OCD Symptoms and Signs
Obsessive-compulsive disorder (OCD) is a cycle of unwanted intrusive thoughts and the acts a person feels driven to perform to relieve them, taking up more than an hour a day or causing real distress.
Also called: Obsessive-Compulsive Disorder, Obsessive compulsive disorder.
ICD-10 F42 · ICD-11 6B20
Not tidiness. Doubt that will not settle.
Almost everyone has thoughts they do not want. It might be a flash of "what if I left the door unlocked". It might be an image of something awful happening to someone they love. Most people shrug these off.
In OCD, obsessive-compulsive disorder, the thought sticks. It brings a surge of anxiety, or a feeling that something is not right. With it comes an urge to do something to make that feeling go away. The person checks, washes, repeats, asks, or cancels the thought out with another thought. That brings relief for a few minutes.
Then the doubt comes back, and the more the person does the ritual, the harder it returns. This is not a quirk, and it is not a love of order. It can take hours out of a day.
FROM INSIDE
What it is actually like
You lock the front door. Halfway down the road the thought arrives: did I? You remember locking it, but the memory does not feel solid. So you go back and check. It is locked. You walk away, and the doubt comes back.
People with OCD usually know the fear does not make sense. That does not help. The feeling of not being sure is stronger than the knowledge.
The most painful obsessions go against everything a person believes in. They might be about harming someone. They might be sexual or religious thoughts the person finds horrifying. These thoughts are frightening precisely because the person does not want them.
A smoke alarm with a sticky button
Pressing it silences the beeping, so you press it. But every press makes the button stickier, and the alarm goes off sooner the next time.
WHAT IT DOES
Four common forms
The themes differ from person to person. The loop underneath them is always the same.
Checking
The person checks doors, taps, the cooker, and emails they already sent. The fear is of causing harm by mistake. Checking never quite settles it.
Contamination
The fear is of germs, dirt or illness. It leads to long washing and cleaning, and to avoiding anything that feels unclean.
Just right
Things must be even, or in order, or done a set number of times, until it feels right. This is about the feeling. It is not about tidiness.
Unwanted thoughts
These are thoughts about harm, sex or religion. The person cancels them out with mental rituals such as praying, counting or going back over things. Nobody else can see any of it.
2.3% — LIFETIME
94% — EVERYONE
7 — YEARS
1hr+ — A DAY
When it tends to begin
Peak age of onset: 15.
Median age of onset: 19.
OCD often starts in childhood or the teenage years. A second group of people develop it in early adulthood. It rarely starts for the first time after 40. Many people hide it for years before they tell anybody.
How it is actually diagnosed
Obsessions, compulsions, or usually both, that meet all of the following.
- Obsessions are unwanted thoughts, urges or images that keep coming back and cause anxiety
- Compulsions are actions or mental acts a person feels driven to do, to reduce that anxiety or prevent something bad
- They take up time, often more than an hour a day, or cause real distress or problems
- They are not caused by drugs, medication or another condition
Doctors also record how much insight a person has. Most know their fears are unlikely. Some are not sure. A few are convinced the fear is real. Doctors note tics too, because tics often come together with OCD.
If it is worse than that right now
OCD often comes with depression, and it can make life feel unbearable. Having a frightening thought push into your mind is not the same as wanting to act on it. If you are thinking about ending your life, that is a different thing, and it needs help now.
If you are thinking about harming yourself, contact emergency services or a crisis line now.