Obsessive-compulsive disorder (OCD) is a chronic mental health condition that causes a cycle of obsessions and compulsive mental or physical behaviors. These symptoms can significantly impact your day-to-day life, affecting your work, school, and relationships.
In this guide, we’ll discuss the symptoms of OCD, and how evidence-based treatments like exposure and response prevention (ERP) therapy can help you manage them.
Obsessions
The OCD cycle begins with intrusive thoughts, images, urges, feelings, and/or sensations known as obsessions. While everyone experiences intrusive thoughts from time to time, the difference is people with OCD need to find a meaning behind them.
“People with OCD think there must be a meaning to intrusive thoughts,” says Patrick McGrath, PhD, NOCD’s Chief Clinical Officer. “‘Why did I think that I want that? What if that were to come true? Should I do something to try to make that never happen?’ People without OCD can go, ‘Well, that was weird,’ and move on.”
Intrusive thoughts are much different from impulsive thoughts or hyperfixations. OCD intrusive thoughts can feel disturbing and unwanted. In contrast, impulsive thoughts are sudden, intense urges or desires to do something spontaneously, often without thinking about the consequences. Hyperfixation is typically a deep focus on a specific topic, activity, or interest that brings enjoyment rather than distress.
Common themes of OCD obsessions
OCD symptoms can be grouped together as themes or subtypes that fall under four main categories: harm, contamination, “just right,” and taboo topics.
Here are some common themes in OCD obsessions:
- Fear of being contaminated or contaminating others physically, mentally, or emotionally
- Fear of harming yourself or others
- Excessive worry about romantic and/or platonic relationships
- Excessive need for exactness and orderliness
- Fear of going against ethical, moral, or religious beliefs
- Excessive worry about identifying with the “wrong” sexual orientation
- Excessive concern about bodily sensations or functions
- Unwanted sexual thoughts
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Compulsions
Compulsions are repetitive mental or physical behaviors performed to cope with the distress caused by obsessions, or to prevent something bad from occurring. “Compulsions are what you do in response to the intrusive thoughts to try and neutralize, escape, fix, or avoid them,” says Ibrahim.
The issue with compulsions is that they’re only a temporary fix. “Unfortunately, the neutralization of distress usually works for a little while, and then we find ourselves back in the cycle of having to do everything all over again,” explains Dr. McGrath.
Common OCD compulsions
OCD compulsions can be either physical or mental. Below are some examples of physical compulsive behaviors:
- Excessive handwashing and cleaning
- Checking stoves, doors, locks, etc.
- Body-checking, such as weighing yourself, pinching your skin, taking your measurements, or looking for a groinal response
- Counting objects, steps, or other things in a certain way
- Ordering or arranging items in a particular way until they feel “just right”
- Repeating acts or behaviors (e.g., repeatedly walking back and forth through a doorway)
- Seeking reassurance from others
- Performing rituals, such as repeating certain words or phrases
- Hoarding possessions
- Avoiding certain places, people, or situations
- Excessive prayer
- Excessive confession of potential wrongdoings
- Excessively researching to find answers to your doubts with 100% certainty
Mental compulsions can include:
- Mentally reviewing past events over and over again until you find clarity
- Counting in your head while performing tasks
- Mental reassurance (e.g., replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong)
- Rumination or overthinking
- Mental checking
- Memory hoarding
- Thought suppression
- Replacing “bad” thoughts with “good” ones
Obsessions and compulsions can be very time-consuming, you may spend a significant portion of your day trying to neutralize intrusive thoughts—which ultimately can interfere with the things you care about.
Also, in many cases, OCD symptoms are ego-dystonic, meaning that they don’t typically align with your values.
Can OCD symptoms change?
It’s likely that your obsessions and compulsions will change or spike (flare up) throughout your life for various reasons. “Lack of sleep, not eating well, stress, moving, school, marriage, having a baby, hormones [can cause symptoms to change or flare up],” says Ibrahim. “I see pedophilia OCD or harm OCD coming up a lot when someone is pregnant or has a baby.”
However, Ibrahim says that some themes may just stick around. “Sometimes you have [an OCD theme] forever, which I call your ‘ride or die’ theme. They’ve been by your side for so long and never want to leave. New ones pop in and out over time, and we treat them all with exposure and response prevention (ERP) therapy the same way.”
However, Ibrahim emphasizes that it’s impossible to “catch” a new theme. “You’re not going to see a show about sexual predators and become one or develop a new theme about it. That’s not how themes pop up. Themes are not contagious.”
How are OCD symptoms diagnosed?
The first step of getting OCD treatment is getting diagnosed. When it comes to OCD, self-identifying your symptoms can be helpful for sharing your experiences with a clinician. From there, they can perform assessments to confirm an OCD diagnosis and help you start your treatment journey.
When do OCD symptoms develop?
“Late childhood to early adolescence is a common window of time [for OCD symptoms to develop], but it can also happen earlier or later in life,” says Ibrahim. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), 25% of cases of OCD start before the age of 14, with the average age of onset for symptoms being 19 years old.
It’s less common for OCD symptoms to appear after the age of 35 (known as late-onset OCD), but it is possible. OCD symptoms may occur gradually over time, but there are rare instances of acute-onset OCD that can develop from conditions like Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) or PANS (Pediatric Acute Neuropsychiatric Syndrome). Children may be diagnosed with PANDAS/PANS if OCD, a tic disorder, or both suddenly appear after a streptococcal (strep) infection. The conditions may also occur when OCD or tic symptoms worsen following a strep infection.
Are there gender differences in OCD symptoms?
While anyone can develop OCD, women are 1.6 times more likely to be diagnosed with the mental health condition than men. Limited research has also shown gender-based differences in themes of OCD symptoms.
Boys and men have a higher prevalence of harm- and sex-related obsessions, with compulsions related to perfectionism and counting. In contrast, women are likelier to have obsessions tied to contamination and experience compulsions centered around cleanliness and orderliness.
As of now, there’s little research on the prevalence of certain OCD themes and symptoms in trans and non-binary people.
When to seek help
If obsessive thoughts and compulsive behaviors are interfering with your day-to-day life, relationship, work, school, or overall well-being, please seek professional mental help.
If you leave your symptoms unmanaged, they can get worse over time, but if you work with a mental health professional—preferably someone who specializes in OCD, it’s possible to conquer your OCD symptoms.
How OCD symptoms are treated
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP is a form of cognitive behavioral therapy (CBT) specially designed to treat all themes of OCD.
A therapist specializing in ERP will guide you through exposures, which are situations where you confront your fears head-on. Your therapist will then teach you response prevention techniques, which are exercises that help you refrain from engaging in compulsions like reassurance-seeking or checking.
If you have severe symptoms or co-occurring mental health conditions (such as depression and anxiety), combining ERP therapy with medication can also be an effective treatment plan.
Bottom line
Everyone experiences intrusive thoughts from time to time. However, if these thoughts are so distressing that you feel the need to perform compulsions for temporary relief, you may have OCD.
If you’re experiencing OCD symptoms, your best bet for getting them under control is through first-line, evidence-based treatments like exposure and response prevention therapy. To get started, reach out to a therapist who specializes in OCD to create a customized treatment plan.
Key takeaways
- The main symptoms of obsessive-compulsive disorder (OCD) are obsessions and compulsions.
- Obsessions can revolve around themes like contamination, relationship, harm, and perfectionism.
- Significant life changes, such as moving, getting a new job, or having a baby, can cause your symptoms to switch themes and/or become more intense.
