Obsessive Compulsive Disorder: Symptoms, Signs, & Treatments

Originally published on April 20, 2020 Last updated on May 4, 2020

Written by:

Obsessive Compulsive Disorder, or OCD, is a mental health condition defined by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). People suffering from OCD experience intense anxiety about the nature of their obsessions and engage in compulsive behaviors to alleviate this distress. OCD is treatable with therapy and/or medication and can result in a decrease in the frequency and severity of symptoms.

Obsessive Compulsive Disorder

While not considered separate disorders, some experts believe that there are distinct subtypes of OCD. Each subtype describes specific fears that change the nature of the obsessions and compulsions people may experience.

Taylor Newendorp, LCPC, an OCD specialist, trainer with NOCD, and clinician, explains “OCD subtypes represent the experiences that people with OCD describe again and again, both in my practice and in the literature.” In fact, there is evidence for some of these subtypes, with the most research support existing for contamination, symmetry, and checking subtypes.¹

OCD Subtypes include:

- Harm OCD: A type of OCD where symptoms center around fears of causing harm to self or others. These harm-related thoughts may be violent and graphic in nature, causing some people with OCD to not trust themselves, believing they will act on these thoughts.
- Contamination OCD: A type of OCD where a person’s symptoms center around fears of spreading disease or being contaminated.
- Symmetry OCD: A type of OCD where a person becomes obsessed with patterns and symmetry, needing things to be even or balanced.
- Checking OCD: A type of OCD where the obsessions and compulsions involve checking behaviors, which are often compulsively repeated. A person with checking OCD might repeatedly check locks, their pockets, or even a part of their own body.
- Relationship OCD: This type of OCD usually centers around intimate/romantic relationships and features a preoccupation with some aspect of the relationship. This may include doubts about whether a partner is a good match or on fears of being cheated on or abandoned.
- Pedophilia OCD: A type of OCD where a person has intrusive sexual thoughts about children and becomes panicked that they may be attracted to children or that they may act on these thoughts.
- Emotional Contamination OCD: A relatively rare subtype where obsessions focus around concerns that a person can be negatively affected by certain people or places or energies.
- Existential OCD: A subtype where a person becomes obsessed with certain questions about the meaning of life, an individual’s specific purpose, or on doubt about the nature of reality.
- Sexual orientation OCD: A type of OCD where a person has become preoccupied with questions or doubts about their sexual orientation/identity. The person may begin to doubt their attraction to men, women, or both and engage in a variety of compulsions to test themselves or their level of attraction.
- Somatic OCD: A type of OCD where the focus is on some aspect of one’s body or health. Fixations could be on basic activities like breathing or blinking, or on more specific functions of the body like chewing or walking.
- “Just-right” OCD: A type of OCD where a person becomes fixated on needing something to be “just right”. This can show up in a variety of situations and may not have specific details about what would make the situation “right” but tends to feature a lot of anxiety or dread about something not being right.
- Pure-O OCD: While some experts contest whether this type of OCD exists, there are a subset of people who report that they only experience obsessions, without any form of mental or behavioral compulsions. This is called pure-O OCD. Obsessions may take on a variety of themes, but follow the pattern of being intrusive, upsetting, and repetitive.

While OCD is its own separate condition, it belongs to a cluster of disorders with similar features. These disorders are grouped within the same chapter of the 5th edition of the Diagnostic and Statistical Manual. While some individuals are diagnosed with OCD and one of the following conditions, it is also possible to have one of these conditions and not have OCD.

Some of the more common disorders that are related to OCD include:

- Excoriation disorder: this disorder is characterized by compulsive skin picking where a person either creates wounds or worsens existing wounds
- Trichotillomania: this disorder is characterized by compulsive hair pulling, which often is in response to stress or anxiety but can also occur because the person finds it pleasurable
- Body Dysmorphic Disorder: people with this disorder have a distorted view of some aspect of their own body or appearance and a preoccupation with perceived flaws. This preoccupation causes distress and often leads to compulsive checking, grooming, exercising, comparing or even cosmetic surgeries to correct perceived flaws
- Tourette Syndrome: this condition features involuntary speech or movements. Tourette syndrome is a type of tic disorder (people who experience involuntary twitches or movements) but is often seen in people with OCD or other anxiety disorders.
- Hoarding disorder: people with hoarding disorder have intense attachments to their belongings and collect belongings to the point where their homes become overcrowded and sometimes virtually unlivable.

