OCD symptoms fall into two categories: obsessions, or intrusive thoughts, and compulsions, or what you do to soothe stress caused by an obsession.
You’re just sitting there minding your own business when a disturbing thought suddenly pops in your mind.
That’s a strange thought. You try to ignore it, as it has no logical basis. But you feel a surge of anxiety. You try to argue with the thought, but the anxiety seems to dig in its heels, making the thought feel even more alarming.
The next day, the strange feeling is still there. Maybe you do something to try to banish or calm the thought, like repeating a phrase over in your head or tapping your foot in a certain way.
Your mind suddenly feels like the enemy. The more you try to fight this thought, the stronger it seems to get.
What’s going on?
Obsessive-compulsive disorder (OCD) often starts this way. If you’re experiencing symptoms like this, you’re not alone.
OCD is a chronic condition with two groups of symptoms. These are unwanted thoughts, or obsessions, and compulsions.
Symptoms of obsessions
Obsessions are intrusive repetitive thoughts, images, or urges that cause intense stress. The one thing obsessions have in common is that they’re unwanted and often distressing.
According the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), you’re experiencing obsessive symptoms when:
- you experience stressful thoughts or urges that keep coming back
- you have methods for trying to make these thoughts go away or calm the stress related to them
Obsessive thoughts can include many focuses. Some common themes in obsessions related to OCD include anxiety about:
- doing harm to others or yourself
- losing control
- sickness or disease
- perfection or symmetry
OCD obsessions can vary. If you’re experiencing obsessions but don’t see yours listed, it certainly doesn’t mean you don’t have OCD.
Symptoms of compulsions
The more you fight an obsession, the stronger it might seem to get — and that’s enough to make most people anxious. So where do compulsions come in? If you experience obsessions, you might engage in a compulsion to reduce anxiety caused by the obsession.
But what is a compulsion? In short, compulsions are repetitive thoughts or actions you feel a need to act out when you experience an obsessive thought. You might use compulsions to reduce anxiety about an obsessive thought.
Similar to obsessions, compulsions can come in many forms. Some people might have compulsions to do physical actions. Others may act out compulsions with their thoughts.
Here are some examples of compulsions:
- excessive praying to prevent harm or ask for forgiveness
- doing things exactly right to prevent harm (for example, not missing a spot while cleaning the table to prevent contamination or sickness)
- “canceling” or “undoing” (replacing a negative word with a positive word to cancel out the bad vibes)
- counting or performing other rituals to prevent harm
- washing, cleaning, showering, and grooming to avoid contamination
- constantly checking whether you locked the door or turned off the oven
- arranging objects until it feels “right”
- repeating activities until it feels “right”
- driving back to where you came from to make sure you didn’t hit a pedestrian
- not using, touching, or wearing certain clothes or objects to prevent harm
Insight and OCD
Very often, people with OCD recognize that their obsessions and compulsions aren’t making any logical sense, but they often feel compelled to do them anyway.
When it comes to OCD, insight is defined as the ability to perceive and separate reality from obsessive thoughts.
This can be difficult for many people, as the thoughts and feelings of OCD feel much stronger than their typical thoughts. These obsessions tend to bulldoze over any logical, opposing thoughts.
But having insight about how the condition works rather than getting swept up in what it’s telling you can make treatment easier.
According to the DSM-5, OCD insight is
- Good or fair insight. You know that many of the beliefs that come with your OCD symptoms either aren’t true or probably aren’t true.
- Poor insight. You think many of your OCD-related beliefs are probably true.
- Absent insight. You believe the thoughts you have related to OCD represent reality.
The diagnostic criteria for OCD in children are similar to that of adults. The DSM-5 notes that children are less likely to have insight into their obsessions, most likely due to less-developed cognitive skills.
Childhood-onset OCD is also more genetic in nature than adult-onset OCD.
Studies involving twins show that genetic factors explain
Children with OCD are also more likely to have other related conditions, such as:
Obsessions and compulsions in children are widely similar to those of adults — both vary greatly. Children may be more likely to have obsessive thoughts about the safety of their immediate family members, such as their parents.
Left untreated, a child’s OCD symptoms may come and go but typically remain into adulthood.
PANDAS and PANS
PANDAS occurs when strep bacteria cause a severe immune reaction in a child, leading to OCD-like symptoms.
The cause of PANS is unknown, but it’s thought to be triggered by:
- metabolic disturbances
- other inflammatory reactions
The obsessions and compulsions of children and teens with PANDAS or PANS may look the same as childhood-onset OCD, but there are some differences between the two.
Childhood-onset OCD often begins when the child is 8 to 12 years old, and symptoms tend to increase over time. In PANDAS and PANS, children can be anywhere from 4 to 14 years old and experience a sudden onset of symptoms.
Kids with PANDAS or PANS will also have symptoms not usually seen in people with OCD, such as:
- urinary frequency
- handwriting difficulties
- separation anxiety
OCD often co-occurs with other conditions. It can have overlapping symptoms or similar-looking symptoms with some of these conditions, making it harder to tell them apart.
According to the DSM-5, conditions that can appear alongside OCD include:
- Body dysmorphic disorder (BDD). A person with BDD might become fixated on a perceived flaw in their appearance.
- Trichotillomania (hair pulling). This condition involves recurrent, strong urges to pull out hair on the head or other parts of the body.
- Hoarding disorder. A person with hoarding disorder might feel stress or anxiety about parting with possessions, even seemingly meaningless objects like used napkins.
- Excoriation (skin picking) disorder. This condition involves repeated picking at the skin despite causing irritation.
Other conditions that often co-occur with OCD but are not considered obsessive-compulsive disorders in the DSM-5 include:
Do you relate to any of the OCD symptoms?
Do you find yourself constantly thinking about something that may even feel irrational, but you just can’t stop? Are you experiencing significant distress over the unwanted thoughts?
OCD can also involve things that many people worry about, but these thoughts are taken to the next level with OCD. For example, cancer isn’t an unusual worry for many people. But it typically doesn’t consume their day and repeat itself, making it hard to think about anything else.
In addition, many worries about cancer don’t lead to compulsive behaviors. For example, feeling as if you need to cancel out the word “cancer” with a safe word.
If you think you might have OCD, and your symptoms cause a lot of stress and interfere with your life, a mental health professional can help.
You can also take this short Psych Central quiz to see whether your symptoms could be related to OCD. While it’s not a substitute for a professional diagnosis, it could be a good conversation starter with your doctor if you’re not sure how to discuss your symptoms with them.
For some more information about getting a diagnosis, you can check out How Do I Know If I Have Obsessive-Compulsive Disorder? to learn more.
If you have OCD — or think you may have OCD — you’re not alone. OCD is a treatable condition, and many people with it find a treatment approach that relieves their symptoms.
You can also find many online support groups for OCD as well as podcasts like “The OCD Stories.” And if you’d like to learn more about what treatment options are available for OCD, you can get more info here.