Symmetry OCD: What It Is, Symptoms, & Treatment

What Is Symmetry OCD?

Symmetry OCD is characterized by the need for sameness, orderliness, or perfect arrangement of objects. Symmetry obsessions provoke neurotic anxiety about things not feeling or being ”right.” That feeling can cause a sense of dread that something terrible might happen unless a compulsion to align the items is performed to prevent it. They also will view their environment as cluttered or disorganized until things are put in perfect order.

The person with this type of OCD knows the fear is irrational but has difficulty attending to anything else until the feeling is resolved by performing compulsive acts to fix it. Research has shown that about 36-50% of people with OCD have this subtype.^1,2

Symmetry OCD Symptoms

Symptoms of symmetry OCD are similar to many other OCD symptoms, like obsessions about needing things to feel “just right” or dealing with perfectionism in OCD. Some experience a sense of superstition, over-responsibility, or guilt that ignoring the feeling is equivalent to being morally negligent. Others may not necessarily have obsessive thoughts but feel anxious that something wrong or bad has happened that needs to be made right.

Symmetry OCD Obsessions

Some common obsessions for those with symmetry OCD include:

• The need to order things
• Obsessive need for “evenness”
• The need for things to end on an even number
• The need for sameness
• The need for visual perfection
• The need for balance
• Obsessive concern that something terrible will happen if an object is uneven or imperfectly aligned
• Extreme need for balance (items symmetrically placed, walking with the same amount of pressure on each foot, the same amount of steps on each foot, etc.)

Symmetry OCD Compulsions

Common symmetry OCD compulsions include:

• Lining things up
• Repeating behaviors so they are performed equally on both sides (washing dishes, putting on shoes, touching objects)
• Positioning items so that there is the same amount of space between them
• Ordering/arranging items by color or size (items in the closet or books on a shelf)
• Rounding numbers up or down to make them even
• Repetitive visual checking that things are in order
• Rewriting something until penmanship is perfect
• Asking others to straighten things up or doing it for them if they don’t comply
• Counting while performing actions to leave off on an even number (walking, written number of words)

Sensation & Body Symmetry OCD

Sensation or body symmetry OCD is a form of OCD in which someone is obsessed with achieving symmetrical body sensations, often related to their movements or body positions. Some examples include walking in a perfectly symmetrical way or needing a sensation to be equally balanced on both sides of the body. This can lead to repeating body movements until things feel just right.

What Can Trigger Symmetry OCD?

Symmetry OCD can be triggered by seeing things that aren’t visually symmetrical or having body sensations that are unequal and need to be “evened out.”

Common triggers of symmetry OCD include:

• Seeing things that are not visually symmetrical
• Odd, uneven, or out-of-order numbers
• A group of objects that are not balanced or lined up
• Feeling a sensation on only one side of the body
• Walking unevenly
• Crooked wall hangings or picture frames
• Disorganized arrangements, such as books on a shelf that aren’t in line
• Messy, cluttered spaces
• Mismatched patterns or designs

How Do I Know It’s OCD & Not Just a Preference for Symmetry?

Having a specific aesthetic preference doesn’t indicate OCD, and doesn’t involve obsessions or compulsions. A person can have a strong preference for things to be orderly, and may even feel uncomfortable if they are not. However, OCD is a serious and often debilitating condition that interferes with a person’s ability to function at work, at home, or in relationships.

A person with symmetry OCD will find it extremely upsetting when things are out of order, to the point that the obsessions overtake their thoughts. Then, they will practice compulsive behaviors such as straightening, ordering, or trying to balance out body sensations to quiet the obsessions. These compulsions often take up the better part of a person’s day.

Symmetry & Ordering OCD’s Impacts on Someone’s Life

One effect of symmetry OCD for the sufferer is being late to their scheduled activities due to rituals they “have to” perform before leaving the house. They also may suffer from lateness in handing in assignments due to perfectionism, or be distracted during meetings, classes, and family events due to the preoccupation with imperfectly ordered objects in their immediate environment and strong urges to align them.

Other examples of how symmetry OCD can impact someone’s life include:

• Increased risks of injury, such as when compulsions take effect while using dangerous items like a curling iron, saw, knives, or even driving.
• The need to wear slip-on or velcro shoes to avoid the obsessive and tedious need to tie shoelaces perfectly.
• Poor self-esteem when they notice imperfections in their face or body’s symmetry can lead to disruptive checking rituals to see if the asymmetry is still there and a fear that others are actively noticing the same distortions in their looks.

Why Am I Obsessed With Order & Symmetry?

