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OCD symptoms: What are the early signs of OCD?

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician
Updated Jul. 3, 2023  •  Published Mar. 12, 2023
Fact Checked
OCD symptoms

Overview: What does OCD look like?

Obsessive-compulsive disorder is a serious mental illness characterized by repeated, unwanted, and painful thoughts, urges, or images, as well as repeated, ritualized behaviors used to relieve or suppress these thoughts. The intrusive thoughts are called obsessions. They are not the same as worries or anxieties because they are often extreme and detached from reality. The repetitive and patterned behaviors are called compulsions. Some may seem logically related to the fear, like repeated hand-washing to prevent infection. Some may seem illogical or magical, like tapping a doorknob forty times to keep germs away. OCD is disabling and can seriously interfere with a person’s ability to function.

Key takeaways:

  • OCD is a relatively uncommon mental health condition that can affect anyone, regardless of age, sex, race, or ethnicity. Find updated OCD statistics here.

  • Early signs of OCD include intrusive and distressing thoughts.

  • Serious symptoms of OCD, such as severe distress, suicidality, or harmful behaviors, may require immediate medical attention.

  • OCD is related to many factors, but there is a strong genetic component. You may be at increased risk for developing OCD if you have immediate relatives who have been diagnosed with it. There are no specific causes of OCD, but streptococcal infections in some children can result in brain changes that are associated with symptoms of OCD.

  • OCD requires a medical diagnosis.

  • Symptoms of OCD require treatment. 

  • Treatment of OCD may include SSRIs, other psychiatric drugs, and psychotherapy. Read more about OCD treatments here.

  • Untreated OCD could result in complications like severe disability, low quality of life, and suicide.

  • Save on prescriptions for OCD with a SingleCare prescription discount card

What are the early signs of OCD?

Many early signs of OCD may look like anxiety. But in OCD, a person’s obsessions and compulsions cause significant distress or trouble with day-to-day functioning. 

Some early signs might be:

  • Rigid habits

  • Frequent angry outbursts or panic over trivial matters

  • Coercive behaviors about unimportant issues

However, these may be signs of other mental health issues. To be certain, a healthcare professional needs to make a diagnosis.

Other OCD symptoms

OCD is diagnosed based on the presence of obsessions, compulsions, and the severity of the symptoms. The severity is determined by the amount of distress people feel and how much time is spent every day on obsessions and compulsions.

Obsessions are intrusive thoughts, images, or urges that cause significant distress. Common obsessions include thoughts or fears of:

  • Contamination or infection

  • Disorder

  • Superstitions such as bad numbers or unlucky colors

  • Sexual urges or behaviors

  • Killing or hurting someone

  • Damnation

  • Doing things wrong or losing control

Compulsions are repeated or ritualized behaviors that counteract intrusive thoughts or relieve distress. People without OCD also act on distressing thoughts. For instance, if someone is worried their car is unlocked, they go back to the car once, check the lock, and then feel better. But compulsions are repetitive and ritualistic, like checking the car exactly 25 times each time it’s parked. 

Common compulsions include:

  • hand-washing 

  • Cleaning

  • Ordering or arranging objects 

  • Counting 

  • Tapping

  • Thinking of good words or praying

One criteria for an OCD diagnosis is that at least one hour per day is spent on obsessions and their associated compulsions and rituals.

OCD vs. OCPD symptoms

Although they have similar names, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are very different. Obsessive-compulsive disorder involves intrusive and obsessive thoughts, ritualized behaviors, significant distress, and functional disability. On the other hand, someone with OCPD may simply appear to be a perfectionist or chronic workaholic. Still, “obsessed” is a word people might use to describe them. 

Unlike people with OCD, people with OCPD derive their sense of identity from work and achievement. However, their standards are so unreasonably high that they often don’t finish things. They obsess over details and imperfections. Most importantly, they have low-quality relationships with other people because of their high standards, rigidity, negativity, lack of empathy, inability to compromise, and preoccupation with work. While OCD is debilitating, people with OCPD are often very functional in their occupations. Some are unquestionably successful and high achievers.

OCD OCPD
Shared symptoms
  • Rigidity
Unique symptoms
  • Intrusive thoughts, images, or urges (obsessions) that cause significant distress
  • Repetitive behaviors or rituals (compulsions) designed to prevent or relieve obsessions
  • Significant distress
  • Significant impairment of day-to-day functioning
  • Sense of identity is derived primarily from work or productivity
  • Rigid perfectionism in many if not all aspects of life
  • Unreasonable standards and expectations of self and others
  • Difficulty completing tasks
  • Overly conscientious attitudes
  • Low empathy
  • Inflexibility and resistance to change
  • Difficulty with intimacy or connecting with other people

When to see a doctor for OCD symptoms

Any sign of persistent or extreme anxiety, unexplained behaviors, or bizarre thoughts requires medical evaluation. It could be OCD, but the problem may be due to other conditions. Conditions that may look like OCD include:

  • Anxiety disorders

  • Personality disorders

  • Eating disorders

  • Psychosis

  • Autism

  • Tourette syndrome or other tic disorders

  • OCD-related disorders such as body obsessions, hair pulling, picking at skin, or hoarding

  • A side effect of a medication or substance

When any symptoms are evident, see a doctor or mental health professional.

