Signs and Symptoms of Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a chronic mental health condition that causes uncontrollable, intrusive, and continuous thoughts (obsessions) that lead to repetitive activities and behaviors (compulsions).

Symptoms of OCD usually appear slowly and intensify over time, but some people may experience a sudden onset of symptoms that seem to appear overnight. OCD symptoms tend to fluctuate with some periods of mild, manageable symptoms and other periods called "flares"—which occur when symptoms worsen. OCD flares often occur in response to stressful events or changes in routine. 

OCD symptoms manifest in two ways: obsessions and compulsions. Some people with OCD may only have symptoms of obsessions or symptoms of compulsions, but most people with the condition have both. Symptoms often cause significant anxiety and distress and can interfere with daily life, including work, school, and relationships.

Obsessive Symptoms

OCD obsessions are repetitive thoughts, mental images, or urges that cause anxiety, fear, or discomfort. Obsessions can be related to any topic or theme, and many people with OCD feel shame and try to ignore or suppress them with—usually with limited success.

Common OCD obsessions include:

• Contamination: Fear of coming into contact with items that may be contaminated with bodily fluids, germs, dirt, and household chemicals (e.g., cleaning solutions). 
• Harm: Intrusive thoughts or mental images of violence and aggression that lead to a fear of someone harming you or causing harm to others. 
• Perfectionism: Excessive concern for symmetry and perfection in your environment, fear of forgetting or losing important items and information, and extreme focus on doing things "perfectly" to avoid making mistakes. 
• Religious or moral: Extreme concern of right vs. wrong, morality, blasphemous religious thoughts, or fear of damnation or committing a sin.
• Sexual: Taboo thoughts or mental images of sexual desires and fear of acting on sex-related impulses or aggressive sexual behaviors.

If you have OCD, it may be common to experience more than one type of obsession. For example, you may have a fear of contamination and a fear of causing harm to others by accidentally getting them sick. 

Compulsive Symptoms 

OCD compulsions, or rituals, are repetitive behaviors or mental acts that a person with OCD feels compelled to perform in response to their obsessions. You might feel the need to perform these compulsions in an effort to reduce anxiety, fear, or discomfort caused by the obsessions. Still, they often provide only temporary relief and can become overwhelming rituals that are time-consuming and interfere with daily life. 

Common OCD compulsions include:

• Cleaning and washing: Excessive handwashing or personal grooming routines (e.g., showering) or cleaning objects, such as doorknobs and countertops, to get rid of germs. 
• Checking: Repeatedly checking doors, windows, or appliances to ensure they are locked or turned off.
• Repeating: Saying words, numbers, phrases, or prayers and performing certain rituals or behaviors (e.g., tapping, blinking, going in and out a door) a specific number of times.
• Ordering and arranging: Arranging objects in a specific order or pattern or performing certain actions in a particular sequence.
• Mental: Seeking reassurance from others, repeatedly reviewing events or conversations, canceling or undoing thoughts (e.g., replacing a negative thought with a positive thought to cancel the bad one out). 
  

Symptoms in Children

OCD can occur at any age, and research shows that approximately 80% of people with OCD first notice symptoms before the age of 18. OCD symptoms in children are similar to those in adults but may present differently, especially in small children who aren't able to fully articulate their thoughts and feelings. 

Examples of common symptoms in children include:

• Repeatedly checking, arranging, or cleaning things or performing acts in a specific way 
• Excessive worry about germs, harm, injury, illness, or dirt 
• Fear of harm happening to themselves or others
• Intrusive thoughts, impulses, or mental images the child finds distressing or uncomfortable 
• Following the rules to avoid something bad from happening
• Repeating words or counting 
• Avoiding situations, people, or objects that trigger fears  
• A strong need for symmetry and order, leading to repeated checking or arranging behaviors 

Symptoms in Men and Women

While symptoms of OCD are generally the same for men and women, research suggests that sex may play a role in the age of symptom onset, the types of obsessions a person has, and how symptoms affect the quality of life.

In people assigned male at birth, OCD is more common in childhood, and adult males report more symptoms related to blasphemous or sexual thoughts. In contrast, those assigned female at birth often experience symptoms during or after puberty or pregnancy and tend to have more symptoms related to contamination and cleaning than males.

When to See a Healthcare Provider 

Most people have occasional compulsions. For example, you might repeatedly check your bag to ensure your passport is there before a big trip or double-check to make sure you turned the stove off before leaving for work. With OCD, obsessions and compulsions interfere with daily life, even when people recognize their thoughts and behaviors are irrational. 

If you or someone you know is experiencing symptoms of OCD, talk to a healthcare provider who specializes in diagnosing and treating OCD, such as a psychiatrist, psychologist, or mental health professional.  It may be time to see a healthcare provider for OCD symptoms if you:

• Have repetitive thoughts or behaviors that are all-consuming and cause overwhelming anxiety and distress 
• Spend at least one hour a day on obsessive thoughts or compulsive behaviors 
• Are struggling with your work or academic performance or are having trouble with social relationships due to your symptoms
• Avoid certain situations, people, objects, or settings due to obsessive thoughts or fears 
• Feel a brief period of relief when performing compulsive behaviors (rituals) but derive no joy or feelings of pleasure from them 
• Use substances (e.g., alcohol, drugs) to manage symptoms and the associated anxiety and distress

A Quick Review 

Obsessive-compulsive disorder (OCD) is a chronic mental health condition in which people experience intrusive, unwanted, and repetitive thoughts (known as obsessions) that cause them to engage in activities or behaviors (known as compulsions). 

OCD symptoms are often based on fears of contamination, worries of harm to self or others, perfectionism, responsibilities, or sexual and religious topics. How severe your symptoms are will depend on your condition and your exact obsessions and compulsions.

Most people with OCD struggle with work, school, relationships, and other aspects of daily living. If you or a loved one have symptoms of OCD, talk to a healthcare provider about getting tested and starting treatment if necessary. An early diagnosis can improve symptoms and boost your quality of life.