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Health Concerns

Obsessive-Compulsive Disorder (OCD)

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Signs and Symptoms

The symptoms of OCD are primarily mental obsessions and behavioral compulsions (Seibell 2013; BPS 2006a). The condition has few outward signs: tics (sudden, brief, intermittent movements or sounds) or dermatological evidence of excessive hand washing may be apparent in some cases (Sudak 2012; Veale 2014). Several other psychiatric disorders can cause signs and symptoms similar to those caused by OCD, which can make identification and correct diagnosis of OCD difficult (Glazier 2013).

OCD symptoms have been categorized into four “symptom dimensions,” which can be thought of as subtypes of the condition. These are contamination/cleaning, symmetry, forbidden thoughts, and hoarding, as presented in Table 1 (Gentil 2014; Bloch 2008). The subtypes of OCD have different clinical presentations and responses to treatment (Landeros-Weisenberger 2010; Mataix-Cols 2002; Kichuk 2013).

There are some gender associations with obsession subtypes: men are more likely than women to have forbidden thought obsessions, particularly sexual thoughts (Landeros-Weisenberger 2010), while women are more likely than men to have cleaning obsessions and contamination compulsions (Alonso 2011).

Table 1: The Four Symptom Dimensions of OCD (from Bloch 2008; Leckman 2009; Williams 2013; Torres 2012; Veale 2014; Bratiotis 2009)





Excessive concern with symmetry or order; things need to be “just so”

Ordering, repeating, counting

Forbidden thoughts

Forbidden thoughts or images (aggressive, religious, sexual)

Suppression of unwanted mental images, compulsive avoidance of triggers


Fear of contamination (eg, dirt, germs, bodily fluids, feces, chemicals, dangerous material)

Cleaning or washing compulsion, compulsive avoidance of triggers


Hoarding (ie, collecting or failing to discard useless items to an extent that causes distress or impairs daily activity)


*Hoarding has been categorized as a separate mental illness in the American Psychiatric Association’s most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Recognizing OCD

OCD can be difficult to recognize because affected individuals often conceal their distress and behaviors from others. However, OCD is characterized by certain cognitive and behavioral patterns. Some of the most common obsessions and their associated compulsions are listed in Table 2.

Table 2: Common obsessions and examples of compulsive responses (Mayo Clinic 2013; Grant 2014)

Example Obsession

Associated Compulsions

Fear of contamination from shaking hands or by touching objects others have touched

Excessive hand washing

Doubts that one has locked the door or turned off the stove

Checking doors repeatedly to make sure they are locked; checking the stove repeatedly to be certain it has been turned off

Severe stress when objects are not orderly or facing a certain way

Arranging items so they all face the same direction

Fear of harming others; recurrent violent images

Seeking reassurance that one is a good person; monitoring news for reports of violent crime

Thoughts about eternal damnation, or that one is immoral

Asking forgiveness or praying

Recurrent anxiety about doing things incorrectly or incompletely

Excessive checking; performing actions in a particular order

Fear of making inappropriate comments in public

Avoidance of social situations