Identifying OCD Behaviors and Symptoms
Clinically reviewed by: Leigh Hall, LMFT
Written by: Janelle Martel
Obsessive-compulsive disorder, or OCD, is a disorder that is characterized by obsessive, repetitive thoughts and/or compulsive behaviors. While this can create significant distress, there are several available treatments that can help to manage these overwhelming thoughts and behaviors. In this article, we’ll discuss how to identify OCD behaviors to help you better understand symptoms and determine if you or a loved one could benefit from seeking treatment.
Someone who enjoys keeping a particularly clean home might refer to themselves as “having a little OCD.” Despite this term being used in casual conversation, OCD isn’t simply about liking things to be clean or orderly. Rather, OCD thoughts and behaviors can be overwhelming, cause intense anxiety, and impact your daily life. In this article, we’ll focus on the real symptoms of OCD and introduce you to effective treatments. We’ll also discuss how OCD symptoms can manifest differently in adults and children, and how OCD can specifically impact women.
What is Obsessive-Compulsive Disorder (OCD)?
OCD is considered a mental health and behavioral disorder that involves obsessive thoughts and compulsive behaviors. While everyone experiences unwanted thoughts at times, with OCD these thoughts cause high levels of anxiety and fear. Engaging in repeated behaviors can also be considered normal, such as following the same morning routine every day. However, with OCD, the compulsive behaviors can negatively impact the individual’s daily life, and the individual often doesn’t want to perform them but feels compelled to. While OCD symptoms can manifest at any time, they often begin in late childhood or early adulthood.
Behaviors of OCD in Adults
In adults, OCD typically involves intrusive or obsessive thoughts that cause the individual to perform compulsive behaviors in an attempt to relieve anxiety. These behaviors and thoughts cause anxiety and impact the individual’s daily life. A person who is struggling with severe OCD might have trouble working and maintaining social relationships.
Obsessions
Obsessions are thoughts that are intrusive and anxiety-provoking. In OCD, these obsessions often lead people to perform associated compulsive behaviors in an attempt to manage the anxiety caused by the obsessions. However, the relief from anxiety is often only temporary. Examples of obsessions include:
Fear of losing or discarding something important: For example, an individual with OCD might be worried about accidentally losing important information, despite being organized.
Fear of coming into contact with contaminated substances: An individual with OCD might become overly concerned about coming into contact with a substance that might harm them, such as a virus, environmental contaminant, or dirt.
Fear of causing harm to yourself or someone else: An individual with OCD might fear that they will act on an impulse to harm themselves or others. They might also be worried about being responsible for a disastrous event, like causing a fire or a car accident.
Unwanted sexual thoughts: If an individual with OCD has a sexual-related thought, then they might become worried about impulsively acting on the thought or performing a sexually aggressive behavior.
Excessive concern with morality: An excessive concern with morality might look like an overwhelming obsession with an individual’s role in the world, or obsessive fears of having done something the person considers morally wrong.
Excessive concern about sexuality: Individuals might become overly focused on their sexual orientation or gender identity, experiencing doubts or worries that these aspects of themselves will suddenly change.
Religious worry: An individual with OCD might have a compulsion regarding religion or morality. They might become overly focused on what is “right” and what is “wrong,” and develop anxiety around doing the “wrong” thing.
Perfectionism: A compulsion around perfectionism might involve a fear of making mistakes or intrusive thoughts about needing to do something perfectly or correctly.
Relationship obsessions: An individual with OCD might develop obsessive thoughts concerning their relationship. For example, they might become overly focused on finding “the one,” or develop an obsession about whether their partner truly loves and cares about them.
Compulsions
A compulsion, which is also referred to as a ritual, is a repetitive behavior. In OCD, these compulsions are driven by an attempt to relieve anxiety, although the relief is often only temporary. Compulsions can also be time-consuming, impacting work, school, and social relationships. The individual might recognize that the behaviors are excessive and won’t change things, but still feel the need to perform them to relieve their anxiety. Examples of compulsions include:
Excessive showering, hand-washing, or brushing teeth: Washing and cleaning are common compulsions for individuals with OCD. They may need to perform these behaviors in a certain way or spend an excessive amount of time on them. Excessive washing can also lead to issues like chapped skin.
Repeatedly checking things like doors or appliances: While it can be normal to double-check if you’ve locked the door now and again, with OCD, this repeated checking can be overly time-consuming. Individuals might also feel as though they need to check that appliances are turned off or doors are locked a set number of times, or until it feels “right.”
