OCD in Women: Symptoms, Treatment, & Getting Help

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition where a person is caught in a cycle of obsessive triggers and performing compulsions to relieve distress.¹ OCD is distinct from a generalized anxiety disorder and is categorized in the DSM-5 under the category obsessive-compulsive and related disorders. The World Health Organization categorizes OCD as one of the top ten most disabling conditions.

Symptoms of OCD are characterized by the nature of obsessions and their compulsive rituals. Obsessions might include fears of contamination, harm, imperfection, religion, sex, violence, relationships, or even bodily functions. Compulsions can be behavioral or mental and might include checking, correcting thoughts, seeking reassurance, rearranging, or even avoidance.

OCD is characterized by:

• Obsessions: Obsessions are unwanted intrusive thoughts, images, or urges that plague a person with OCD. Obsessions often contain taboo material that is distressing to the person with OCD.
• Compulsions: Compulsions are mental or behavioral acts that are performed to alleviate the distress caused by obsessions. Compulsions sometimes give short-term relief to the person with OCD, but long-term, they cause avoidance of dealing with the obsession.

Is OCD More Common in Women Than Men?

During their lifetime, women are more likely to experience OCD symptoms than men.⁶ In one review of clinical samples, women were 1.6 times more likely to experience OCD than men.⁶ Younger adults are also more likely to experience OCD symptoms, meaning that if you are a younger woman, you are at more risk of experiencing OCD than your older male counterparts.⁶

How Do OCD Symptoms Differ in Women & Men?

OCD symptoms may manifest differently based on sex. OCD is more common among males during childhood and more common in females during adolescence and adulthood.⁷ Males also usually have an earlier onset of symptoms, while females tend to report onset either during or after puberty or pregnancy.⁷

Regarding specific symptoms, males tend to have more blasphemous thoughts, often found in scrupulosity OCD.⁷ Females report more aggressive obsessions, characteristic of harm OCD, or sometimes contamination obsessions.⁷ Females also report higher rates of co-existing anxiety and depression.⁷

Here are a few OCD subtypes that can manifest differently in women and men:

Harm OCD

Harm OCD in women contains obsessions centered around fears of harming oneself or others. These obsessions can begin around pregnancy or postpartum and involve fears of hurting their child or failing to prevent someone else from hurting their child. Examples might include checking if the baby is breathing multiple times, washing hands until they are chapped for fears of spreading germs, or refusing to let anyone visit the baby.

Contamination OCD

Contamination OCD in women includes fears of contracting illness or spreading germs. Contamination OCD is one of the more common manifestations for women and often results in compulsive cleaning. Societal pressures that women should keep clean and organized homes can add to the expectations women feel around cleanliness. Triggers for compulsions might include hosting guests, times of illness, or pregnancy.

Symmetry OCD

Symmetry OCD in women includes obsessions related to orderliness. Societal expectations of women around an organization may contribute to pressures around needing to keep a neat appearance of self and home. Examples of symmetry OCD in women might include arranging and rearranging furniture before guests arrive, changing the baby’s outfit over and over until it is “right”, or re-doing makeup until it feels “correct”.

Hoarding OCD

Hoarding OCD includes obsessions around collecting generally useless items and refusing to discard them, even if they are old, unusable, or dirty. One study found that hoarding OCD in women was associated with low levels of conscientiousness and aggressive, sexual, and religious obsessions.⁸ In the same study, hoarding behaviors were also associated with checking compulsions.⁸

Relationship OCD

Relationship OCD, also known as ROCD, is a newer subtype characterized by obsessive fears and doubts of a person’s relationship. In the general population, issues with desire and arousal are the most common sexual dysfunctions for women.⁹ Relationship OCD may latch onto a woman’s issues with desire or arousal and prompt urges to mentally review problems with the relationship, compare the relationship to others, or compulsively avoid sexual relations.

Perinatal OCD

Perinatal OCD in women occurs either during pregnancy or after the birth of a child.¹⁰ Perinatal OCD is characterized by obsessions around the theme of caregiving and the child.¹⁰ This subtype of OCD can manifest in women who may not have had issues with symptoms prior to pregnancy.¹⁰

Pregnancy onset is generally associated with fears of harming the baby through contamination, while postnatal onset, also known as postpartum OCD, is associated with fears of harming the baby.¹⁰ Examples of pregnancy onset might include restricting diet or avoiding leaving the house. Examples of postnatal onset might include fears of inappropriately touching the baby during diaper changes or avoiding bathing the baby due to fears of drowning them.

