How can I get diagnosed with OCD?

When you suspect you could be living with obsessive-compulsive disorder (OCD), you might feel tempted to ignore what’s going on or wish it would just go away. You may wonder if there’s another explanation—like an anxiety disorder—or if you’ve just got some personality quirks to work out. 

Because OCD is surrounded by so many misconceptions and stereotypes, it’s understandable to feel unsure about whether or not a diagnosis actually makes sense for you. If you’ve been struggling and battling it out with your thoughts, you may try to convince yourself you’re coping well enough on your own. But another part of you might wonder if you could live a fuller, freer life if you just got the help that you need. 

No matter your situation, it’s better to reach out sooner rather than later. Symptoms of OCD, among other mental health conditions, can get worse and take over more pieces of your life over time, says April Kilduff, MA, LCPC, LPCC, LMHC, a Clinical Trainer and licensed therapist with NOCD. But with the right support, you can determine what’s going on, get the relief of a clear diagnosis, and begin to regain control of your life with a research-backed treatment plan.  

To get an OCD diagnosis, you’ll need to meet with a mental health professional like a therapist, psychologist, or psychiatrist for a formal assessment. There’s no blood test, brain scan, or physical exam that can pinpoint a case of OCD. Rather, you’ll answer a series of questions about your symptoms and health history to see if you meet the criteria for a diagnosis of OCD. Before you schedule an appointment, it can be helpful to educate yourself on the basics of what OCD can look like, and what treatment might entail. 

What does OCD look like? 

OCD is a mental health condition that causes an overwhelming cycle of obsessions and compulsions. Obsessions are unwanted thoughts, urges, memories, sensations, feelings and/or mental images that cause intense distress. Compulsions are physical or mental repetitive behaviors you use to try to get rid of the obsessions and ease your anxiety. 

Symptoms of OCD can emerge at any age, but the condition tends to first appear in kids ages 8 to 12, or between the late teen years and early adulthood, according to the International OCD Foundation. Although seeking help can put you on a faster track to managing your symptoms, researchers estimate that for many people, it can take about 13 years to get the right diagnosis and treatment. Many people don’t get support until they’ve reached adulthood. Then, reflecting back, they can see that their symptoms had emerged even earlier in life.

Kilduff says that one of the most common misconceptions about OCD is that “we’re all a little bit OCD.” You might like having the clothes in your closet color-coordinated, or need your desk to be well-organized in order to focus. Or you may feel paranoid about getting sick. Ewww, I touched the handle on the grocery cart before I wiped it down. Germs! Where’s the hand sanitizer? “There’s this idea that you could have OCD and that it could be a good thing, but that’s not true,” she adds. “OCD is a horrible experience that can be very debilitating.” 

Anyone can become “obsessed” with a certain topic, feel the need to double-check that they turned off the stove from time to time, or have a particular morning routine they follow day to day. But with OCD, obsessions and compulsions are extreme, unwanted, and time-consuming. They can take an hour or more of your day, and disrupt your ability to show up fully at work, school, and in relationships. 

You might know that your thoughts are excessive or illogical, but you still can’t control or stop them. While it’s not enjoyable to do compulsions either, they may at least give you a sense of relief. Sadly, it doesn’t last.

Examples of OCD 

OCD can appear in many different ways, called subtypes, or themes. “OCD finds things that are meaningful to you in order to find the right buttons to push that will trigger and scare you,” says Kilduff. For you, being exposed to germs might not be a big deal. For someone else, it could be debilitating and totally throw off the course of their day. And you may be reallllly bothered if things aren’t organized just so, while another person could care less if there were clothes on the floor, or if the cereal boxes in the pantry weren’t perfectly aligned.   

“OCD is often a reflection of who you are as a person in terms of your values, what you care about, and how you live your life,” says Kilduff. “But what the disorder shows you is this awful reflection of what is almost the exact opposite of who you are. So you become afraid of, What if I become that person? Or Could I do this? OCD can literally go after anything, which leaves a lot on the table.” 

Here are a few examples of common obsessions and compulsions in OCD. 

Common obsessions in OCD 

There are many, many subtypes of OCD—so this is not an exhaustive list. But obsessions can include:

• Responsibility obsessions circle around the fear of being responsible for something terrible happening, like a fire or car accident. 
• Contamination obsessions flood you with thoughts related to the fear of touching perceived contaminated things such as germs, disease, household chemicals, radiation, or dirt. 
• Harm-related obsessions overwhelm you with the fear that you might hurt yourself or others, either on accident, or on purpose. 
• Perfectionism-related obsessions cause excessive concern with doing everything just right, or a need for correctness, evenness, exactness, or the need to know or remember something perfectly.
• Sexual obsessions can look like unwanted thoughts or mental images related to sex, such as fears of acting on inappropriate sexual impulses, or sexually harming others.
• Sexual orientation obsessions trigger excessive concerns with your sexual orientation or gender identity, like the fear that you may be gay and not know it or could suddenly “turn” into someone with a different sexual orientation. 
• Religious or moral obsessions can cause you to fixate on the fear of offending a higher being, being damned, blaspheming, or being morally right or wrong. 

