Signs of OCD

Obsessive-compulsive disorder (OCD) shows up in two ways. There are obsessions: unwanted thoughts, images or urges that keep coming back. And there are compulsions: things a person feels driven to do, out loud or in their head, to calm the fear those thoughts bring.^1,5 Most people with OCD have both.

OCD can look very different from one person to the next. One person washes for hours. Another prays silently until a prayer feels "right." This page walks through the most common patterns, explains what doctors mean by "insight," and shows how OCD differs from ordinary worry or neatness.

The OCD cycle

OCD tends to run in a loop:

1. A trigger. Touching a doorknob, leaving the house, or hearing a word.
2. An obsession. A thought like "What if I get sick?" or "What if I left the door unlocked?"
3. Distress. Strong fear, disgust, guilt, or a feeling that something is "not right."
4. A compulsion. Washing, checking, counting, or asking someone to say it is okay.
5. Short relief. The fear drops for a while. Then the doubt comes back, often stronger.

The relief is the trap. Each time the ritual seems to "work," the brain learns to need it again.³ People with OCD usually get no pleasure from their rituals. They do them to feel less afraid, and the calm does not last.²

Common themes

OCD can latch onto almost anything. Experts sort the most common patterns into a few groups.^3,6 A person may have one theme or several, and the theme can change over the years.²

Sources for the table: International OCD Foundation and NIMH.^2,3,4

Other themes include fear of losing or throwing away something important, doubts about a relationship, worries about one's sexual identity, and fear that a past event happened in a bad way.^3,7

Contamination

This is the theme most people picture. The fear may be germs, body fluids, dirt, or household chemicals.³ Some people feel disgust or a sense of being "dirty" rather than fear of illness. Some avoid hugging, shaking hands, or visiting family.

Harm and checking

Harm thoughts are among the most upsetting. A person may have sudden images of hurting a loved one.³ These thoughts go against what the person values, which is why they cause so much distress.³ Having a thought is not the same as wanting it or doing it.

Checking often comes from a fear of being to blame for a disaster, like a fire, a break-in, or a car crash.³ Each check gives a moment of relief. Then the doubt returns: "Did I really check it properly?"

Symmetry and order

Some people do not fear any disaster. They just feel that things are "not right" until they are even, exact, or complete.^3,7 This can mean lining up objects or redoing a task until it feels right.

Religious and moral worry (scrupulosity)

Scrupulosity is OCD that targets faith or morals. A person may fear they have sinned, offended God, or will be punished.⁴ Compulsions can include repeating prayers until they feel right, confessing again and again, making deals with God, or avoiding worship because it sets off fears.⁴

From the outside, it can look like great devotion. But the International OCD Foundation notes some key differences. Scrupulosity often goes beyond what the faith asks. It may fixate on one small rule while ignoring others. It is driven by fear rather than meaning, and it can pull a person away from their faith community.⁴ Faith leaders can be a helpful part of treatment.⁴

Hidden signs: mental rituals, reassurance and avoidance

Not every compulsion can be seen. Some of the most common happen silently or look like normal behavior.³

• Mental rituals. Going over a conversation to make sure nothing bad was said. Counting to a "safe" number. Saying a "good" word in your head to cancel a "bad" one. Praying in a set way to prevent harm.³
• Asking for reassurance. "Are you sure the door is locked?" "Do you think I'm a bad person?" Telling or confessing things to others to feel better.³
• Avoidance. Staying away from places, people or objects that set off the fear. Avoidance counts as a compulsion too.^3,7

Families often notice these signs first: a loved one who takes much longer to leave the house, asks the same question over and over, or suddenly avoids certain rooms, foods or people. See Helping a family member with OCD.

