Onset of symptoms may be acute or insidious and associated with a precipitating event in 60% of cases.
Patients may have a continuous course of symptoms (in 70%) or a waxing and waning course (in 23%) (1),
Patients with severe symptoms pursue a prolonged, steady course with symptoms decreasing slowly with time. There is some worsening of symptoms with stress, though an episodic course is unusual unless there is also an underlying affective disorder.
15% of cases suffer a deteriorating course and these patients are most likely to be men with an early age of onset, with a need for symmetry and exactness. Bad prognostic indicators also include the presence of an obsessional personality and relative severity of symptoms.
About two thirds of cases however improve within a year.
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