Signs of OCD: What it Looks Like

Obsessive Compulsive Disorder is a disorder characterized by the presence of intrusive (unwanted, upsetting and repetitive) thoughts and/or compulsive (impulse-driven) behaviors. Most people with OCD describe struggling with both intrusive thoughts and compulsive behaviors. Excessive anxiety is common for people with OCD, which usually rises in response to obsessions and falls in response to compulsions.

The content of OCD obsessions varies (see subtypes), but usually share these features:

Come in the form of words, images, or impulses to act
Are obsessive in nature, meaning a person gets stuck repeating or ruminating on them
Cause the person to question whether they are crazy, evil, or that there is something wrong with them
Are fear-based, and the person is afraid that some aspect of the thought is real/true
Neutralize in response to specific mental acts or behaviors (compulsions)

Compulsions are mental acts or behaviors that a person has strong urges to repeat. Compulsions are not typically enjoyable, but instead are repeated because they provide some temporary relief from OCD symptoms (including obsessive thoughts and anxiety). Over time, the compulsions people with OCD experience tend to become disruptive to their lives and routines.

Some of the common types of compulsions people with OCD experience include:

Repeatedly checking
Cleaning, washing, or sterilizing
Ordering, organizing, or creating symmetry
Collecting or hoarding items
Counting or repeating words or numbers
Following rigid routines (like hygiene or eating)
Repeating prayers or mantras
Avoidance of specific objects, places, or situations
Doing research online
Seeking reassurance from others

Other signs that may indicate OCD include:

A tendency to ruminate or fixate on specific upsetting thoughts and finding it difficult or impossible to refocus attention away from these thoughts
Being consistently upset, anxious, or disgusted by the content of thoughts
Feelings of going crazy or not being in control of one’s thoughts and actions
Noticing strong urges to engage in certain mental tasks (like listing or counting)
Noticing strong urges to engage in certain behaviors that relieve anxiety (ie: handwashing, checking, repeating a certain word)
Needing a high level of control in any situation or environment
Needing to follow time-consuming routines or rigid processes to avoid feeling anxious, especially during times of stress
Giving up activities or tasks that need to be done or are enjoyable to engage in certain routines or ritualistic behaviors that reduce anxiety
Difficulty tolerating irregularities in a task, situation, or an interruption in a normal routine or process
Avoiding certain situations, places, people or things because of intense anxiety or intrusive thoughts
Finding that intrusive thoughts or routines are occurring 1 or more hours per day

Symptoms of OCD

OCD can only be diagnosed by a licensed health or mental health professional with the appropriate qualifications and experience. Usually, this occurs during an initial appointment with a counselor, psychologist, psychiatrist or other medical professional. Like all mental health disorders, a standardized set of symptoms drawn from the 5th edition of the Diagnostic and Statistical Manual.²

The criteria used to diagnose OCD include the following symptoms:

The presence of obsessions, compulsions, or both, with obsessions defined as both:

Intrusive, unwanted, repetitive thoughts or urges that cause distress and,
Thoughts a person tries to actively suppress, neutralize, or ignore with some other thought or action (compulsion)

And compulsions defined as both:

Repetitive mental acts (ie counting, praying, repeating words) or behaviors that a person feels driven to perform in response to an obsession, urge, or invented rule
Behaviors or mental acts are repeated in an attempt to prevent or reduce stress or anxiety but have little or no actual impact on the source of the anxiety

In addition to experiencing obsessions and/or compulsions, the person must also report:

That the obsessions or compulsions are time-consuming (taking 1 or more hours per day) or causing significant distress or impairment in functioning
That the symptoms are not attributable to a medical issue or effects of a substance
That the symptoms are not better explained by another mental health disorder

OCD Signs in Children, Teens, and Adults

While the same criteria are used to diagnose children, teens and adults with OCD, there can be some variations in symptoms depending on a person’s age. These variations help explain why most cases of OCD go undetected for several years before diagnosis.³

Younger children with OCD may:

Complain of physical symptoms like stomach aches or headaches
Become fixated or anxious on their body or health
Have separation anxiety when away from caregivers
Have difficulty with changes in routines
Display unusual or overly picky eating habits
Have tantrums or refuse to participate in certain situations
Take an unusually long time in parts of their daily routine
Need frequent reassurance from parents
Become fixated on specific irrational fears

Teens with OCD may:

Act out, refuse tasks, or defy authorities to avoid certain situations
Become preoccupied with certain irrational fears or concerns (ie their health, the planet, etc)
Seek frequent validation or reassurance from parents
Request to go to the doctor frequently
Spend a lot of time online researching things that concern or scare them
Have difficulty making decisions
Attempt to hide their symptoms out of embarrassment

OCD can even be difficult to detect in adults.

