OCD phenomena are nearly universal, but in this disorder they are experienced at a severe and debilitating level. Core symptoms involve one or both of the following: 

• Obsessions. This term refers to recurring, unwanted and intrusive thoughts or images. These thoughts may bring a feeling of shame, but they are not a reflection of one’s authentic beliefs or wishes. A central phenomenon is doubt. Themes and content can vary, but here are common examples:
  • Contamination: fears of contacting something that is infectious or toxic.
  • Harm/violent: fears that one will be harmed or cause harm to someone else. 
  • Sexual: fears of having sexual attraction to, or behavior towards, an inappropriate target.  
  • Health: fears that one has a severe illness, or excessive worry about one’s physical symptoms (sometimes classified separately as health anxiety disorders). 

• Compulsions. These are recurring, irresistible acts and urges. Typically they are done physically but sometimes can be done mentally (in one’s own head). The central phenomena are avoidance and/or reassurance seeking.  Common examples include:
  • Washing/cleaning, typically done as a response to contamination obsessions (per above), but can exist as a standalone behavior. 
  • Checking for harm or potential harm- doors, locks, windows, closets, stoves, ovens. Other common examples include avoiding knives, and circling back to check if one caused a car accident.
  • Counting, typically focused on certain number patterns or ending numbers. 
  • Symmetry, such as with items in one’s environment or with how their body interacts with the environment (such as touching something on both sides). 

This diagnosis is commonly missed or misdiagnosed. Our experience is that misinterpreting these symptoms as moral failures, or dismissing them as simple quirks, can have unfortunate or even disastrous consequences.