Signs of OCD
Although it is difficult to determine exactly what causes OCD, a key sign of OCD is an obsessive thought about unrealistic and fearful things happening. It’s a continuous pattern that can (but doesn’t always) result in compulsive behavior in an attempt to thwart those unwanted, intrusive thoughts.
For example, someone with contamination OCD may experience debilitating fear about contracting a disease or infection. They may act on that fear by going to any (often unreasonable) lengths necessary to avoid contact with situations, objects, or people they believe could contaminate them or their environment.
They might have such severe OCD that they repetitively shower, change clothes multiple times a day (or hour), or incessantly clean their house. They could even end up washing their hands 70, 80, 90, or more times every day, attempting to clean themselves until they feel no more threat of contamination.
Regardless of how many times a compulsive behavior is repeated, the obsessive thought always returns. OCD is an exhausting condition to live with on a daily basis.
OCD typically starts in early life, often appearing in childhood, teenage years, or young adulthood. The average age OCD in children usually appears is around 19 years, yet many people live with the condition for a significant portion of their life before ever receiving the correct OCD diagnosis.
Some people with OCD recognize and understand that their intrusive thoughts and compulsive behaviors are not warranted or helpful. Yet how they think and act is beyond their control. It’s not just a matter of willpower. Most people who live with OCD truly feel that they absolutely must engage in their ritualistic behaviors and that not acting will definitely lead to terrible consequences.
According to researchers at the University of California, while there are many subsets of obsessive-compulsive disorder, it can manifest differently in each person. However, initial signs commonly include:
- Fear of infection, disease, or dying
- Worrying about performing adequately
- Experiencing unwanted thoughts about self-harm or harming others
Repetitive thoughts, mental images, and urges concerning obsessions can cause people with OCD to engage in irrational behaviors, like:
- Meticulously and repetitively cleaning themselves, their clothing, and their environment
- Repeatedly asking for reassurance about performance
- Avoiding others to not harm them
In many cases, the symptoms of OCD will onset slowly. However, in rare cases, the condition can progress very rapidly. In almost all cases, without proper intervention and OCD treatment, symptoms will progressively worsen.
It’s important to note that many people in the world exhibit behavioral idiosyncrasies. We all know someone (perhaps it’s yourself) who’s serious about attention to detail or who likes their house to be exceptionally clean. Those are “normal” (and acceptable) behaviors for a lot of people. However, someone with OCD will have an obsession with persistent thoughts or engage in repetitive behavior for more than one hour daily.
Symptoms of OCD
What are the symptoms of OCD? It’s first necessary to differentiate between a couple of random compulsive acts and obsessive-compulsive disorder. Clinical diagnosis of OCD requires that someone experiences:
- Compulsive behaviors that interfere with an ability to function for at least one hour every day
- Major life distress because of their compulsive behaviors
- Impaired performance at work, school, or in social settings
Now, let’s look at some of the specific symptoms of OCD to be aware of if you think you or a loved one might have this challenging mental health condition.
Obsessions
According to the National Institute of Mental Health (NIMH), thorough OCD symptom checklists include the following symptoms of obsessive-compulsive disorder, some or all of which might be experienced:
- Repetitive doubts about locking a door, turning the stove off, turning lights off, etc.
- Experiencing intense stress if certain objects aren’t aligned in a precise manner
- Fearing contamination from microbes, insects, animals, people, bodily fluids, or objects
- Strong mental images, urges, or worries about harming others or oneself
- Repetitive, inappropriate sexual thoughts or urges
People with OCD may also avidly avoid places, situations, or people they know or worry might trigger obsessive thoughts or feelings.
Compulsions
Compulsive behaviors are another aspect of OCD symptoms. These are mental or physical behaviors that might be done in an attempt to reduce nervousness or fear that’s related to obsessive thoughts or feelings. OCD can cause people to engage in compulsive behaviors in an effort to prevent dreadful things from happening.
Even in cases when people with OCD understand that their obsessions and compulsions are illogical, they still might be unable to stop themselves from experiencing either.
Common compulsions on an OCD symptoms checklist include:
- Arranging items like canned goods and knickknacks to face the same direction
- Checking, rechecking (and checking again) light switches, stove knobs, door locks, etc.
- Repetitively asking for reassurance about performance
- Excessive washing of hands, body, clothing, dishes, etc.
- Silently repeating a word, phrase, prayer, or mantra
- Adhering to an excessively strict schedule
- Counting and recounting
Compulsive behaviors can also include grunting, swallowing, blinking eyes, and tapping distinct parts of the body.
Wondering if you may have obsessive-compulsive disorder? Take our free OCD test to learn more.