This is especially true when:

Adults have crafted specific schedules and routines that help them avoid OCD triggers
People are socially isolated and less likely to need to deviate from routines or compromise
Symptoms are masked as personality traits, like saying they are “type A” or “detail oriented”
Adults have only mental compulsions (things they do in their mind) vs behavioral compulsions
They have lesser known subtypes of OCD like pure-O or somatic OCD
They do not display commonly stereotyped compulsions like hand washing or checking locks
They have other mental health disorders (like depression or another anxiety disorder) which lead to conflicting symptoms

Causes and Triggers of OCD

There is no singular cause for OCD. A variety of genetic, cognitive, psychological, social and environmental factors likely play a role in determining the risk for developing this disorder. Risk factors do not determine who will develop OCD, but they do increase the risk in susceptible individuals.

Perinatal Risk Factors

Some of these risks may begin even before birth, as recent research has suggested that there is a strong link between OCD and children who are born early or who are delivered breech or via cesarean. Research also suggests that smoking during pregnancy increases a child’s risk for OCD, as does having a large birth weight or a low Apgar score.²

Genetic Risk Factors

Most mental health disorders have at least some known genetic link but in people with OCD, this link is especially strong, with 25% of people diagnosed with OCD having a family member with the disorder. Twin studies (considered to provide some of the strongest evidence) suggests that 45-65% of OCD is determined by genetic factors when symptoms develop in childhood.⁵ When symptoms develop in adulthood, the genetic link is estimated between 27-47%. ⁶

Neurological Abnormalities

Neuroimaging studies have found that there are significant differences in the brains of people with OCD. These include differences in the size and structure of different regions of the brain, differences in the chemical makeup of the brain, and in the way different regions of the brain communicate with one another.⁷ Accidents that result in traumatic brain injuries also sometimes are linked to the onset of OCD symptoms. In children, certain viral infections also may trigger the onset of OCD symptoms, a disorder known as PANDAS or PANS.

Psychological Risk Factors

Some research suggests that people with certain personality traits are more likely to develop OCD. Specifically, people with perfectionistic or neurotic tendencies, an inflated sense of responsibility, or who are indecisive or impulsive may be at higher risk.⁸ Also, new research suggests that people with OCD have differences in the way their brains process and send information. Specifically, the research showed that in the brains of people with OCD, the mechanisms for error processing (identifying a wrong thought) and inhibitory control (stopping an unhelpful action) are malfunctioning.⁹

Social and Environmental Risk Factors

There are some studies which have identified factors that place certain children at higher risk for developing OCD. Specifically, children who have a lot of separation anxiety or somatic anxiety (about their body or health) are more likely to develop OCD.⁴ Children from lower socio-economic statuses may also be at higher risk.

Stress-Related Risk Factors

Stressful events are known to be a trigger which can result in an onset of OCD symptoms for people who are already predisposed to the condition. These include things like traumatic events, accidents or major life transitions. Women may be at higher risk for developing OCD in the postpartum period. While stressful events likely play a part in whether and when OCD symptoms begin, they are not thought to cause OCD.

Treatment of OCD

With treatment, people with OCD are often able to minimize the extent that their symptoms disrupt their lives and routines and learn ways to manage their symptoms. Treatment can include medication, therapy, or a combination of the two.

Common treatments for OCD include:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a type of therapy that helps people adjust unhelpful patterns of thinking and make behavior changes that support improved functioning. CBT is considered an Evidence-based practice because it has been proven to be effective in treating a variety of mental disorders, including OCD. There is no set time frame for treating OCD or other anxiety disorders with CBT, but generally the therapy is more solution-focused and results can be seen within 12-20 sessions.

