Symptoms of obsessive-compulsive disorder (OCD) vary, but are divided into 5 categories: symmetry, contamination, unacceptability, harm, and hoarding

Obsessive-compulsive disorder (OCD) is characterized by distressing and repetitive thoughts (obsession) that often compels a person to perform a repetitive action or behavior (compulsion). 

Symptoms of OCD vary from person to person, and doctors usually categorize them into specific groups.

5 main symptoms of OCD

1. Symmetry OCD symptoms

OCD often presents with an urge to keep everything in order, symmetry, or perfection. The person may tend to spend hours positioning objects symmetrically or write or rewrite lists repeatedly. Failure to keep things in order can make them feel stressed and anxious. They may have a fear that disorganization may cause unrelated harm to them or their loved ones.

Examples of symmetry OCD

• Need for order, neatness, symmetry or perfection
• Keeping everything on their desk neat 
• Making labels on cans in the pantry face all face the same way
• Leveling all wall hangings

Common obsessions of symmetry OCD

• Constant worry that something bad will occur if an object at home or work is uneven (pillows on the bed or books on the bookcase)
• Intense anxiety over asymmetry
• Extreme need for stability, such as placing items symmetrically or walking with the same pressure on each foot

Common compulsions of symmetry OCD

• Writing a set number of words on each line on a page and keeping words directly symmetrical
• Rewriting words and letters until there are no noticeable flaws or asymmetries in handwriting
• Arranging clothes or shoes in a specific manner
• Avoiding areas with symmetrical geometric shapes, so that they do not feel the need to trace the edges with their eyes

2. Contamination OCD symptoms

The person may be constantly worried about being contaminated with dirt or germs, causing them to perform various compulsive actions to combat the fear and anxiety.

Examples of contamination OCD

• Fear of germs or dirt
• Bathing, cleaning, or washing hands repeatedly
• Refusing to touch doorknobs or shake hands (although this may be seen in normal people as well, due to the fear of COVID-19)
• Cleaning items frequently

Common obsessions if contamination OCD

• Extreme fear of getting “contaminated” by touching certain substances or items in particular places
• Obsessive fears about sticky residue, grease, or dirt on body or clothing
• Obsessive fears about HIV, blood, cancer, bodily fluids, feces, or urine
• Extreme fear of being coughed or sneezed on
• Fear of wearing clothes that have been contaminated 
• Fears of spreading contaminants around house, car, personal belongings, or bedroom

Common compulsions of contamination OCD

• Repeatedly washing and cleaning oneself (washing hands, disinfecting, showering, or bathing)
• Excessive and ritualized showering that may be time-consuming
• Avoiding public spaces
• Avoiding touching other people
• Changing clothes often or discarding clothes or other items that have become “contaminated”
• Seeking reassurance that they have not been “contaminated”

3. Unacceptability OCD symptoms

Unacceptability symptoms are characterized by intrusive, aggressive, sexual, or religious thoughts and can affect anyone regardless of gender, ethnicity, or age. These intrusive thoughts can cause

• Distress
• Anxiety
• Panic attacks

Examples of unacceptability OCD

• Hurting loved ones
• Causing harm to strangers
• Mentally repeating something
• Saying something loud

Common obsessions of unacceptability OCD

• Intense fear of acting on an undesirable yearning
• Fear of contamination
• Fear of committing a sin
• Constantly second guessing one’s sexual orientation
• Fear of harming themselves or others

Common compulsions of unacceptability OCD

• Impulsively repeating a ritual to reduce anxiety
• Checking oneself or others to ensure that everyone is safe
• Ruminating (continually thinking)
• Seeking reassurance from others
• Intense desire to perform a task with perfection
• Avoiding objects, places, or people that can trigger intrusive thoughts
• Constantly praying while doing other tasks

4. Harm OCD symptoms

Harm OCD is characterized by the fear of hurting oneself or loved ones. The person may have mental images of violence against themselves or others. As a coping mechanism, they may avoid the person or situation that triggers these symptoms.

Examples of harm OCD

• Fear of hurting themselves or their loved ones
• Constantly checking on their loved ones

Common obsessions of harm OCD

• Fear that one day they will break and hurt a loved one or themselves
• Fear of executing a violent act
• Fear of giving into a violent desire
• Worry about acting on an impulse, such as stabbing or killing someone
• Worry about committing suicide before hurting someone
• Anxious about falling unconscious and harming themselves without even knowing

Common compulsions of harm OCD

• Compulsively checking themselves and others to confirm they have not harm anyone
• Avoiding people or situations that may trigger this fear
• Seeking reassurance from others to ensure that they did not do any harm
• Mentally going over their memories to ensure they did not harm anyone
• Avoiding knives, pens, or other sharp objects to prevent harming someone

5. Hoarding OCD symptoms

Hoarding OCD is characterized by having difficulty in letting things go. The person may tend to collect things that have no value and are completely useless.

Obsessions associated with hoarding OCD

• Difficulty organizing things
• Strong positive feeling (joy or delight) when acquiring new items
• Strong negative feelings (guilt, fear, anger) related to getting rid of items
• Strong beliefs that things are “valuable” or “useful” even when other people consider them useless
• Feeling responsible for objects and sometimes thinking of inanimate objects as having feelings
• Denial of a problem even when the clutter or accumulating interferes with a person’s life

Compulsions associated with hoarding OCD

• Difficulty getting rid of items
• Collecting things to form clutter in the home, office, car, or other spaces
• Being unable to stop taking free items, such as flyers or sugar packets from restaurants
• Buying things just because they are a “bargain” 
• Not allowing family or friends into the home due to shame or embarrassment
• Denying people into the house to make repairs