What Are the Signs and Symptoms of OCD?

Obsessive-compulsive disorder, or OCD, is a mental illness that can range from mild to debilitating. It causes a person to experience obsessive thoughts and to be compelled to engage in repetitive behaviors. OCD can cause a great deal of anxiety and distress, and can impact many areas of a person’s life, from the ability to work or go to school, to relationships with other people.

Understanding the signs of OCD is important, because recognizing that there is an issue is the first step in getting much-needed help. Like other mental illnesses, OCD will not get better on its own. It requires professional treatment and ongoing care to manage symptoms and to be able to function better. The prognosis is good for someone who has OCD but seeks out and is committed to treatment.

OCD is a mental illness that is characterized by obsessive thoughts and compulsive behaviors. The obsessive thoughts are persistent, unwanted, and cause significant distress. They could be about anything, but they are always negative. Examples of obsessive thoughts someone with OCD might struggle with include bad things happening to loved ones or being contaminated by germs.

OCD also causes compulsive behaviors, repetitive actions that a person uses to reduce the anxiety caused by the obsessive thoughts or to prevent the bad things from happening. The behaviors may or may not be related to the thoughts. For instance, someone who obsesses over germs might wash their hands over and over again. On the other hand, someone who is afraid something bad will happen to loved ones might self-soothe by compulsively turning the lights on and off a specific number of times.

Obsessive-compulsive disorder is not uncommon, with about two percent of the population meeting the criteria for OCD at some point in their lives. Even more common is experiencing some degree of symptoms without meeting the criteria for a clinical diagnosis. Millions of people struggle to some extent with unwanted thoughts and use repetitive behaviors as a way to mitigate anxiety.

To be diagnosed with OCD, the obsessive thoughts and compulsive behaviors must take up a lot of time in a person’s life, cause significant distress, or impair the ability to function socially, at work, or in other areas of life. Experiencing unwanted thoughts and engaging in compulsive behaviors to a lesser extent may cause some problems, but are not enough to warrant a diagnosis of OCD.

The symptoms of OCD are the presence of obsessions, compulsions, or both. Obsessions are thoughts that just won’t go away, no matter what the person does to try to stop them. They are always negative, but the specifics vary by individual. Compulsions are OCD behaviors that may or may not be directly related to the thoughts, but which are repetitive and designed to soothe, reduce stress, or prevent something bad from happening. The content of the obsessions and compulsions can be anything, but there are a few types of OCD that are more common:

• Self-harm or harm to others. This type of OCD is characterized by thoughts related to harm—that harm will come to oneself or to loved ones. Alternatively, the thoughts may be fears that the person will cause harm to someone else. Compulsions are designed to reduce the stress from these thoughts and may be related, such as compulsively checking that the stove is turned off to avoid burning down the house. The behaviors may also be unrelated to the actual thoughts.
• Morality and religion. For some people the obsessive thoughts are related to morality or religious shame, like sexually explicit thoughts. The compulsions that follow the thoughts are typically non-visible and may include silently counting words or reciting prayers or mantras.
• Cleanliness. A fairly common type of obsession with OCD is a fear of being contaminated by germs. Compulsions are typically related and may include excessive hand washing or using tissues and paper towels to avoid direct contact with door handles.
• Order. An obsession with having everything ‘just so’ is a common form of OCD. A person with this kind of obsession needs to have objects arranged at right angles or in certain designated places. Having things out of order causes great distress, and the compulsions that follow usually involve arranging things or looking for patterns or being superstitious about numbers.

Most people experience obsessive thoughts and engage in ritualized, repetitive behaviors to some degree or at some point in their lives, especially during times of stress. It is a common experience that many people understand, but to actually meet the criteria for OCD is different. OCD is much more time-consuming, it causes a lot of distress, and it prevents a person from being able to function normally. Here are some signs of OCD and what it feels like to live with this condition:

• You have bad thoughts that you just can’t shake, no matter what you do.
• Those thoughts generally follow a particular theme; they aren’t random and changing.
• The bad thoughts you have cause you a lot of pain and anxiety.
• You constantly feel as if something bad is going to happen—something specific, like getting in a car accident.
• The bad thoughts get in the way of being able to focus on other things or get things done.
• To try to soothe the anxiety these thoughts cause, you engage in a ritual-like behavior.
• You repeat the behavior over and over again, and may get some relief but from the thoughts and anxiety, but it never lasts.
• You engage in behaviors to try to make the thoughts stop or to prevent them from becoming a reality.
• The behaviors you do, like counting words on printed pages, take up a lot of time and prevent You may want to stop these behaviors, but you can’t; you feel compelled to keep doing them.

The obsessive thoughts and compulsive behaviors caused by OCD can be literally anything. Experiencing any negative thoughts that persist, or engaging in any kind of behavior that is repetitive and that is motivated by a need to combat those obsessive thoughts, are characteristic of OCD. Some examples of obsessive thoughts caused by OCD include:

• Fear of causing someone else harm
• Violent or sexually explicit images
• Fear of doing something impulsive or dangerous
• Ordering of objects
• Fear of violating religious rules or morals
• Fear of disease and contamination
• Irrational superstitions
• Worries about natural disasters
• Fear of shouting out obscenities

Examples of compulsive OCD behaviors include:

• Washing hands excessively
• Cleaning excessively
• Checking lights and door locks multiple times
• Excessively checking that a loved one is safe
• Looking for patterns in words or numbers
• Repeating phrases or prayers
• Counting and needing to end on a “good” number or word
• Repeating a specific body movement multiple times

There is some overlap between OCD symptoms and signs of other, related conditions. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which mental health professionals use to diagnose and categorize mental illnesses, OCD is part of a category of similar conditions with similar symptoms:

• Hoarding disorder. Hoarding used to be considered a type of OCD but is now a separate condition. It causes a person to obsess over tangible things and to fear what might happen if they get rid of them. The collecting of items is similar to the compulsive OCD behaviors.
• Body dysmorphic disorder. This condition causes a person to obsess over their image and to see it in a distorted way. It also causes the person to engage in repetitive behaviors related to appearance, like excessively checking mirrors, over-grooming, or looking for constant reassurance about appearance.
• Trichotillomania. Obsessive hair-pulling was once considered a type of OCD, but it is now this separate condition. It most often affects women.
• Excoriation. Also once categorized as OCD, excoriation is compulsive skin picking. It may be triggered by a skin condition, but this is not always the case.

The signs and symptoms of OCD can cause significant distress and can even be debilitating, preventing someone from being able to function normally. The obsessive thoughts are impossible to get rid of and the compulsions take up a significant amount of time, taking away from other activities and responsibilities in a person’s life. The good news for anyone struggling with these symptoms is that OCD is treatable and manageable. With a diagnosis and a treatment plan, a person can learn to live with this condition, to minimize the thoughts, and reduce or eliminate compulsive behaviors.

OCD Treatment at Bridges