Ordering or arranging things in a specific way: Individuals with OCD might also arrange and rearrange objects in a certain way until it feels “right.” While organizing one’s space is a normal behavior, the OCD compulsion to do so differs in that it is often repetitive and causes the individual to feel distress or anxiety.
Rituals related to numbers, such as counting or repeating numbers: Individuals with OCD might have rituals associated with numbers. For example, they might perform tasks a set number of times because it feels “right” or safe for them. They may also consider certain numbers “lucky” and others “bad” or “unlucky,” to the point that they may go out of their way to avoid certain numbers, or feel great distress when they encounter them.
Repeating words or phrases: An individual with OCD might repeat certain words or phrases over to themselves in their head, fearing that, if they don’t, something bad might happen. This might also be in the form of religious prayers or phrases. While praying can be a positive behavior for individuals who value their religion, in OCD, prayer is performed repeatedly in an attempt to quell anxiety.
Reassurance seeking: If an individual with OCD is worried about harming others, they might repeatedly check or seek reassurance that they haven’t made a mistake or hurt someone.
Correcting negative thoughts: Individuals with OCD might also be compelled to correct or counter any negative thoughts that they might have. For example, if an individual with OCD thinks of a word that they consider negative, then they might attempt to counter it with a word that they deem good or positive.
OCD Behaviors in Women
Women tend to be more likely to experience OCD in their lifetime than men, with some studies suggesting that women experience OCD symptoms 1.6 times more than men. These symptoms are more likely to arise in adolescence or young adulthood. Women might also experience OCD symptoms in relation to changing hormone levels. For example, they might start experiencing symptoms of OCD during or after pregnancy.
OCD symptoms can differ in women versus men. In comparison to men, women are more likely to develop obsessions and compulsions around contamination, harm, and order. Women are also more likely to experience an anxiety or depressive disorder alongside OCD.
Some of the more common OCD symptoms in women include:
Intrusive thoughts: While men are more likely to report obsessions related to morality or religiosity, women more commonly report experiencing aggressive or intrusive thoughts. These may be unwanted thoughts, images, or urges that can be disturbing. For example, they might experience a distressing image of something bad happening to themselves or their child.
Compulsions: As a result of these intrusive thoughts, women might engage in compulsions in an attempt to manage or prevent these unwanted things from occurring. For example, they might repeatedly go over events in their head to try to manage the situation.
Checking: Checking is a more common compulsion in women that can occur as a result of intrusive thoughts. For example, if a woman is worried about something happening to her baby, she might check that the baby is breathing multiple times throughout the night. Other more common checking behaviors include checking if appliances have been turned off and that doors are locked.
Ordering: Ordering tends to be more common in women with OCD, perhaps due to concern that their home and appearance need to appear tidy. They might constantly rearrange items so that they appear symmetrical or change their outfit multiple times until it feels “right.”
Washing: Due to a fear of contamination or germs, women with OCD are more likely to engage in compulsive washing and cleaning. They might excessively clean objects or overwash their hands until they are raw.
Fear: Some of the more common fears that women with OCD experience include fear of germs, being a bad mother, or harming a baby.
Anxiety: The intrusive thoughts, compulsions, and fears often cause anxiety, which can impact daily life.
OCD Behaviors in Children
For about half of individuals with OCD, symptoms begin in childhood or adolescence. Although numbers tend to even out more in adulthood, male children experience OCD more than female children. Research indicates that the mean age of OCD onset in males is between 9 and 11 years old, whereas the mean age in females is between 11 and 13 years of age.
While OCD symptoms are similar between children and adults, symptoms can be harder to identify in children. This can be due to children not yet having the language or understanding to communicate their symptoms. OCD symptoms in children may also be mistaken for attention-deficit hyperactivity disorder (ADHD) and tic disorders.
By being aware of these common OCD behaviors in children, parents, teachers, and childcare workers can help children seek a diagnosis and begin treatment.
More common obsessions in children include:
Fear of dirt, germs, or contamination: A child with OCD might consistently worry about dirt or germs making them ill. This can lead to compulsions like excessive handwashing.
Intrusive thoughts about violence, hurting others, or hurting themselves: These thoughts often cause significant anxiety or stress. They may be in the form of images or intrusive thoughts and are persistent.
