Obsessive-compulsive disorder (OCD) is a mental health condition that involves:
- Obsessions. These symptoms involve unwanted thoughts or ideas that disrupt your life and make it hard for you to focus on other things.
- Compulsions. These symptoms involve things you feel you have to do in a specific way in response to the obsessions.
OCD can present in different ways. While there are no official classification or subtypes of OCD, researchTrusted Source suggests people experience OCD symptoms in four main categories:
- cleaning and contamination
- symmetry and ordering
- forbidden, harmful, or taboo thoughts and impulses
- hoarding, when the need to collect or keep certain items relates to obsessions or compulsions
These groups of symptoms are also described in the recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Mental health professionals might refer to them as symptom dimensions rather than OCD subtypes.
Not every person living with OCD experiences it the same way. Specific symptoms may be similar among some people. However, symptoms can also vary widely. You might have symptoms from more than one dimension.
Read on to learn more about the clinical dimensions of OCD, including symptoms, diagnosis, causes, and treatment.
What are the symptoms of OCD?
With OCD, you have thoughts or compulsions that upset you and cause distress. You might try to ignore them or push them out of your mind, but this is generally difficult or impossible.
Even if you do stop thinking about them for a while, they usually keep coming back.
If you live with OCD, you might have a range of different symptoms. Your symptoms might come mostly from one group or more than one group.
Cleaning and contamination
This type of symptom may involve:
- persistent worry about germs or sickness
- thoughts about feeling dirty or unclean (physically or mentally)
- persistent fears about exposure to blood, toxic substances, viruses, or other sources of contamination
- avoidance of possible sources of contamination
- compulsions to get rid of items you consider dirty (even if they aren’t dirty)
- compulsions to wash or clean contaminated items
- specific cleaning or washing rituals, such as washing your hands or scrubbing a surface a certain number of times
Symmetry and ordering
These symptoms may involve:
- a need for items or belongings to be aligned in a certain way
- an extreme need for symmetry or organization in items
- a need for symmetry in actions (if you scratch your left knee, you also must scratch your right knee)
- a compulsion to arrange your belongings or other items until they feel “just right”
- feeling incomplete when items aren’t exact
- counting rituals, such as needing to count to a specific number a certain number of times
- magical thinking, or believing something bad will happen if you don’t arrange or organize things in the right way
- organization rituals or specific ways of aligning objects
Symptoms may involve:
- frequent intrusive thoughts that are often sexual or violent in nature
- guilt, shame, and other distress about your thoughts
- persistent questioning of your sexual orientation, desires, or sexual interests
- persistent worry that you’ll act on your intrusive thoughts or that having them makes you a bad person
- frequent worry that you’ll harm yourself or someone else without meaning to
- obsessions about religious ideas that feel blasphemous or wrong
- persistent feelings of responsibility for causing bad things to happen
- compulsions to hide things you could use as a weapon
- seeking reassurance that you won’t act on intrusive thoughts
- seeking reassurance that you’re not a bad person
- mental rituals to dispel or cancel out your thoughts
- frequently reviewing your daily activities to make sure you haven’t hurt anyone, whether mentally or physically retracing your steps
People are currently describing a “type” of OCD they call “pure O,” which is described as involving obsessions and intrusive thoughts of a sexual or religious nature with no outwardly visible compulsions.
While this has recently become a popular term, it’s not a clinical or diagnostic term. It could be said to be similar to other symptoms involving forbidden thoughts.
Symptoms of this category often involve:
- persistent worry that throwing something away could bring harm to you or someone else
- a need to collect a certain number of items to protect yourself or someone else from harm
- extreme fear of throwing away an important or essential item by accident (such as mail with sensitive or needed information)
- a compulsion to buy multiples of the same item, even when you don’t need that many
- difficulty throwing away things because touching them could cause contamination
- feeling incomplete if you can’t find a possession or accidentally lost or threw it away
- a compulsion to check or review your possessions
Hoarding in the context of OCD differs from hoarding disorder, a separate mental health condition. The main difference between the two is the distress involved with hoarding-related OCD.
If you have OCD, you don’t want all of the things you collect, but you might feel compelled to save them because of obsessive or compulsive thoughts.
Another subtype of OCD involves behavioral tics, such as:
These tics may help relieve the unwanted obsessions and feelings of distress or incompleteness that can occur with OCD. Adults and children both can have tic-related OCD. It’s often more common when OCD begins in childhood.
Children don’t always experience OCD in the same way adults do. Compulsions can involve less obvious responses, such as avoiding contact or social interaction, but they’re typically still noticeable.
Obsessions may seem less apparent. For example, magical thinking, seeking reassurance, and checking behaviors might resemble ordinary developmental stages.
Children also often experience more of a range of symptoms than adults do.
How is OCD diagnosed?
If you or a loved one have OCD symptoms, talk to a mental healthcare provider. They can diagnose OCD and work with you to find the most effective type of treatment.
A mental healthcare provider will ask you about the types of symptoms you experience, whether they cause distress, and how much time they take up each day.
Diagnosis of OCD generally requires that symptoms affect your daily function and consume at least an hour of your day.
Your mental healthcare provider will likely note the group of symptoms you experience, since not all OCD treatments have the same benefits for all symptoms.
They’ll also explore if you have tics or other behavioral symptoms and discuss the level of insight or beliefs you have surrounding the obsessions and compulsions you experience.
In other words, they’ll want to know whether you feel OCD-related beliefs are likely to happen, might happen, or definitely won’t happen.
Your provider will also ask how long you’ve had symptoms. Results of a 2009 study suggest OCD symptoms that begin in childhood are often more severe.