For people with OCD, the obsessions typically aren’t super logical. A person may notice that a bookshelf isn’t perfectly straight, and start to obsess about it. This obsession will grow until it creates extreme stress and anxiety. There are usually specific fears or thought patterns behind the obsessions, worst-case scenarios that grow until they are temporarily relieved by compulsions.

Some reasons why people with OCD may obsess over symmetry include:

• Magical thinking: People who engage in magical thinking believe that their actions or compulsions can influence or control unrelated external events. A person with symmetry OCD may believe that if things aren’t perfectly aligned, something terrible will happen.
• Dysfunctional protecting: This refers to an individual who takes protecting themselves or others to an extreme, and believes that aligning things just right or performing symmetrical actions will protect them or others from harm.
• The need to feel “just right”: This is a common experience for people with OCD. Symmetry OCD results in extreme discomfort and the inability to tolerate anything that isn’t symmetrical or aligned.

What Causes Symmetry OCD?

Symmetry OCD, like other forms of OCD, has a variety of potential causes and risk factors. There is thought to be a strong genetic component. Neurobiology, including the balance of neurotransmitters in the brain, can play a role, and environmental factors like experiencing trauma can contribute as well. Some people develop OCD as a result of observing their parents’ obsessive and compulsive behaviors.^3,4

• Biology: Studies support that differences in neurochemistry, such as serotonin imbalance, as well as brain anatomy, can contribute to OCD.³
• Genetics: Genetic factors have been found to play a part in OCD. Exciting research is looking to increase knowledge of the specific genetic factors involved in OCD and exactly how they work.⁴
• Environment: Other possible factors contributing to OCD are being raised by parents with OCD or experiencing life stressors or a traumatic event. One study showed that 61% of patients experienced life stressors before their OCD symptoms began and around 57% of patients had traumatic experiences within one month before.⁵

Other Risk Factors for Developing Symmetry OCD

Other risk factors including gender, age, and the presence of other comorbidities may increase a person’s risk of developing symmetry OCD:⁶

• Gender: OCD is more common in females than in males.
• Age: Males are generally diagnosed earlier in life, while females are most commonly diagnosed during or after puberty or during pregnancy.
• Having other comorbidities: People with tics or tourettes, as well as other comorbidities like anxiety or depression, may be more likely to develop symmetry OCD and other types of OCD.⁷

Symmetry OCD Treatment

Symmetry OCD is treatable. The gold standard treatment for all types of OCD is exposure and response prevention, and many people find that medication can aid their recovery as well.

Exposure & Response Prevention (ERP)

Treating OCD typically involves a behavioral technique called exposure and response prevention (ERP) therapy. An example of an ERP for OCD might be for a therapist to purposely put items out of order and leave them that way until the client habituates or gets used to it. Response prevention might also consist of learning to resist ordering, arranging, or visual checking rituals to see if things are aligned.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy for OCD can also help people learn to be more flexible in their thinking and behavior. It can help people reset their standards from perfectionism to a more functional or practical lifestyle. This therapy can be especially beneficial for those with obsessive fears that harm will come without doing rituals and might “wish” harm upon themselves if they cannot fix the thought.

Mindfulness Training

Mindfulness is all about learning to notice the present moment without judgment. For someone with symmetry OCD, this would include noticing the obsessive thoughts as well as the resulting anxiety, discomfort, and body sensations. Mindfulness can allow a person to practice curiosity, without judging themself or immediately performing a compulsive action to relieve their distress.

Medication

OCD Medication can help decrease stress by reducing obsessive thoughts’ intensity, frequency, and duration. They can also help reduce the urge to perform rituals.

Common medications prescribed for symmetry OCD include:

• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Fluvoxamine
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)
• Citalopram (Celexa)

How to Get Help for Symmetry OCD

If you suspect you have symmetry OCD (or any other subtype), ask your doctor for a referral to a licensed therapist who specializes in OCD. You can also use an online therapist directory and further online OCD resources, including how to find a therapist that meets your symmetry OCD needs.

The International Obsessive Compulsive Foundation is a clearinghouse for information about all forms of OCD, including symmetry. NOCD can also be a great starting point for people looking to get remote treatment.

Outlook: Does Symmetry OCD Ever Get Better?

Symmetry OCD, like all OCD subtypes, is often a long-term, chronic condition that is not likely to get better on its own, and OCD is not considered curable. However, with proper treatment and support it absolutely can get better. Many people with OCD are able to find relief from their symptoms through therapy and medication and can enjoy fulfilling and meaningful lives.