If unwanted thoughts keep coming back, or you feel you have to do certain things to feel okay, you may be wondering about the signs you may have OCD. It's a common question, and it can feel scary to ask. This guide describes what obsessions and compulsions can look like in plain words, including the ones people rarely talk about. It also explains how OCD differs from worry and perfectionism, and what a psychological assessment involves.
This article is general information, not a diagnosis. A list of signs can't tell you whether you have OCD, and nothing here should reassure you that you don't. Only an assessment can answer that.
Why this is not a quiz
You won't find a score at the end of this page. Many people have a few of these experiences without having OCD, and some people with OCD don't see themselves in every example. OCD can look very different from one person to the next.
What matters is the pattern: how often it happens, how much time it takes and how much it gets in the way. That's something a trained professional can look at with you, kindly and without judgment.
Obsessions, the thoughts and urges that keep coming back
CAMH describes obsessions as uninvited or intrusive thoughts, urges or images that surface in the mind over and over again. People with OCD usually know the thoughts come from their own minds, but they can't control, ignore or get rid of them.
CAMH lists some common themes:
Fear of contamination, such as dirt, germs or illness
Repeated doubting, such as whether the stove is off
A need for exactness and order
Religious or moral thoughts that feel forbidden
Fear of harming oneself or others
Fear of blurting out something inappropriate in public
Unwanted sexual thoughts, images or urges
Unwanted thoughts like these can feel shameful or frightening. Having them doesn't make you a bad person. The distress is part of why people hide them for years.
Compulsions, including the ones nobody sees
Compulsions are the rituals or actions a person feels driven to do to ease the distress. CAMH says people with OCD often try to reduce or suppress their obsessions by acting out certain rituals. Common ones include excessive cleaning or washing, checking, ordering and arranging, and hoarding.
Not every compulsion can be seen. CAMH also names mental rituals, such as praying, counting or repeating words. Some people replay a conversation in their heads again and again. The American Psychiatric Association also lists frequently seeking approval or reassurance among common compulsions. Our live post on Pure O and intrusive thoughts goes deeper into the form of OCD that is mostly in the mind.
How the cycle works
Many people describe OCD as a loop. An unwanted thought or doubt shows up, and anxiety rises. A ritual brings some relief, so the next time the thought appears, the urge to repeat the ritual is stronger. Our OCD counselling page puts it this way: compulsions work well to reduce anxiety in the short term, but over time they keep OCD going.
CAMH describes a similar idea. One theory it mentions is that people with OCD link certain objects or situations with fear, then learn to avoid them or to do rituals that lower the fear. That's why reassurance and avoidance can feel helpful in the moment, yet leave the problem in place.
What makes it more than a habit
Plenty of people have routines or double-check a lock. So when does it become OCD? CAMH says the main symptoms are recurrent obsessions or compulsions that interfere with a person's life. They are time-consuming, for example taking more than one hour per day, or they cause significant distress or problems at work, school, in relationships or elsewhere.
CAMH also notes that for people with OCD, rituals may become "stuck" and last for hours. Time and distress are the two ideas to hold onto. They matter more than the particular thought or habit. The American Psychiatric Association makes the same point: many people without OCD have distressing thoughts or repetitive behaviours, but for them these are not time-consuming, distressing or disruptive. With OCD, the behaviours feel rigid, as though they must be done, and not doing them often causes great distress.
OCD, anxiety and perfectionism, how they differ
These three can overlap, which is why it gets confusing.
Everyday worry. CAMH points out that everyone has bothersome worries now and again. Worries that consume a person are called obsessions.
Anxiety. CAMH describes OCD as an anxiety disorder. Someone can have OCD and other anxiety as well. NIMH notes that it's common for people with OCD to also have a mood or anxiety disorder.
Perfectionism. Wanting things done well isn't the same as OCD. MedlinePlus calls it a myth that OCD just means being neat. With perfectionism, high standards are often tied to achievement. With OCD, a person feels driven to do rituals to ease distress, even when they don't want to.
If you aren't sure which one fits, that's a good reason to talk to someone. An assessment is built to sort this out.
Common questions about the signs
Can you have OCD without visible compulsions? MedlinePlus says people with OCD may have obsessions, compulsions or both. Mental rituals are easy to miss because nobody else can see them.
Can the signs change over time? MedlinePlus notes that obsessions and compulsions can shift over time. A person who once worried about germs may later struggle with doubt or moral thoughts.
Is OCD just being neat? No. Cleaning can be one sign, but it's not the whole picture. What matters is the feeling of being driven to repeat something, and the distress and time that go with it.
When it's worth getting an assessment
You don't need to wait until things are at their worst. It may be worth asking for an assessment if:
Unwanted thoughts or rituals take up a lot of your day
You avoid places, people or tasks because of them
The thoughts or rituals are affecting your work, sleep or relationships
You feel distressed when you can't complete a ritual
You've kept this secret for a long time and feel stuck
CAMH says OCD is an anxiety disorder that affects about one adult in 40, and that it usually begins gradually.
What a psychological assessment involves
Our psychologists offer OCD assessments for adults, teens and children. Psychologists can assess and diagnose. Our OCD assessment page describes the steps, which include:
A clinical interview. You talk through your thoughts, behaviours, history and how they affect daily life.
Questionnaires. Standard tools help measure how often symptoms happen and how severe they are.
Looking at other possibilities. The psychologist checks whether something else, such as another anxiety or mood concern, explains what you're feeling.
Feedback. You receive a summary of the findings and recommendations for what could help.
Assessment fees depend on the service, and we go over them with you in your free consultation.
What support can look like
CAMH says people with OCD should get treatment specific to OCD from a fully qualified therapist, and that some forms of traditional psychotherapy do not relieve OCD symptoms. It adds that counselling, most often cognitive-behavioural therapy, is a main part of treatment. The American Psychiatric Association says a type of cognitive-behavioural therapy called exposure and response prevention is the first-line therapy for OCD, and that people who get appropriate treatment usually see improvement.
On our OCD counselling page, we describe using evidence-based therapies including Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) in Waterloo, Kitchener and Cambridge. Registered Psychotherapists (RPs) and Registered Social Workers (RSWs) provide therapy. Individual sessions are $130 to $200, and student therapists offer sessions for $0 to $80. Depending on your plan, your insurance may cover the full session fee.
If you're curious about medication, raise it with your prescriber or ask about our Nurse Practitioners, and don't stop anything on your own.
If the thoughts frighten you
Intrusive thoughts can be upsetting, even when you'd never act on them. Having a frightening thought is not the same as wanting it. If you feel unsafe, or you're thinking about harming yourself, call or text 9-8-8 any time, or call 911.
Start with a free conversation
You don't have to figure this out alone, or be certain of anything. Book a free 15-minute consultation to ask about an OCD assessment, our team and how we work. We don't have a waitlist. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario. No referral is needed. For background, NIMH has an overview of OCD.