Preoccupation with order, symmetry, or exactness: A child who has OCD might become overwhelmingly concerned about things needing to be in a specific order or “perfect.”
Persistent thoughts about forbidden or taboo behaviors: These thoughts might be violent or sexual and are distressing to the child.
Troubling thoughts that go against personal religious beliefs: A child with OCD might also experience persistent intrusive thoughts or images that they consider upsetting and anxiety-provoking as they go against their personal religious beliefs.
Worry about others: In addition to worrying about themselves, a child with OCD might worry about other people getting sick, hurt, or dying.
Obsessive or intrusive thoughts can often lead to compulsions or rituals, including:
Excessive hand washing, showering, grooming, or cleaning: This is the result of obsessive thoughts about things being contaminated or containing germs. A parent might notice that their child is washing more than required, or they might notice that activities like showering are taking an extended time.
Following rigid rules or ritualized behavior: This may look like repeating the same words and phrases, or a parent might notice their child touching things repeatedly, and perhaps a set number of times.
Checking to ensure that no mistakes were made and no harm was caused: A child with OCD might be overly concerned with things being perfect. This might look like checking their homework over and over for mistakes or asking a parent repeatedly for reassurance.
Repeating, counting, touching, ordering, or arranging: A parent or other caregiver might notice that a child with OCD is counting things a set number of times or constantly rearranging things. They might take steps in a particular and unusual way, or touch things in a set order. The child might also ask a parent to do things in a certain way, like to say something a certain number of times.
Difficulty making decisions: Due to intrusive thoughts and a need for things to be “right,” a child with OCD might have difficulty making decisions. Parents might note that they experience a high degree of uncertainty, even with making simple decisions.
It’s important to note that OCD thoughts and behaviors can be highly distressing for the child. Because children might not share their thoughts with their parents, and they might hide their OCD behaviors from parents, it may take some time for parents or other caregivers to notice the behaviors. Caregivers might also notice the emotions that are the result of the obsessions and compulsions that their child is experiencing, including anxiety, frustration, irritability, sadness, and fatigue.
How to Treat OCD
Treatment for OCD typically includes psychotherapy, medication, or a combination of both. Psychotherapy for OCD may include cognitive-behavioral therapy (CBT), which is a specialized type of therapy that works to help clients understand how thoughts, feelings, and behaviors are connected, and introduce more helpful coping methods. During CBT for OCD, you might engage in exposure and response prevention (ERP) therapy. This involves slow, gradual exposure to things that you find anxiety-provoking to help reduce fear and learn ways to manage associated compulsions.
Medication may be used alongside psychotherapy to help manage symptoms. Typically, antidepressants are the first type of medication that is introduced to help with controlling the obsessive thoughts and compulsive behaviors that are associated with OCD. However, several different medications can be helpful, with options available for different age groups.
When seeking treatment for OCD, there are a few important factors to keep in mind:
Early intervention: Research has shown that early intervention helps to improve treatment outcomes, which is why it is so important for parents and other caregivers to be aware of the signs of OCD. If a parent notices potential symptoms of OCD in their child, they can make an appointment with a child psychiatrist or psychologist for an assessment. During this assessment, the psychiatrist or psychologist will ask both the parent and child questions to gain more information about symptoms to help them make a diagnosis.
Individualized treatment plans: A medication or treatment that helps one person with their OCD symptoms may not work the same for someone else. When working with a therapist, psychologist, or psychiatrist, you’ll want to ensure that they’ve taken the time to understand your unique triggers and lifestyle. They can then use this information to create a tailored treatment plan that addresses your personal triggers, thoughts, and behaviors.
The importance of long-term management of OCD behaviors and symptoms: While there is no cure for OCD, it can be managed through treatments like medication and psychotherapy. Incorporating self-care into your life is another important aspect of managing OCD. You might consider joining a support group to connect with others who experience OCD symptoms, or practice strategies that are designed to reduce stress, like mindfulness, meditation, and deep breathing.
Taking Steps to Manage OCD Symptoms
Now that you have a better understanding of OCD thoughts and symptoms, you may be wondering what the next step is. If you, your child, or a loved one is showing signs of OCD, several effective treatments are available. The first step is to visit a therapist, psychologist, or psychiatrist to complete an assessment and get started with a treatment plan. Part of your treatment plan might include starting therapy, where a therapist specializing in OCD can help you learn skills to manage OCD symptoms and improve your quality of life.