Managing Symptoms of OCD
We know that OCD typically onsets during teenage or young adult years. However, it can also start in childhood. The symptoms of OCD tend to start slowly and progressively intensify throughout life. A specific obsession or compulsion may also change over time.
OCD treatments can include psychotherapy (talk therapy), medication, and holistic self care routines. The most effective forms of in-person and online OCD treatment generally come from a combination of approaches.
Cognitive behavioral therapy (CBT), specifically a subdiscipline called exposure and response prevention (ERP) therapy, is a science-based therapy for OCD.
“OCD includes obsessions and compulsions. In some cases, one is present and in some cases both are present. Some of the most common obsessions are fear of germs and a need for things to be in order. Common compulsions include checking behaviors and washing or cleaning. Cognitive behavioral therapy is one of the most effective ways to treat OCD symptoms.”
— Bisma Anwar, Licensed Mental Health Counselor (LMHC), MA, MSc
What Causes OCD?
The precise cause of any of the types of OCD is not fully known. However, what we do know is that it seems to be related to one or a combination of the following:
- Comorbid mental health conditions like an anxiety disorder or depression
- Imbalanced brain chemistry
- A change in brain function
- Environmental factors
- Family history of obsessive-compulsive disorder
- A specific type of streptococcal infection
- Alcohol or drug abuse
- Unmanaged stress — note that while stress doesn’t actually cause OCD, it seems that trauma may trigger symptoms in those predisposed to it
OCD is a disorder that tends to onset slowly, but it’s not uncommon to be able to trace when the related obsessions and compulsions begin.
Very early research found that OCD can be related to either life changes or an extremely stressful life event. This can be especially true when an event results in incredible responsibilities, for example, the birth of a baby, a new big promotion or job, or a divorce. For some people, even the onset of puberty can trigger OCD. The key findings of this research recognize that compulsive rituals help serve a specific purpose for people with OCD — an attempt to reduce their discomfort.
“The general public commonly misunderstands OCD, so if you’re struggling with clinical OCD, it can feel difficult to find answers to your questions amidst people who flippantly use the term. Be encouraged and keep reading for a deeper understanding of what may be going on and how you can find some relief.”
— Ashley Ertel, Licensed Clinical Social Worker (LCSW), BCD, C-DBT
Four Possible Causes of OCD
Everyone is affected uniquely by their upbringing, subjective experiences, life events, genetic makeup, self-image, self-esteem, learned behaviors, and unlimited other variables. It’s also worth noting that different subsets (types) of OCD can present with different symptoms and behaviors.
Understand that there may not be one single culprit to blame for causing OCD. Thus, it can help to look at some of the distinct factors we know about that might play a role in whether or not someone develops the condition.
Genetics
Possible OCD causes can, at least in part, include genetic makeup. Research has shown us that obsessive-compulsive disorder clusters in families, making it very likely that there’s a genetic component.
However, genes appear to be only partially responsible for causing OCD. Certain genes may be activated by excessive stress in life, illness, or other conditions, resulting in OCD symptoms. Significant efforts have been made to discover the genetic basis of OCD. However, much remains unknown about how both genetic and environmental risk factors can interact when OCD is present. More research is needed.
Environmental
According to researchers at VU University Amsterdam, understanding what causes OCD means we should consider environmental factors. Things like experiencing major stress or a traumatic experience like the death of a loved one might contribute to the onset of symptoms.
That said, we still need to do much more research if we’re to link solid, specific scientific evidence between environmental factors and the onset of OCD.
Psychological
We believe obsessive-compulsive disorder involves psychological factors caused by a direct lack of communication between the frontal brain and deeper brain structures.
This inefficient communication may be due to an imbalance in levels of neurotransmitters, including serotonin, dopamine, glutamate, and others. It could also be caused by faulty brain circuitry, brain damage, or other chemical imbalances.
According to research, studies examining brain images consistently show a difference in blood flow patterns in those diagnosed with OCD. Compared with control subjects, it appears likely that cortico-striatal-thalamic-cortical (CSTC) circuitry abnormalities are at least somewhat at play.
Depression
According to researchers at Maastricht University, a third of OCD patients in their study were depressed. Further research confirms that depression occurring in those with OCD is common. That said, whether depression actually causes OCD, or is a result of it, remains to be determined.
“While knowing what has caused your diagnosis of OCD may feel comforting, it’s also okay if you’re not able to pinpoint a single source. Many mental health diagnoses are caused by multiple factors, and the cause is often less important than participation in your treatment plan.”
— Ashley Ertel, Licensed Clinical Social Worker (LCSW), BCD, C-DBT
What Are the Different Types of OCD?
All forms of OCD are similar in that a trigger occurs, causing intrusive thoughts, which then cause distress and anxiety and ultimately lead to compulsive behavior. Both OCD obsessions and mental compulsions can have either physical or emotional symptoms.
