OCD Symptoms and Diagnosis Obsessions in Obsessive-Compulsive Disorder (OCD) The Types of Obsessions in OCD By Marla Deibler, PsyD Marla Deibler, PsyD Facebook Twitter Marla W. Deibler, PsyD, MSCP, is a licensed clinical psychologist and nationally-recognized expert in anxiety disorders and other mental health topics. Learn about our editorial process Updated on November 17, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Maskot / Getty Images Obsessive-compulsive disorder (OCD) is a mental health disorder in which a person experiences repeated thoughts (called obsessions) that drive them to perform certain actions (known as compulsions) to alleviate the anxiety the thoughts cause. In a given year, approximately 1% of adults in the United States have a diagnosis of OCD. Males often show symptoms of OCD in childhood, but females are affected at a higher rate by adulthood. OCD can appear in any person at any age, but the average age of onset is 19.5 years. 25% of people with OCD have symptoms by the time they're 14 years old. OCD, Obsessions, and Compulsions Defined The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines diagnostic criteria for “Obsessive-Compulsive and Related Disorders." To be diagnosed with OCD, a person must meet the following criteria: The presence of obsessions, compulsions, or bothThe obsessions or compulsions are time-consuming (more than one hour per day) or cause significant distress or impairment in one’s daily functioningThe symptoms are not better accounted for by the physiological effects of a substance, medical condition, or other mental illness Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or urges that cause anxiety or distress. People with OCD attempt to ignore or suppress obsessions, or have to neutralize them by performing a compulsion. Compulsions, on the other hand, are repetitive behaviors or mental acts a person with OCD is driven to perform in response to an obsession or according to a rigid set of rules that govern them. Compulsions are clearly excessive or not connected in a realistic way to the problem they are intended to address. The 5 Types of OCD Obsessions and Compulsions Obsessions often involve a feared outcome, such as being responsible for harm to oneself or to others or being seen as unethical, immoral, or imperfect. For example, someone with OCD may become obsessed with the worry that they will unintentionally cause a fire in their home due to carelessness. The fear may become so overwhelming that it drives them to perform compulsions to minimize the perceived potential for harm and decrease the anxiety and distress they feel. A person dealing with a harm obsession related to fire might need to check all the outlets in their home before leaving the house to reduce the perceived risk that a fire will occur. Doing so drastically diminishes the anxiety associated with the obsession. Compulsions are also commonly misunderstood and can vary from one person with OCD to the next. How OCD Obsessions Can Change Over Time Types of Obsessions Contrary to common misunderstandings about OCD, being "obsessed" is not the same as thinking about something or someone often with fondness and deriving pleasure from the thoughts. Obsessions in OCD are distressing, time-consuming, and fear-driven. Characteristics of OCD Obsessions Internal experiences occur repeatedly, are unwanted, and feel as though they are outside of the individual’s control.They cause a great deal of discomfort, such as anxiety, disgust, fear, and may be overwhelming.The persistence of these ideas interferes with the person's ability to attend to other things of importance to them. While the exact content and nature of obsessions will vary from one person with OCD to the next, there are some common themes. Contamination Common obsessions related to contamination can include dirt, germs, bodily fluids, disease, environmental contaminants, or chemicals. Harm People with harm obsessions may fear of harming themselves or others, be afraid of being responsible for something bad happening, or unintentionally causing harm. When people with OCD have harm-related obsessions, they do not necessarily fear that they will intentionally do harm. Instead, they might fear unintentionally causing harm through carelessness, which can lead to checking compulsions (like needing to check all the outlets in their home before leaving). Unwanted Sexual Thoughts A person with OCD may have intrusive, unwanted, forbidden, or perverse sexual thoughts. These obsessions can take the form of images or impulses concerning homosexuality, sexual thoughts about children, incest, rape, or sexual aggression. Religiosity/Scrupulosity People with OCD may have obsessive thoughts, worries, or concerns about moral judgment and behaviors (or "being good"). If they are religious, they may be worried about offending God or blasphemy. Losing Control Some people with OCD fear that they will lose control. They worry about harming themselves or others through impulsive verbal acts, such as insulting someone or saying something taboo or forbidden, or physical acts like stealing or violence. The mental imagery of these obsessions may be aggressive or even horrific in nature. Perfectionism "Just right" OCD obsessions are concerned with evenness, exactness, symmetry, a need to know or remember, being driven to adhere to rigid routine or expectation, and an overall need for something to feel "just right." Physical Illness Separate from contamination obsessions related to germs, people with OCD can also have obsessions around illness and disease. They may be preoccupied with worries that they have a disease or that they will get one. Sometimes, people with OCD are hyperaware of bodily processes like swallowing or breathing. These somatic obsessions can contribute to obsessions related to illness, pain, or disease. Hypochondria and OCD Are Not the Same Thing Superstitious Beliefs A person with OCD may believe that certain numbers, colors, words, or phrases are "lucky" or "unlucky." If the latter, they may go to great lengths to avoid them, or, if they are unable to do so, use compensatory compulsive behaviors to quell the anxiety. A Word From Verywell People who have OCD have unwanted, intrusive, and often distressing thoughts that preoccupy their minds much of the time. To deal with these thoughts, and the anxiety or fear they case, a person with OCD often needs to engage in compulsive behaviors. The obsessions and compulsions that define OCD can have a significant and negative impact on someone's life. However, there are ways to manage the condition. Many people with OCD find relief with a combination of therapy and medication. Support groups, both online and in-person, can also be of enormous benefit for people with OCD (as well as their loved ones) by providing resources, information, or simply a compassionate, listening ear. Tips for Living Better With OCD 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Obsessive-Compulsive Disorder (OCD). National Institute of Mental Health (NIMH). American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596 What Is Obsessive-Compulsive Disorder?. American Psychiatric Association (APA). What Is OCD?. International OCD Foundation. Clark DA, Radomsky AS. Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. 2014;3(3):265-268. doi:10.1016/j.jocrd.2014.02.001 Navigating Hyperawareness Obsessions. Sheppard Pratt. Additional Reading Obsessive-Compulsive Disorder (OCD) - Psychiatric Disorders. Merck Manuals Professional Edition. Hirschtritt ME, Bloch MH, Mathews CA. Obsessive-compulsive disorder. JAMA. 2017;317(13):1358. doi:10.1001/jama.2017.2200 By Marla Deibler, PsyD Marla W. Deibler, PsyD, MSCP, is a licensed clinical psychologist and nationally-recognized expert in anxiety disorders and other mental health topics. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for OCD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.