What causes OCD?
Experts don’t entirely understand why some people develop OCD. They have some theories about possible causes, including:
You’re more likely to have OCD if a family member also has the condition. Tic-related OCD also seems more likely to run in families.
Experts believe it’s possible certain genes could play a part in development, but they haven’t yet discovered any specific genes that cause OCD. What’s more, not all people who have OCD also have a family member with the condition.
Brain chemistry may also play a role. Some research suggests impaired function in certain parts of the brain or problems with the transmission of certain brain chemicals, such as serotonin and norepinephrine, could contribute to OCD.
It’s also possible that trauma, abuse, or other stressful events can play a part in the development of OCD and other mental health conditions.
Another environmental factor linked to OCD is PANDAS, which stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.
This diagnosis occurs in children who get a strep infection and then suddenly develop OCD symptoms, or experience worsened OCD symptoms after a strep infection.
There’s little evidence to suggest certain factors are more likely to contribute to certain types of OCD. But one 2015 study looking at 124 young people with OCD does suggest tic-related OCD appears to often run in families.
How is OCD treated?
Mental health experts generally consider therapy and medication, or a combination of the two, to have the most benefit in the treatment of OCD.
Exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT), is generally the recommended approach. This type of treatment gradually exposes you to subjects of your obsessions or things that cause compulsions.
In the safe space of therapy, you can learn how to deal with the discomfort you experience without acting out compulsions. You’ll probably also spend some time practicing these skills at home or in other environments outside of therapy.
If you have severe OCD symptoms, or if your symptoms don’t seem to respond to therapy alone, your mental healthcare provider may recommend talking to a psychiatrist about medication.
You might take medication just for a short time while you learn how to cope with symptoms in therapy. Drugs that can have benefit for OCD symptoms include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or antipsychotics.
The most helpful treatment for OCD can sometimes depend on your symptoms. One 2008 review looked at existing studies on how OCD symptoms respond to different types of treatment. Researchers found evidence to suggest some symptom subtypes, such as cleaning and contamination symptoms, may not respond as well to SSRIs.
The same study also suggests ERP therapy may not as effective for obsessive thoughts. Different CBT approaches, such as mindfulness-based CBT, may have more benefit.
However, research results can vary. Two people won’t always respond to treatment in the same way, even if they have very similar symptoms.
Deep brain stimulation is a new type of treatment that may help improve symptoms of OCD in people who don’t see improvement with other treatments.
This treatment hasn’t yet been fully researched, however. It may pose some health risks. If you’re interested in deep brain stimulation, your primary care doctor or mental healthcare provider may be able to provide more information.
WHEN TO SEEK HELP FOR OCD SYMPTOMSMany people experience minor obsessive or compulsive symptoms from time to time. It’s also not uncommon to have intrusive thoughts or fixate on what they might mean. But it may be time to get help for OCD if:
- obsessions or compulsions take up more than an hour of your day
- intrusive thoughts or your efforts to suppress them cause distress
- OCD symptoms upset you, frustrate you, or cause other distress
- OCD symptoms get in the way of the things you need or want to do
- OCD symptoms negatively affect your life and relationships
Your primary care provider can refer you to a mental healthcare provider, like a therapist. You can also search for a therapist in your area online.
Websites like these offer therapist directories that help you locate more specialized care providers:
- Anxiety and Depression Association of America. They offer support and resources to individuals and families affected by OCD and offer a therapist directory to help you find help in your area.
- The International OCD Foundation. They can help you find support in your area and information about OCD.
- SAMHSA’s National Helpline. They offer information and help finding a mental healthcare provider in your area.
QUESTIONS TO ASK A POTENTIAL THERAPISTThese questions can help locate a therapist with expertise in treating individuals with OCD:
- Have you specifically treated people with OCD who are my age?
- Do you have experience treating people who have OCD and other mental health conditions, like depression or anxiety?
- Do you have specialized training in exposure and response prevention?
- Do you take my insurance? Do you file insurance claims?
Keep in mind the first therapist you try may not be the best fit for you. Remember that it’s always OK to try a different therapist if you don’t feel right about the one you’re currently seeing.
When beginning therapy, make sure to ask any questions you might have about the process or your therapist’s approach. Therapy may not work as well if you don’t feel comfortable with your therapist.
You also want to feel able to voice any concerns you might have during the therapy process.
What’s the outlook for people with OCD?
Without treatment, OCD symptoms may worsen over time and affect your personal relationships and quality of life.
According to the DSM-5, people with “poor insight” — those who have more belief in OCD obsessions and compulsions — may have worse treatment outcomes. Having poor insight about OCD may make treatment especially important.
With treatment, OCD symptoms often improve. Getting treatment can help improve day-to-day function and quality of life.
Treatment isn’t always easy at times. Therapy in particular can often bring up feelings of anxiety and distress. But stick with your treatment plan, even if you have a hard time with it at first.
If therapy really doesn’t seem to work or your medication causes unpleasant side effects, talk to your therapist. You may need to try a few different approaches before you find the one that leads to the most improvement.
Working with a compassionate therapist who understands your symptoms and needs is key to improvement.
The bottom line
OCD symptoms can present in many different ways. It’s also possible to have OCD combined with other mental health conditions and situations, such as schizophrenia, anxiety, a tic disorder, or postpartum OCD.
Whatever symptoms you have, treatment can help.
If you struggle with daily responsibilities and personal relationships because of OCD symptoms, talk to your primary care provider or a therapist. They can help you find the right treatment to help you learn to cope with OCD.