Lesser known types of OCD that are not listed in this article include:
- Relationship OCD
- Responsibility OCD
- Retroactive Jealousy OCD
- Just Right OCD
- ‘Pure O’ OCD
- Existential OCD
- Pedophilia OCD
- Sexual Orientation OCD
The following four stand out as they’re some of the more commonly seen types of OCD:
- Cleaning/contamination OCD
- Order/symmetry or counting compulsions OCD
- Harm OCD
- Hoarding OCD
We will take a deep dive and discuss these types of obsessive-compulsive disorder.
Cleaning/contamination OCD
People who have a cleaning or contamination OCD tend to focus on fear or intense feelings of discomfort that results from contamination or uncleanliness. Washing excessively is normal and is done in an attempt to relieve the feelings of distress.
A good example of contamination OCD is touching a light switch and convincing yourself that it was dirty and that you’re now contaminated. You may fear that you’ll contaminate others which may lead to the repetitive behavior of frequently washing your hands to try and cleanse yourself.
Order/symmetry or counting compulsions OCD
Order and symmetry and counting compulsions OCD creates a very intense urge to arrange and rearrange things until they’re just right — or at least exactly how you think they should be. In some cases, this compulsive behavior could look like a need to constantly rearrange the socks in your drawer to be organized by color or by type.
Order and symmetry OCD might also make you count or say phrases or words over and over again until you feel something is done perfectly. Sometimes the need to order, count, or repeat can be an attempt to stave off danger or bad luck. You may feel like if you get something perfectly arranged, or if you say a certain phrase so many times, perhaps someone won’t die, or they won’t leave you.
Harm OCD
Harm OCD involves extreme feelings or worry that you’ll harm yourself or others. In order to relieve these unwanted thoughts, you might use what’s known as checking rituals.
An example of harm OCD is you may believe that you accidentally hit someone with your car. You can feel so strongly about this that you’ll be compelled to drive back to the place where you thought the accident occurred to prove to yourself nothing happened. You’ll likely do this repeatedly in an attempt to be absolutely sure.
Hoarding OCD
Hoarding OCD is now actually recognized as its own diagnosis in the DSM-5. When someone hoards, they collect items that typically don’t have much value. Magazines, notes, clothing, games, containers — a hoarder may keep so many of these items, their home becomes virtually unlivable as it’s so filled with clutter.
An obsessive thought surrounding not having something you might one day need is common with hoarding. This OCD subtype has a higher rate of co-existing depression and anxiety than others.
Note that hoarding OCD is a separate condition from compulsive hoarding and can occur on its own without a distinct OCD diagnosis.
“The three most common types of OCD include cleaning/contamination, order/symmetry, and harmful, intrusive thought patterns. Cleaning/contamination involves washing everything excessively to ward off contamination. Order/symmetry involves organizing items by color, shape, or category to the point where other areas of our life are impaired. Harmful, intrusive thought patterns can be described as being forced to think about things without having control over the topics.”
— Meaghan Rice, Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC)
In addition to these main subtypes, there are also obsessive-compulsive-related disorders that can occur.
- Hair-pulling disorder (trichotillomania) — Hair pulling disorder causes a strong urge to pull hair from the head, eyelashes, eyebrows, or anywhere else on your body. Habit reversal training or cognitive behavioral therapy (CBT) are often successful treatment options.
- Skin picking disorder (excoriation) — Excoriation disorder causes persistent picking of the skin. It can cause infections, lesions, and extreme distress.
- Body dysmorphic disorder — Body dysmorphic disorder involves a preoccupation with what you may perceive as a flaw in your own appearance. Most often, the imperfections you see either aren’t observable at all, or they’re only very slightly observed to others. Body dysmorphic disorder causes repetitive behavior to check your appearance or groom yourself. It also typically involves comparing yourself to others.
Understanding More About OCD
The bottom line is that, at least for now, nobody knows for sure exactly what causes OCD. However, we do have an abundance of research that allows us to learn more about obsessive-compulsive disorder, and when you know more, you’ll be able to manage OCD symptoms better. The most important thing to remember is that you can find help if you need it.
When it comes to how to deal with OCD, many people with OCD are surprised at how fast they experience benefits from OCD treatment. It can allow them to regain control over their obsessions, minimize compulsive behaviors, and develop increased confidence and enjoyment in life.
Online therapy with Talkspace has helped countless people gain control over their OCD. It’s a convenient way to access the therapy you need to manage obsessive-compulsive disorder and any other mental health condition you’re trying to cope with.
Find out how online therapy can offer affordable, easy-to-access therapy that you can do right in the comfort of your own home. You deserve to get the effective help you need. Talkspace is there to ensure you can find it.
