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Written by:Meaghan Rice, PsyD., LPC

Published On: July 25, 2022

Medically reviewed by: Elizabeth Keohan, LCSW-C, MSW

Reviewed On: July 25, 2022

Updated On: July 17, 2023


Symmetry and ordering OCD is a subtype of obsessive compulsive disorder that causes a person to focus excessively on how things look or are arranged, balanced, or positioned. For instance, someone with symmetry OCD might experience severe anxiety if every single can in the pantry isn’t facing in exactly the same direction. They can feel anxiety or extreme distress if things aren’t in a certain order. This fixation can interfere with daily functioning and cause an incredible strain on relationships.

Although it’s labeled as a subtype, symmetry OCD is actually a very common form of obsessive-compulsive disorder. It’s estimated that somewhere between 36% – 50% of all adults who have OCD experience symmetry obsessions.

Keep reading to learn about what symmetry OCD is, its symptoms and causes, and available OCD treatment options.

What is Symmetry OCD?

Symmetry OCD is a long-term, treatable form of obsessive-compulsive disorder that causes people to fixate on the arrangement or position of specific objects. If someone with symmetry OCD encounters an item that isn’t properly aligned, that’s incomplete, or that appears imperfect in any way, they feel intense anxiety. Symmetry OCD can even cause difficulty writing — someone may struggle to try and make lists look perfect, writing and rewriting over and over in an attempt to get it “just right.”

Of course, many people find symmetry and order appealing — we all have those friends or family members (or maybe it’s us!) in our lives who we consider “neat freaks.” Symmetry OCD goes far beyond just liking things organized, though. This preoccupation with order and neatness often results in a fixation on repositioning items or re-performing tasks in an attempt to reach (largely unachievable) results. This obsession can ultimately result in extreme anxiety over disorder that affects a person’s day to day life.

Symptoms of Symmetry OCD

People with symmetry OCD often have a lot of anxiety and stress over their condition. They can be so deeply bothered about a certain symmetry obsession that they might spend exorbitant amounts of time trying to cope. They can feel helpless and like they have no choice but to give in to their urges.

Some others, however, might feel that their desire for order and symmetry is completely reasonable and appropriate. This subtype is a more easily recognizable OCD diagnosis compared to other variations of OCD.


Common symmetry OCD obsessions include:

  • Requiring extreme balance in all things, like exerting equal pressure on each foot while walking
  • Needing things to look and feel balanced —pillows on a couch or bed, books or frames on a table or bookcase
  • Continuous feelings of fear and dread that something bad will happen if an item is out of place
  • Experiencing extreme anxiety due to asymmetry


As it is with all types of OCD, people with symmetry OCD can begin to engage in compulsive behaviors in an attempt to stop their unwanted thoughts, mental pictures, and urges from occurring.

Common symmetry OCD compulsions include:

  • Feeling compelled to trace along the edges of geometrically symmetrical shapes and figures
  • Meticulously ensuring there are no visible asymmetries in handwriting
  • Writing or typing the exact same number of words on every line of a page
  • Impeccably arranging clothes, shoes, knickknacks, pantry items, etc.

“Compulsions feel overwhelming because they’re the behavioral reaction to uncontrollable thoughts. With symmetry OCD, the thoughts that typically flood the brain have everything to do with the position and arrangement of objects, so the behaviors that relieve stress involve rearranging at the expense of other categories.”

Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC) Meaghan Rice

What Causes Symmetry OCD?

Like other forms of the disorder, we don’t fully understand what causes OCD or more specifically, symmetry OCD. That said, there are several plausible and likely contributors. Particularly when looking at this form of OCD, some specific influences seem to be contributing factors.


  • Gender — Symmetry OCD is more prevalent in men.
  • Age — It seems likely that when OCD is discovered earlier, the more risk there is of the condition involving symmetry obsessions.
  • Comorbidity — Symmetry OCD is linked to a higher rate of comorbidity (existing with another condition) with certain tic disorders (for example, Tourettes).

“Biology, genetics, and environment are typically the culprits of OCD. Our own chemistry is fluid, can change over time, and often intersects with genetics or the environment and leads to OCD symptoms. We can also acquire OCD by watching people in our lives cope with adversity with OCD-specific symptoms.”

Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC) Meaghan Rice

Other things are thought to contribute to someone developing symmetry OCD, too.


Research seems to suggest that brain structure and levels of neurotransmitters like dopamine and serotonin are thought to play a role in whether or not someone develops symmetry OCD.


According to researchers at the Icahn School of Medicine at Mount Sinai, “obsessive-compulsive disorder (OCD) is a psychiatric disorder with multiple symptom dimensions (e.g., contamination, symmetry). OCD clusters in families and decades of twin studies clearly demonstrate an important role for genetics in the etiology of the disorder.”


Other research suggests that upbringing, familial and other intrapersonal relationships, trauma, and unmanaged stress can all be contributors to symmetry OCD.

Treatment for Symmetry OCD

If you think you might be living with symmetry OCD, it’s important to take action to get the support and OCD treatments you need.

  • Get help by connecting with a mental health provider who specializes in this type of obsessive-compulsive disorder. The right support can be life-changing. A therapist can teach you coping skills to help reduce the frequency and intensity of your symmetry obsession or compulsion.
  • Educate yourself about symmetry OCD. Try to understand the nuances of this challenging, frustrating, and often debilitating mental health condition.
  • Take note of your symptoms and take a few minutes to write them down before contacting an OCD therapist. Keep track of how your OCD symptoms affect you and how much time you spend routinely engaged in compulsive behaviors. Also, track any other details you feel may help a doctor or therapist understand your situation better.
  • Find a support system or don’t hesitate to reach out to a friend, loved one, family member, or religious leader for support. Symmetry OCD can be overwhelming. It can help to keep in mind that obsessive-compulsive disorder is fairly common. In fact, it affects about 2% of the world’s population annually. Millions of other people experience similar obsessions and compulsions, so there’s absolutely no reason to feel shame, guilt, or embarrassment.
  • Consider medication as part of your OCD treatment plan. Selective serotonin reuptake inhibitors (SSRIs) can be helpful for some people who are living with OCD, however, in general medication is best used in addition to therapy, not as a sole treatment method.
  • Try talk therapy in addition to prescription medications. The combination of therapy for OCD and medication is the first line of treatment for symmetry OCD. Cognitive-behavioral therapy (CBT) focuses on mindfully staying in touch with your thoughts as they develop, so you can better manage your compulsive reactions. This type of treatment is highly effective for OCD, anxiety disorders, depression, and other similar psychological conditions.


Therapy is an essential part of your treatment plan. Getting the support you need is a crucial step to getting your obsessions and compulsions under control so you can begin to reclaim your life.

Online therapy platforms, like Talkspace, are growing more popular every day. Our accessible approach to mental healthcare is changing the ways people think and feel about therapy. Licensed therapists are available to help you learn about and manage all forms of OCD.

See References

Meaghan Rice, PsyD., LPC

Meaghan Rice is a mental health consultant specializing in professionals who are looking to close the gap between where they are and where they envision themselves being. With a decade of experience in the mental health field, working in a variety of different capacities, Dr. Rice has found her niche amidst the therapist, consultant, and trainer roles.

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