What "insight" means

Insight is how much a person sees that their OCD fears are not true. Most people with OCD know, or at least suspect, that their thoughts do not make sense. Yet they still feel unable to stop.⁷ Only a small share, about 2 to 4 in 100, lack insight completely.⁶

Doctors describe insight in three levels:⁵

Doctors no longer require insight for a diagnosis, so a person can have OCD even if they feel sure their fears are real.⁵

Children often have less insight than adults. They may not see their rituals as odd, so parents or teachers are often the ones who notice.²

How OCD differs from worry, neatness and ordinary thoughts

Unwanted thoughts are normal. In a study of 777 students in 13 countries, about 94 in 100 had at least one unwanted, intrusive thought in the past three months.⁸ The difference in OCD is not the thought itself. It is how often it comes, how much distress it causes, and the rituals that follow.³

OCD is not the same as general worry. People with generalized anxiety disorder worry about real-life matters such as bills, health or family. Those worries tend to shift from topic to topic. OCD fears are often odd or out of proportion, and they usually come with compulsions. Anxiety disorders usually do not.⁶ Fear of having a serious illness, with lots of body checking or doctor visits, may be health anxiety.

OCD is not the same as being a perfectionist. Obsessive-compulsive personality disorder (OCPD) is a different condition. It involves a lasting need for order, control and perfection. People with OCPD often see these traits as sensible and good. People with OCD usually find their thoughts and rituals unwanted and distressing.⁶

The hour-a-day guide. Doctors look for obsessions or compulsions that take more than about an hour a day, or that cause real distress or get in the way of work, home life or relationships.⁵ Saying "I'm so OCD" about a tidy desk is not OCD.

Tics and other conditions that can come with OCD

Some people with OCD also have tics. Tics are quick, repeated movements or sounds, such as blinking, shrugging, grimacing, sniffing or clearing the throat.^2,10 When diagnosing OCD, doctors make a note of any past or current tic disorder.⁵

Depression and other anxiety problems often come with OCD.¹ Hoarding, hair pulling, skin picking and intense worry about one's looks are related conditions. Read more on Hoarding disorder and Conditions related to OCD.

How symptoms change over time

OCD symptoms may start slowly. They can fade for a while and then return, or get worse over time. Stress often makes them flare up. The theme can also shift over the years, for example from washing to checking.²

Signs in older adults

OCD most often begins between late childhood and young adulthood.¹ Many older adults have lived with it for decades. Some never had a name for it, or felt too ashamed to talk about it. It is never too late to get help.

New symptoms in later life are different. OCD that starts after age 50 is rare. In one group of 1,000 patients, only 5 had symptoms start after 50.⁹ When OCD-like behavior appears for the first time in an older adult, doctors look for a medical or brain cause. This may include damage to part of the brain, or a type of dementia such as frontotemporal dementia or Lewy body dementia.⁹ See Frontotemporal dementia and Lewy body dementia.

It also helps to know that repeated questions, checking, or hoarding in a person with dementia often come from memory loss, not OCD. A person may ask the same question because they forgot the answer, not because they fear something bad. See Repeated questions and stories and Hoarding disorder.

Common questions

I have violent or sexual thoughts that horrify me. Does that mean I am dangerous?

Unwanted thoughts like these are a common part of OCD. They upset you because they go against what you value.³ Having a thought is not the same as wanting it or acting on it. A therapist who knows OCD will not be shocked. They hear about these thoughts often and can help.

My parent has always been "particular." Could it be OCD?

It might be, or it might be a personality style. Ask whether the habits cause distress, take hours, or keep your parent from doing things they want to do.³ If the behavior is new in later life, ask their doctor for a full exam.⁹

Will OCD go away on its own?

OCD usually lasts a long time without treatment, though symptoms can rise and fall.^2,6 Treatment helps most people feel much better. See OCD for an overview.

When to get help

Talk with a doctor or mental health professional if:

• Thoughts or rituals take up more than an hour a day.⁵
• You avoid people, places or tasks because of your fears.
• OCD gets in the way of work, sleep, money or relationships.¹⁰
• Your skin is damaged from washing, or you are late or stuck because of checking.
• You feel low, hopeless or worn out along with these symptoms.
• An older family member shows new rituals, checking or hoarding.

A family doctor is a good first stop. They can rule out other causes and refer you to someone who treats OCD.² The most effective therapy is exposure and response prevention (ERP). Medicines also help many people. You can also try steps from Self-help for OCD, and read about what causes OCD.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.