Common Obsessions & Compulsions in Women

OCD in women may include obsessions centered around self, relationships, and children. Female OCD patients tend to present with more fears of contamination and, consequently, more OCD cleaning behaviors.² Women with OCD commonly obsess over the need for symmetry and exactness.³ Women also have more of an overlap with OCD symptoms and eating disorders, as well as impulse control disorders.²

OCD symptoms in women may include compulsions that center around perfection in body, home, relationships, or performance. Compulsions may also include fears of harm coming to self or children, especially during or after pregnancy.⁴

Common obsessions in women include:

• Needs for symmetry or exactness³
• Worries about physical appearance, weight, or body image²
• Impulse control disorders²
• Contamination fears^{2, 3}
• Fears of harm coming to their children, either from self or others⁴

Common compulsions in women include:

• Seeking reassurance from others
• Compulsive dieting, exercise, or body-checking
• Compulsive cleaning behaviors^{2, 3}
• Compulsive checking behaviors⁴
• Avoiding situations where harm to a child might occur, like taking a bath or walking up or down stairs⁴
• Thought suppression⁴
• Hoarding⁵
• Agoraphobic avoidance⁵

What Causes OCD in Women?

Environmental impacts, such as childhood sexual abuse, can influence the development of OCD.¹² Women note more changes in OCD symptoms during puberty, periods, and menopause.¹² Additionally, some studies have found evidence that hormonal changes may play a role in the development of OCD around pregnancy.¹¹ Research is ongoing on the genetic factors that may contribute to OCD in women.¹³

Diagnosis Challenges of OCD in Women

Women may experience sex-specific challenges when seeking a diagnosis of OCD. The majority of research finds evidence that OCD symptoms tend to start during puberty or pregnancy for women. Since both of these life periods are societally associated with dramatized emotions, some symptoms of OCD may be minimized or dismissed during adolescence or pregnancy.

Similarly, women are often perceived as emotional, hysterical, or making up symptoms, leading doctors who are unaware of challenging their own gender biases to minimize or dismiss symptoms.¹⁴ An accurate and timely diagnosis is the best course of treatment for OCD, meaning that women who face these types of challenges are at higher risk of untreated symptoms.

Unique Ways OCD Impacts Women

OCD can impact a woman’s personal and professional life, including her relationships in these areas. When relationships begin to suffer, self-esteem can also take a hit. Due to societal expectations of women, certain pressures may exist that exacerbate existing OCD symptoms. The recovery process itself can even be affected by unique challenges to the woman.

Here are some unique ways OCD impacts women:

Work

Women can be deeply impacted by OCD in the workplace, and it can show up in relationships with colleagues or performance. Perfectionism OCD is a common subtype in the workplace, and women who experience symptoms may engage in compulsive checking of emails, monitoring communication with colleagues, or compulsive re-doing of work projects until they are “just right.” Women may also engage in reassurance-seeking behaviors at work, such as over-asking supervisors for validation of performance.

Navigating OCD in women at work may include:

• Asking for work accommodations if you qualify, such as a private workspace or increased break times
• Engaging in exposure therapy under the guidance of a therapist
• Reciting positive affirmations about your capability
• Finding a safe space at work to use grounding skills
• Finding strong women workplace mentors

Relationships

OCD in women and their romantic relationships may be characterized by doubts and fears of compatibility. Relationship OCD is characterized by these obsessions in intimate relationships, which may show up in compulsions such as mental reviewing of past relationships and comparing them to the current one, checking for feelings of arousal or love, or confessing feelings of doubt to your partner or others.

OCD in women can also affect family relationships, especially if other family members experience symptoms of OCD or related disorders. Family members can become enmeshed in women’s OCD rituals, feeling the need to provide reassurance or let the family member engage in confessing or other ritualistic behaviors.

Self-esteem

OCD in women may negatively affect levels of self-esteem. Since OCD obsessions thrive on uncertainty, women may lack self-confidence in their ability to resist or manage compulsions. One study found that individuals with OCD are under-confident in their performance.¹⁵ OCD in women also has high comorbidity with eating and body image-related disorders, which are also associated with lower levels of self-esteem.

Societal Expectations

Society places high expectations on women regarding physical appearance, home-making, and mothering. These cultural standards can exacerbate certain symptoms of OCD, making compulsions harder to handle. Sometimes, cultural pressures can stack on top of one another to create the perfect storm of OCD symptoms. For example, if a woman comes from an ethnicity, religion, or socioeconomic class that expects perfection in home-making, it may exacerbate her obsessions around symmetry and cleanliness.

Resources for Women With OCD

Women who have more generalized OCD may find support groups helpful, and social media, such as Facebook, is a good resource to find local groups. Women may find group support especially helpful for Perinatal OCD symptoms, and relevant resources such as Postpartum Support International have groups.