Exposure and Response Prevention

Exposure and Response Prevention (ERP) is a type of Cognitive Behavioral Therapy that uses exposure to help desensitize people to anxiety triggers. Over time, exposures result in a long-term reduction in anxiety. The second component of ERP therapy is response prevention, or helping the client resist urges to engage in compulsive behaviors. ERP is considered the most effective form of treatment for people with OCD and can generally be completed in 8-12 sessions with a counselor lasting 60-90 minutes.

Psychiatric Medication

Some people with OCD may also benefit from psychiatric medication. These medications are typically prescribed by a psychiatrist or licensed doctor, nurse practitioner or physician’s assistant with specialized experience in mental health treatment. On occasion, medication may be prescribed by a general practitioner or primary care provider. The most prescribed medications for OCD are SRI’s and SSRI’s, Antipsychotics and Benzodiazepines.

How to Get Help for OCD

If you or a loved one is suffering from OCD, seeking formal treatment is recommended. Therapy is a frirst-line treatment covered by most health insurance plans. To find an in-network therapist or to see if therapy is covered by your plan, you can call the number on the back of your insurance card or use your insurance company’s online search tools. You can also use your insurance company to find in-network psychiatrists or other prescribing professionals who can discuss options for medication.

Once you have a list of in-network therapists, the next step would be to call to see if they have experience in treating OCD and if they are accepting new patients. Dr. Patrick McGrath, Scientific Advisor at the International OCD Foundation, author of The OCD Answer Book and Head of Clinical Services at NOCD underscores the importance of finding trained therapists when he says, “Find a specialist for your therapy. If your therapist does not specialize in OCD, seek out someone who does. This is not a diagnosis that you want to just treat with general talk therapy.” Right now, ERP is the treatment of choice for OCD, because it has the most evidence to support its efficacy.

OCD Statistics

According to data from the National Institute of Mental Health and the International OCD Foundation:

OCD affected 1.2% of adults in the U.S. in the past year
OCD is the 4th most common mental illness
OCD affected more adult women in the US than men in the past year (1.8% vs .5%)
2.3% of adults in America will struggle with OCD in their lifetime
50% of adults with OCD describe their symptoms as causing serious impairment
34.8% of adults with OCD describe being moderately impaired by their symptoms
30% of adults diagnosed with OCD described having symptoms as a child
The average age of onset for OCD is 19 years old
45-65% of the risk for developing OCD is genetic

Living and Coping with OCD Symptoms

OCD is a disorder that can cause debilitating impairments for people, and formal treatment is usually needed to improve symptoms. In addition to therapy/medications, there may be some steps that people with OCD can take to better manage and cope with symptoms. These include:

Managing stress levels: because stress tends to worsen symptoms of OCD, managing stress levels is important in reducing symptoms.
Being flexible in routines: because people with OCD tend to more rigidly stick to certain routines when their symptoms progress, making a point to remain flexible and add variation can be helpful.
Reducing avoidance: many people with OCD may avoid certain anxiety-producing situations and while this can provide temporary relief, it often leads to a worsening of symptoms in the long-term.
Mindfulness and meditation: because people with OCD tend to attribute too much time, energy and attention to specific thoughts, mindfulness and meditation practices can teach people how to become less involved in their thoughts.
Social interactions: social interactions are known to reduce stress and improve health and mental health in several ways. For people with OCD, staying socially active can also help people adapt, compromise, and remain flexible.

OCD vs Anxiety Disorders

In some ways, OCD symptoms mirror those of anxiety disorders and at one point, OCD was even classified as an anxiety disorder. Both people with OCD and those with other anxiety disorders commonly describe experiencing excessive anxiety in response to specific triggers, fixation on fear-based thoughts, and reliance on avoidance or control strategies. In people with OCD, however, the obsessive fears tend to be more intrusive, less realistic, and last longer than in those with other anxiety disorders. In those with OCD, the compulsive behaviors repeated tend to be ones that either are unlikely to prevent the fear from occurring or done even when there is a very low risk of the fear occurring. These behaviors (or mental acts) often cause a lot of disrupting in routine and functioning.

OCD Self Diagnosis Tests and Quizzes

People who suspect they have symptoms of OCD should not over-rely on information found online to self-diagnose. Only a licensed and experienced clinician can determine whether a person is suffering from OCD or whether their symptoms are attributable to another cause. People can, however, conduct screening online to help identify specific symptoms and help determine whether to seek professional help.