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 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

Along with symmetry, other common subtypes of OCD that someone might experience at the same time include:

• Contamination OCD
• Harm OCD
• Somatic OCD
• Contamination OCD
• Scrupulosity OCD (Religious OCD)
• Superstitious OCD
• Existential OCD
• Just-right OCD
• Relationship OCD
• Homosexual OCD (HOCD)
• Moral Perfectionism in OCD
• Postpartum OCD

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 that occur 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, same amount of steps on each foot, etc.)

Symmetry OCD Compulsions

Common symmetry 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 in 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)

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 being 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.

The effects of symmetry and order are not limited to the person with OCD. People around them are often stuck waiting for them to leave for an event together or left waiting for them to show up. Or, suppose someone inadvertently messes up the order or arrangement. In that case, the person with OCD can react angrily, feel frustrated, experience a loss of control, and be left with self-loathing thoughts and emotions.

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

• They can have increased risks of injury, such as when compulsions take effect while using dangerous items like a curling iron, saw, knives, or even driving.
• They may 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.

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.

Therapy

Treating OCD typically involves a behavioral technique called exposure and response prevention (ERP) therapy. An example of an ERP 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 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.

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)
• Celexa (Sertraline)

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.

Final Thoughts

Symmetry OCD becomes problematic when normal functioning is impacted by needing the environment to be in perfect order, needing control over others’ behavior so that they don’t ruin items in a perfectly ordered manner, or cannot focus on more functional tasks. In that case, it’s likely an excellent time to seek help for the obsessive and urgent need for symmetry, order, and arrangement. Symmetry OCD is very treatable with the right therapist and treatment plan.