OCD: Common Signs and Symptoms You Need to Know

When you think of OCD, you might think of the popular ideas about OCD such as handwashing or counting the cracks on a sidewalk. While those behaviors can be indicative of OCD, it’s so much more. True OCD is much more than being a desire for things to be in their place or being attentive to cleanliness. OCD is a severe, often debilitating disorder that can impact a person’s ability to function day-to-day and impact their relationships and overall well-being. 

Living with OCD can be overwhelming and disruptive, affecting how people think, feel, and act. Here’s a look at what OCD is and some common signs and symptoms to look out for.

What Is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects an estimated 1% to 3% of the population worldwide. It is characterized by intrusive thoughts, images, or urges, known as obsessions, which cause significant anxiety or distress. To alleviate this distress, individuals engage in repetitive behaviors or mental acts, known as compulsions. These symptoms can be severe, consuming a significant portion of a person’s time and attention, and causing marked emotional distress and impaired functioning. 

The salient feature of OCD is the presence of obsessions and/or compulsions.

• Obsessions are intrusive, unwanted thoughts, images, or urges that repeatedly enter a person’s mind. These are not simply worries or concerns; they are intrusive and often irrational. These obsessions are what’s known as ego-dystonic, meaning that they go against the person’s beliefs or values. In other words, the person with OCD doesn’t want to have these thoughts. They are distressing and anxiety-provoking. 
• Common obsessions include fears of contamination, harming others, or doubts about having performed a task correctly (e.g., turning off the stove before leaving home).
• Compulsions (sometimes referred to as rituals) are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. These actions are intended to reduce the distress created by the obsession. However, they are often excessive or not connected in a realistic way to the feared obsession. While compulsions may provide temporary relief, they do not address the root cause of the obsession, and the relief is short-lived. Compulsions can be physical actions, such as washing hands excessively, checking locks repeatedly, arranging items in a particular order, seeking reassurance from others, or avoiding certain objects and situations. They can also be mental acts, sometimes referred to as mental rituals, like counting, silently, praying, or repeating certain words or phrases.

OCD can be a chronic condition, with symptoms waxing and waning over time. It can also vary in severity, from mild to severe, where the compulsions can take up hours of a person’s day, severely impacting their quality of life.

OCD can vary in severity and present differently from one person to another. Some may experience more prominent obsessions, while others engage primarily in compulsive behaviors. Regardless, the symptoms interfere with work, relationships, and day-to-day activities.

Common Signs and Symptoms of OCD

OCD can manifest in many ways and not everyone will experience it in exactly the same way. Here are some of the most common signs and symptoms to look for: examples:

Fear of Contamination or Germs

Contamination OCD is rooted in the obsessional fear that a person or their loved one may become contaminated and harmed in some way. 

Obsessions: Persistent fear of coming into contact with germs, dirt, or contaminants.

Compulsions: Excessive washing, cleaning, or disinfecting.

Example: Someone with this type of OCD might wash their hands repeatedly or for prolonged periods of time to avoid germs that might make them or their loved ones “sick”. They may avoid touching objects in public spaces or feel the need to shower multiple times a day. 

These contamination fears can be associated with almost any site or setting. A few examples include: 

• Public toilets
• Chemicals
• Shaking hands
• Door Handles
• Public Telephones
• Eating in restaurants

Checking

Checking OCD is characterized by repetitive checking, seeking reassurance, or excessive doubt, most often in an effort to avoid some type of danger or embarrassment. 

Obsessions: Persistent feelings of doubt about tasks or actions, like whether the door was locked, or the stove was turned off.

Compulsions: Checking repeatedly, asking others for reassurance, or rereading/rewriting tasks.

Example: A person with this symptom may check that the front door is locked five or six times before leaving the house. Even after confirming it’s locked, they may feel compelled to go back again to make sure, feeling anxious if they don’t.

A few of the many checking obsessive worries and compulsions include:

• Repeatedly seeking reassurance 
• Excessively going over past memories, conversations, etc. for fear they offended someone or acted in an inappropriate way
• Repeatedly checking door locks, windows, appliances, etc.
• Rereading emails, letters, or text messages 
• Checking cameras repeatedly 

Need for Symmetry and Order

More than just liking things “tidy”, symmetry/ordering type OCD is characterized by the need to have everything even or arranged symmetrically  or “just right” in order to prevent distress or even to prevent harm from coming to themselves or others. In some cases, they may avoid having people in their home for fear of disrupting the symmetry or order of their things. 

