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Health A-Z

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Harvard Medical School

Symptoms

The two defining symptoms of OCD are obsessive thoughts and compulsive rituals. The symptoms are bad enough to be time-consuming, cause functional impairments or be significantly distressing.

Obsessions are persistent, repeated, anxiety-provoking or distressing thoughts that intrude into a person's consciousness. Obsessions vary and can relate to any kind of fear. Here are some common ones:

  • Fear of contamination Constant worry about having dirty hands or clothing, or about catching or spreading germs.

  • Fears related to accidents or acts of violence Fear about becoming a victim of violence (an unlocked door that admits an intruder) or suffering accidental bodily harm (an oven is not turned off or a cigarette is not properly snuffed out).

  • Fear of committing an act of violence or sexual misconduct Fear of losing control and doing harm to others, or committing a harmful or embarrassing sexual act. For example, a loving mother worrying about suffocating her infant, or a respectable businessman fearing he will take off his clothes in a meeting.

  • Fears that center on disorder or asymmetry An irresistible need for order, anxiety about the smallest out of place detail. Examples are socks not being aligned "properly" in a drawer or food arranged "incorrectly" on a dinner plate.

Often, an adult with OCD will recognize that the obsessive thoughts are not realistic and will try to ignore them or suppress them. But sometimes they get temporary relief by performing a compulsive ritual.

Compulsive rituals are persistent, excessive, repetitive behaviors. The goal of the ritual is to reduce the anxiety caused by obsessive thoughts. Examples include:

  • Repeated washing or bathing

  • Refusal to shake hands or touch doorknobs

  • Repeated checking of locks or stoves

  • Compulsive counting of objects

  • Over-organizing of work or household items

  • Eating items of food in a specific order

  • Repeating specific words or prayers

Anyone may feel compelled to recheck a locked door or wash hands to assure cleanliness. By themselves, such behaviors do not mean a person has OCD.

In OCD, the obsessions and compulsions are excessive and distressing. They are time-consuming, sometimes eating up several hours each day. They may interfere with personal relationships, as well as performance at work or school. Some compulsions may cause physical injury. For example, compulsive hand washing can lead to chapped hands and dermatitis, while excessive tooth brushing can cause torn, bleeding gums.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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