If you’re experiencing obsessive-compulsive disorder (OCD), you may feel stuck in a loop: intrusive thoughts (obsessions) show up, and you feel driven to do something, physically or mentally, to get rid of the anxiety they cause (compulsions). This cycle can take over your daily life, interfering with your work, school, relationships, and well-being.
Everyone has intrusive thoughts now and then, but for people with OCD, those thoughts feel disturbing, persistent, and meaningful. You might feel unsure of what they say about you, or what you have to do to feel “safe” or morally right again.
In this article, we’ll break down the symptoms of OCD—what obsessions and compulsions can look like, how they change over time, when they usually start, and how effective treatment like exposure and response prevention (ERP) therapy can help.
What is OCD?
OCD is a mental health condition characterized by a cycle of obsessions (unwanted thoughts or feelings) and compulsions (repetitive behaviors or mental acts to neutralize distress). These symptoms can impact your relationships, work, school, and overall well-being.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
What are obsessions?
Obsessions are intrusive thoughts, images, urges, feelings, or sensations that cause anxiety or discomfort. People with OCD often feel they must find meaning behind these thoughts, unlike those without OCD, who can dismiss them.
Common OCD obsession themes
| Fear of being contaminated or contaminating others physically, mentally, or emotionally |
| Fear of harming yourself or others |
| Excessive worry about romantic and/or platonic relationships |
| Excessive need for exactness and orderliness |
| Fear of going against ethical, moral, or religious beliefs |
| Fear of being responsible for something bad happening to yourself or others |
| Excessive worry about identifying with the “wrong” sexual orientation |
| Excessive concern about past events |
| Excessive concern about bodily sensations or functions |
| Unwanted sexual thoughts |
What are compulsions?
Compulsions are physical or mental actions performed to reduce anxiety caused by obsessions. While they may offer short-term relief, they reinforce the OCD cycle and increase long-term distress.
Physical compulsions
| Excessive handwashing and cleaning |
| Checking stoves, doors, locks, etc. |
| Body-checking, such as weighing yourself, pinching your skin, taking your measurements, or looking for a groinal response |
| Counting objects, steps, or other things in a certain way |
| Ordering or arranging items in a particular way until they feel “just right” |
| Repeating acts or behaviors (e.g., repeatedly walking back and forth through a doorway) |
| Seeking reassurance from others |
| Performing rituals, such as repeating certain words or phrases |
| Hoarding possessions |
| Avoiding certain places, people, or situations |
| Excessive prayer |
| Excessive confession of potential wrongdoings |
| Excessively researching to find answers to your doubts with 100% certainty |
Mental compulsions
| Mentally reviewing past events over and over again until you find clarity |
| Counting in your head while performing tasks |
| Mental reassurance (e.g., replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong) |
| Rumination or overthinking |
| Mental checking |
| Memory hoarding |
| Thought suppression |
| Replacing “bad” thoughts with “good” ones |
Many OCD symptoms are ego-dystonic, meaning they go against your values, which adds to the distress.
Can OCD symptoms change over time?
Yes, symptoms can shift over time due to stress, life events, hormonal changes (such as the menstrual cycle or pregnancy), or other factors. While some themes stay consistent, others may come and go, but all are treated the same way: with ERP therapy.
It’s important to note that you can’t “catch” a new OCD theme. “You’re not going to see a show about sexual predators and become one or develop a new theme about it,” says Tracie Ibrahim, CST, LMFT, NOCD’s Chief Compliance Officer. “That’s not how themes pop up. Themes are not contagious.”
How are OCD symptoms diagnosed?
The first step of getting OCD treatment is getting diagnosed. When it comes to OCD, self-identifying your symptoms can be helpful for sharing your experiences with a clinician. From there, they can perform assessments to confirm an OCD diagnosis and help you start your treatment journey.
When do symptoms usually start?
- 25% of OCD cases begin before age 14
- Average age of onset: 19
- Late-onset OCD (after age 35) is rare but possible
- In rare cases, symptoms can start suddenly due to PANDAS/PANS (typically in children after strep infections)
Are there gender differences in OCD symptoms?
Yes, research shows some trends:
- Women are 1.6 times more likely to develop OCD and have cleaning and contamination obsessions than men
- Men and boys are more likely to have harm and sexual obsessions
- Twenty-five percent of males develop OCD symptoms before age ten
- There’s limited research on OCD in trans and nonbinary individuals
When to seek help
You should seek help if:
- Your symptoms take up more than an hour a day
- They cause significant distress or impairment
- You’re avoiding people, activities, or responsibilities
Early treatment can prevent symptoms from worsening. OCD is treatable with the right support.
How are OCD symptoms diagnosed?
A diagnosis for OCD involves:
- Describing your symptoms to a mental health professional
- Completing structured assessments
- Ruling out other conditions
Self-recognition is a great first step. From there, a clinician can help confirm a diagnosis and build a treatment plan.
How are OCD symptoms treated?
The most effective treatment for OCD is ERP. ERP is a specialized form of CBT proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
- ERP helps you confront your fears and resist compulsions.
- Often combined with medication (SSRIs) if symptoms are severe or there are co-occurring disorders.
ERP is effective for OCD subtypes and themes, even when symptoms feel “mental” rather than physical.
Frequently asked questions
What are examples of OCD symptoms?
Intrusive fears (e.g., fear of contamination or harm) and repetitive behaviors like checking, cleaning, or mental reviewing are common OCD symptoms.
Can OCD symptoms go away on their own?
OCD symptoms may fluctuate, but they usually don’t go away without treatment. ERP therapy is the most effective approach.
Are mental compulsions part of OCD?
Yes, mental rituals like rumination, mental checking, and reassurance-seeking are everyday in OCD and can be just as impairing as physical compulsions.
Can OCD change over time?
Yes, themes and severity can shift due to stress, life events, or developmental changes, but they’re all treatable with ERP.
Bottom line
If you’re dealing with intrusive thoughts and compulsive behaviors that interfere with your life, you’re not alone, and help is available. OCD can be effectively treated with exposure and response prevention (ERP) therapy, a first-line, evidence-based approach. Recovery is possible.
Key takeaways
- OCD symptoms involve a cycle of obsessions (distressing thoughts) and compulsions (repetitive actions).
- These symptoms can shift over time, but are always treatable.
- ERP therapy is the most effective first-line treatment for OCD.
- Early diagnosis and treatment can significantly improve quality of life.