Certain resources may be helpful for psychoeducation, such as Welcome to Maternal OCD. Seeking relevant books on OCD in women can also provide accurate information about symptoms. If you are a new mom experiencing OCD, the New Mom Mental Health Checklist can be a helpful resource to explore the symptoms you are having and begin a discussion with your doctor.

How to Ask for Support as a Woman With OCD

Research agrees that social support has positive effects for women with OCD symptoms. Possible sources of support might include friends, family, professionals, or groups. Since OCD can cause feelings of shame, asking for support can be difficult for women.

Here are some ideas for how to ask for support as a woman with OCD:

• Ask your doctor to discuss symptoms and recommend resources
• Find a mentor in your community who is also seeking treatment for mental health
• Seek support and spiritual advice from a spiritual leader
• Ask a friend if you can each discuss mental health with one another during a coffee date
• Ask family for help bringing by a meal or helping with household management

How to Support a Woman With OCD

Supporting your loved one includes educating yourself on OCD symptoms and helping encourage self-care. Verbal validation is a great way to support someone, and physical affirmations, such as helping with household management, can also offer support.

Women are sometimes doubted by the medical system. You can support your loved one by encouraging strong female mentors, letting them vent, and accompanying them to the doctor.

Here are some ways to support a woman with OCD:

• Promote self-care: Promoting self-care includes giving your loved one space and time to engage in their self-care activities. Verbally encouraging them to engage in self-care can remind them they are validated to take care of themselves.
• Give them time back: Offer to watch children, fix a meal, or complete a household task for your loved one while they engage in self-care. This could allow them to go on a date, take a nap, or do a hobby.
• Recommend strong female mentor figures: Finding strong female mentors can offer psychological inspiration for women with OCD. If these mentors also manage mental health issues, they can offer transparency and advice from a place of understanding.
• Let them voice their physical and psychological complaints: Societal expectations of women, especially mothers, sometimes include ideas that women should put others before themselves. Sometimes, this leads to having less space to experience mental or physical pain. By allowing them to voice concerns, you can encourage them their concerns are valid and should be treated.
• Offer to accompany them to the doctor: Women’s physical and mental complaints are sometimes doubted by the medical system due to societal stigmas. This can make it difficult for women with OCD to seek treatment for fears of being gaslit by professionals. Accompanying them to the doctor and encouraging them to make a list of concerns can help them advocate for their physical and mental health.

Treatment for OCD in Women

OCD in women is generally treated with therapy, medication, or a combination of treatments.

Exposure therapy for OCD is considered the gold standard for the treatment of OCD symptoms, but there are other approaches if exposure therapy is not helpful for reducing obsessions and compulsions.

Group therapy can be especially helpful for women with OCD to feel validated and supported in their experience of symptoms. Group therapy for perinatal OCD can offer an environment specific to supporting individuals through motherhood experiences of OCD symptoms. OCD treatment for women can also include couples or family therapy to address systemic issues contributing to symptoms.

Treatment options for OCD in women include:

• Exposure-response therapy (ERP): ERP includes gradually exposing someone to their fears. OCD in women can improve through exposure therapy when the person learns to tolerate the distress caused by their obsessions without engaging in compulsions.
• Medications: Medications for OCD in women often include antidepressants, which regulate neurotransmitters such as serotonin and epinephrine. Other medications might include benzodiazepines, which are taken as needed during heightened panic episodes.
• Cognitive behavioral therapy (CBT): CBT for OCD in women can help the person learn how their thoughts and emotions influence their behaviors. Through challenging negative thinking patterns and replacing them with more adaptive thoughts, women with OCD symptoms can change their behaviors, like compulsions.
• Couples therapy: Couples therapy can be helpful for OCD in women when symptoms are affecting their relationship. Through couples therapy, women can learn about their symptoms with a partner and find more adaptive styles of communication.
• Family therapy: Family therapy can be helpful for OCD in women when symptoms are affecting their relationship with family members. Through family therapy, members can learn more adaptive ways to discuss, challenge, and replace unhelpful behaviors that encourage compulsions.
• Group therapy: Group therapy can reduce OCD symptoms in women when they have a space to learn about the disorder and feel validated in their concerns. Having social support while also speaking openly about symptoms can help women with OCD replace their behaviors and feel supported while doing so.

When to Seek Professional Support

Professional support is needed when you are experiencing daily struggles in your professional and personal life. An online therapist directory or online therapy platform can help you explore options for counseling, while online psychiatrist options can help with options for medication management. Therapy, medication, or combined treatment are the best courses for reduction in symptoms.