OCD can be relentless. If untreated, OCD is usually chronic and follows a waxing and waning course. That is, symptoms may get somewhat better for months or even years, only to get worse again before returning to a lower level of severity. Only about 5 to 10 percent of OCD sufferers enjoy a spontaneous remission in which all symptoms of OCD go away for good. Another 5 to 10 percent experience progressive deterioration in their symptoms. Stress can make OCD worse, but trying to eliminate all stress is unlikely to quell OCD. In fact, it is better for most people with OCD to keep busy. Idleness can be the breeding ground for increased obsessional thinking. Changes in the severity of OCD may be related to fluctuations in the body’s internal chemical environment. Women with OCD often report that their symptoms become more severe the week before their menstrual period. Presumably, this is related to the natural ebb and flow of hormones that regulate the menstrual cycle. Diet has not been shown to influence OCD.
In the majority of cases, the onset of OCD is not associated with an external event. On the other hand, recent research suggests that some cases of OCD in childhood may be preceded by an upper respiratory infection with Group A Beta-hemolytic streptococcus, or what is commonly known as strep throat. Sue Swedo, MD, of the National Institute of Mental Health, has coined the term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep, or PANDAS, to refer to this syndrome. This exciting new avenue of research will undoubtedly be the subject of intense investigation in the coming few years. In some adult cases, OCD first appears in women after childbirth, a condition called postpartum OCD.