An OCD diagnosis requires a thorough medical and family history. It is particularly important to give the diagnosing healthcare provider a detailed account of the symptoms. Be prepared to tell the healthcare professional how much time is spent each day on obsessions or compulsions and how much distress you experience—such as anxiety, panic, or anger.. It’s also important to indicate if any other family member has an OCD diagnosis or similar symptoms.

A healthcare professional may give a short, six-question OCD screen on the first visit. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) may be used to determine the severity of the symptoms. A physical exam may be performed to identify any physical problems due to compulsive behaviors or to identify other possible causes.

Complications of OCD

Untreated OCD can lead to complications such as:

How to treat OCD symptoms

Because OCD is debilitating, people with OCD do require treatment. 

OCD is primarily treated with high-dose selective serotonin reuptake inhibitors (SSRIs) combined with cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and other types of therapy. Treatment for people with OCD is usually administered by a doctor, psychiatrist, psychologist, or all of the above.

SSRIs are well-known antidepressants and anxiety medications. The most common SSRIs prescribed for OCD are fluvoxamine, Paxil (paroxetine), and Zoloft (sertraline). Doses are higher for OCD than they are for anxiety or depression, but some people will take a moderate or low dose because of side effects. Other neurological or psychiatric drugs may be used if SSRI therapy doesn’t work or the person has other mental health disorders.

Psychological therapy is a key component of OCD treatment and is more enduring than drug treatment. Cognitive behavioral therapy is designed to help people change their beliefs about their fears and rituals so that they develop better responses to these fears. Exposure response prevention involves exposing people to particular fears or triggers and helping them manage their distress and use more appropriate behaviors in response. 

In very rare and extreme cases, brain surgery may be used.

RELATED: Finding the right medication for your mental health starts with finding the right doctor

Living with OCD

Once treatment has begun, many of the symptoms of OCD will improve. Some may not go away entirely. OCD is, for many people, a chronic and even lifelong illness, especially if it’s diagnosed in a child or adolescent. For people living with OCD, the goal is to manage symptoms and maintain physical and mental health. Here are a few tips for realizing those goals:

  • Follow the treatment plan, including taking medication as prescribed, attending therapy sessions, and practicing skills learned in therapy.

  • Educate yourself, your family, friends, and loved ones about OCD, the treatment options, drug side effects, signs of a relapse, and the goals and processes of CBT and other forms of psychotherapy.

  • Monitor and record thoughts and behaviors to identify possible triggers.

  • Join a support group.

  • Learn and practice mindfulness.

  • Minimize stress.

  • Engage in relaxation techniques such as meditation or yoga.

  • Exercise.

  • Adopt a healthy diet.

  • Take positive measures to prevent illness.

  • Avoid alcohol and recreational or illicit drugs.

Most importantly, follow the treatment plan

Around 30% of people diagnosed with OCD stop or refuse treatment, a decision that usually means a life with disabling bouts of intrusive, distressing thoughts and compensating behaviors. Ultimately, success depends on getting a diagnosis and treatment plan from a healthcare professional and then committing to that plan. It can be difficult. The drugs may have side effects. Cognitive behavioral therapy can be demanding. Exposure-response therapy can be distressing. But these interventions do work. The first step in committing to treatment is to enlist the assistance of family and friends. Support groups can also help sharpen and define that commitment.

FAQs about OCD symptoms

What are the main symptoms of OCD?

The core symptoms of OCD are obsessions and compulsions. Obsessions are intrusive and painful thoughts, images, or urges that keep coming back and are hard to stop. Compulsions are repetitive behaviors that help control obsessive thoughts or relieve distress. Both obsessions and compulsions are significantly time-consuming in people with OCD and interfere with daily life.

How do I know if I have OCD?

The only way to know if someone has OCD is to be diagnosed by a healthcare professional. Some people may think they have OCD because they worry a lot or are too perfectionistic. They might have OCD, but they may have an anxiety disorder, a personality disorder, or other mental health conditions. See a healthcare professional if anxiety or behaviors are making you unhappy or interfering with your daily life.

What are common OCD behaviors?

People with OCD develop behaviors that help them avoid or relieve unwanted thoughts and urges. The behaviors themselves may be normal, like hand-washing  or arranging items on a desk. But compulsions are so ritualized or repetitive that they become extreme and interfere with daily life.

What’s next? Additional resources for people with OCD symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician

Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.

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