Obsessions: A strong desire for things to be symmetrical, organized in a particular way, or aligned precisely. There may be a fear that any deviation could bring unwanted consequences or harm. 

Compulsions: Repeatedly arranging objects until they feel "just right," repeatedly counting items, or organizing items in a very specific way. 

Example: A person with this type of OCD might spend hours arranging pantry shelves so that cans and boxes are perfectly aligned or arranged in specific order. Anything out of place can result in extreme discomfort or distress, starting the process over again. The organizing can take hours, making it difficult to leave the house until everything is “just so”. 

Some of the common items that may be the focus of organizing include:

• Pantry items or cans
• Pictures
• Clothes
• Books and DVDs 

Fear of Harm or Losing Control

This type of OCD is characterized by intense, sometimes disturbing fears of accidentally harming someone or losing control and injuring themselves or someone else. There is no intention to harm anyone. 

Obsessions: Fear of unintentionally harming someone or losing control and doing something terrible, like acting violently or saying inappropriate things.

Compulsions: Depending on the nature of the thoughts, the person may avoid certain situations, constantly seek reassurance, or repeatedly check to be sure no one was accidentally harmed. 

Example: A person may have intrusive, irrational fears of accidentally hitting someone while driving. They may repeatedly retrace their route to make sure no one was injured. They may also repeatedly seek reassurance from others that they didn’t harm anyone. 

Intrusive Sexual or Violent Thoughts

Similar to the fear of losing control, this type of OCD involves intrusive and disturbing, often sexual or violent thoughts of harming someone, often someone the person cares deeply for. To be clear, there is NO intent to harm, but the thoughts are nonetheless distressing. 

Obsessions: Unwanted and distressing thoughts about inappropriate, sexual, or violent acts.

Compulsions: The person may engage in mental rituals to stop or block thoughts, avoid certain people or situations, or constantly seek reassurance. 

Example: A person might have sudden, intrusive thoughts about hurting someone they love, which causes significant distress. They may respond by avoiding sharp objects, isolating themselves, or seeking reassurance that they aren’t a harmful person.

Mental Compulsions

Like overt compulsive behaviors, mental compulsions are actions one may take to reduce or alleviate the distress from obsessive, intrusive thoughts, especially those that may make a person feel guilty or ashamed. What makes them different is that they take place mentally, in the person’s mind, and are not immediately noticeable. 

Obsessions: Intrusive thoughts that make the person feel guilty or ashamed, prompting mental rituals to alleviate them.

Compulsions: Silent counting, praying, or mentally repeating phrases or mantras.

Example: A person has distressing thoughts that they might have offended God in some way. To alleviate those fears and avoid being punished by God, they silently repeat certain prayers or phrases, sometimes for extended periods of time or certain times.  This can disrupt conversations, focus on work, or the ability to complete tasks efficiently.

OCDs Impact On Daily Life

For someone with OCD, these symptoms are much more than quirks. They can be overwhelming and time-consuming. Compulsions may provide brief relief, but the obsessive thoughts quickly return, creating a cycle that’s difficult to break. This cycle can lead to:

• Social isolation due to avoidance behaviors or embarrassment.
• Struggles at work or school, as rituals or intrusive thoughts interrupt focus, may contribute to absenteeism, and can impede the ability to get tasks completed.
• Strained relationships with family and friends who may not understand OCD, leading to misunderstandings or frustration.
• Decreased quality of life due to the difficulty managing symptoms. 

When to Seek Help

OCD is challenging to manage alone. Just when to seek help is an individual choice. However, if you or someone you love is experiencing symptoms that are impacting their daily life, a mental health professional can help.

Exposure and Response Prevention (ERP), a specialized type of Cognitive-behavioral therapy (CBT), has been shown to be effective in treating OCD. In some cases, medication can also help reduce symptoms.

Understanding OCD and recognizing the signs is the first step toward managing it effectively. With the right treatment and support, people with OCD can lead fulfilling lives, free from the control of their obsessions and compulsions.

References

1. International OCD Foundation. (n.d.). OCD Myth-Handout. iocdf.org. https://iocdf.org/wp-content/uploads/2014/10/OCDMyth-Handout-092313.pdf

2. Obsessive-compulsive disorder - StatPearls - NCBI bookshelf. (2023, May 29). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK553162/

3. https://dictionary.apa.org/obsession

4. https://dictionary.apa.org/compulsion

5. Types of OCD. (n.d.). OCD-UK | A national OCD charity, run by, and for people with lived experience of OCD. https://www.ocduk.org/ocd/types/

6. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Current neuropharmacology, 17(8), 710–736.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059159/