researched in general. 

What other conditions are linked to severe OCD? 

As mentioned, severe OCD is often associated with co-occurring mental health conditions. Not everyone with severe OCD, though, will experience these conditions. Some of the common conditions linked to severe OCD include:

  • Generalized anxiety disorder (GAD): Many individuals with severe OCD also experience high levels of anxiety beyond their obsessive thoughts and compulsive behaviors.
  • Major depressive disorder (MDD): Severe OCD can contribute to the development of depression due to the chronicity of symptoms, functional impairment, and distress caused by the disorder.
  • Panic disorder: Some people with severe OCD may also experience panic attacks in addition to their obsessive-compulsive symptoms.
  • Social anxiety disorder (SAD): Severe OCD can lead to social isolation, difficulties in social interactions, and increased anxiety in social settings, all of which are characteristics of SAD.
  • Phobias: People with severe OCD may develop specific phobias related to an obsession or compulsion. For example, a fear of contamination may lead to a phobia of germs, known as “germophobia.”
  • Body dysmorphic disorder (BDD): BDD involves preoccupation with imagined or slight defects in one’s appearance. Some individuals with severe OCD may also experience symptoms of BDD, particularly if their obsessions and compulsions are related to appearance or body image concerns.
  • Tic disorders: Tic disorders, such as Tourette’s syndrome, are characterized by repetitive, involuntary movements or vocalizations called tics. In some cases, severe OCD and tic disorders can coexist, leading to additional challenges in managing symptoms.
A person in a green sweater sits at a desk holding a pencil. She is able to manage school work and severe OCD with the help of therapy and medication.

What happens if severe OCD is not treated?

Without treatment, the symptoms of severe OCD tend to persist and worsen over time, leading to a significant decline in quality of life. At its most severe, the obsessions and compulsions can consume a person’s daily life, disrupting their emotional and physical health.

Untreated severe OCD can affect relationships, as the obsessions and compulsions may be difficult for others to understand or put up with, leading to feelings of isolation. The constant anxiety, fear, and obsessive thoughts can also make people prone to other mental health conditions, like depression or anxiety disorders.

In addition to the emotional toll, untreated severe OCD can also have physical consequences. The repetitive behaviors, such as excessive hand washing or checking rituals, may cause skin irritation or damage. Sleep disturbances, which are common in OCD, can lead to fatigue, weakened immune function, and overall physical health decline.

If severe OCD is not treated, the disorder can upend people’s lives. Seeking appropriate treatment, such as therapy and medication, is essential to manage symptoms, improve quality of life, and prevent further negative consequences.

How is severe OCD treated?

Like OCD in general, severe OCD is usually treated through a combination of therapeutic approaches and, in some cases, medication. The primary goal of treatment is to reduce symptom severity, improve daily functioning, and enhance a person’s overall quality of life. The treatment approach for severe OCD may differ from person to person, and it’s crucial to develop a personalized treatment plan in consultation with a qualified mental health professional. Here are some common treatment options for severe OCD:

Cognitive behavioral therapy (CBT)

CBT is a widely used therapy for OCD. Specifically, a type of CBT called exposure and response prevention (ERP) is highly effective. In ERP, people are gradually exposed to the thoughts or situations that trigger their anxiety and are encouraged to resist engaging in their usual compulsive behaviors. This helps them build tolerance to anxiety and break the cycle of obsessions and compulsions.

Supportive therapies 

Additional therapeutic approaches, such as individual therapy, group therapy, or family therapy, can provide support, education, and guidance to people with severe OCD and their loved ones. These therapies can help improve coping skills, enhance communication, and foster a supportive environment.


In some cases, medication may be prescribed to manage severe OCD symptoms. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that can help reduce the frequency and intensity of obsessions and compulsions. Other medications like clomipramine may also be used for OCD treatment.

Lifestyle modifications 

Making certain lifestyle changes can make OCD treatment more effective. These changes may involve incorporating stress management techniques, regular physical exercise, a healthy diet, and sufficient sleep. By maintaining a well-balanced lifestyle, people can increase their overall well-being and improve their ability to manage OCD symptoms effectively.

Deep brain stimulation (DBS)

DBS is a neurosurgical procedure where electrodes are implanted in specific areas of the brain. In cases of severe and treatment-resistant OCD, DBS may be a treatment option. During DBS for OCD, a specialized surgical team places electrodes in specific brain areas thought to be involved in OCD symptoms. Once the electrodes are implanted, they are connected to a device called a neurostimulator, which is usually placed under the skin in the chest or abdominal area. The neurostimulator delivers electrical impulses to the brain, modulating the activity of the targeted regions. It’s not entirely understood how DBS for OCD works, but experts believe that the electrical stimulation plays a role in regulating abnormal brain activity and restoring balance within the parts of the brain associated with OCD symptoms.

DBS is usually considered a treatment option for severe OCD when other therapies, like medication and therapy, have not provided sufficient relief. DBS is an invasive medical procedure and it’s not a good fit for everyone.

Severe OCD treatment at Charlie Health

Living with severe obsessions and compulsions can be overwhelming, but you don’t have to suffer alone. Severe OCD is manageable, especially when you have the resources and support to cope.

Charlie Health’s virtual Intensive Outpatient Program (IOP) connects each client with a licensed therapist based on their individual needs, preferences, background, and experiences to promote healing in a safe, supportive space. We have therapists who are certified in ERP and experts in OCD treatment. Get started today.

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