question

Hey, I think it's considered severe when it interferes with you day to day living. For instance if your compulsions/rituals cause you to be late for things like appointments or getting to work on time. If ritualizing consumes most of your day or you constantly have intrusive thoughts, and you can't go about your normal routine anymore without the urge to ritualize.

When nothing has worked (ERP and medication) with a therapist and you need to do inpatient and possibly other, way more invasive treatments. I only know of one person with OCD that has that but she legitimately also has 9 other mental illnesses and a host of physical illnesses as well. She was born with severity in all cases and she just has to live through it after the inpatient for 10 years didn’t really work. That’s an absolute extreme and rare case though. Lots of people get better after inpatient care.

mental compulsions are still valid compulsions

Severe is based on how much of your life is consumed with OCD whether mental or physical obsessions or compulsions and how impacted your life is. For example, I am considered severe as I spend 4 hours at a stretch in the bathroom everyday due to my OCD. NOCD and an IOP provider have both said I’m too severe for their programs. I’m currently trying to find higher level care - I have some family challenges that are making this more difficult. A good ERP therapist can tell you whether you are severe.

@peaceandluv...when you say your compulsions are mental, do you just have constant intrusive/unwanted thoughts? Are they triggered by anything specific?