Obsessions can also zoom in on specific life events, relationships, the meaning of life, or memories, among other themes. 

Common compulsions in OCD 

Along with obsessions, OCD can cause many different compulsions. These include excessive and repetitive physical or mental behaviors, such as:

• Washing and cleaning, like washing your hands, yourself, or objects repeatedly—or in a very specific way—over and over to avoid contamination.  
• Checking to ensure that you didn’t or won’t make a mistake, that you didn’t or won’t harm others or yourself, or that something terrible hasn’t happened. For example, you might make sure the door is locked five times before you go out to run errands, or worry that a pothole you hit might have been a person, and need to circle back to check. 
• Repeating routine activities like getting up or down from chairs, tapping, touching, blinking, or doing activities in multiples, such as flicking a light on and off four times because that’s the “right” number of times to do it.   
• Having mental compulsions like a repeated mental review of events to prevent harm, counting while performing a task, or “canceling out” or “undoing” the negative impact of obsessions or worries with specific types of thoughts in response, like replacing “bad” thoughts with “good” thoughts.  

Other compulsions include the need to arrange things until they’re “just right,” telling, asking, or confessing over and over again to get reassurance from others, or avoiding situations that could trigger obsessions. 

The tricky thing about compulsions is that they can make you feel better initially, but they also feed the cycle of OCD. And over time, acting out compulsions only reinforces the obsessions and compulsions in your brain, and makes OCD worse. 

But there’s a silver lining here: With professional support, you can learn how not to act on compulsions and, in time, break free of the OCD cycle. 

How is OCD diagnosed? 

OCD is diagnosed with a series of questions about your health history and symptoms. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5, to determine whether you’re living with OCD or another condition. 

To be diagnosed with OCD, you must: 

• Have obsessions, compulsions, or both 
• Lose more than an hour of your day to your obsessions or compulsions
• Experience significant distress or struggle to participate in important activities, like going to work, school, or social events due to your symptoms 

If you fit the bill for a diagnosis, your mental health care provider will continue to investigate your situation to determine the best treatment plan. “One psychological test is called the Yale Brown Obsessive-Compulsive Scale, also known as the Y-BOCS. Qualified OCD specialists use it to determine different obsessions you have, compulsions you’re engaging in, and the degree to which they’re impacting your functioning and quality of life,” says Kimberley Quinlan, LMFT, a therapist who provides treatment for OCD and related disorders. 

Another test that clinicians use is the Dimensional Obsessive-Compulsive Scale (DOCS), which can also help pinpoint the severity of your OCD symptoms, how much distress they’re causing, and the impact on your daily life.   

How do I know if I have OCD or something else? 

According to the DSM-5, it’s important for your provider to determine whether you’re living with OCD or another mental health condition. Some that can be confused with OCD include: 

• Generalized anxiety disorder. OCD can cause excessive worry and apprehension, which are symptoms of generalized anxiety disorder, or GAD. But if you have OCD, your anxiety is also accompanied by obsessions and compulsions.   
• Body dysmorphic disorder. Like OCD, body dysmorphic disorder causes excessive fear and accompanying behaviors to ease distress, like repetitively checking what you look like in the mirror, or adjusting your clothing. The main difference here is the focus of the anxiety: your appearance. 
• Eating disorders. Like body dysmorphic disorder, eating disorders have a lot of overlap with OCD. There’s a preoccupation with the body or food that comes along with compulsion-like behaviors like restricting food, counting calories, or binging and purging. The key distinction is the nature of the intrusive thoughts: Are they directed at losing weight or body shape, for example? OCD-related obsessions can range in theme, while eating disorder-related thoughts zoom in on the body and eating specifically. 
• Hoarding disorder. There’s a thin line between hoarding OCD and hoarding disorder. In hoarding OCD, there’s a clear pattern of obsessions and compulsions related to possessions. With OCD, you might not want to hold onto things—but you fear if you let go of them something terrible could happen. With hoarding disorder, on the other hand, it’s difficult to get rid of possessions because they’re valuable to you.  

It’s also possible to have OCD and another mental health condition at the same time. For example, more than 40 percent of people living with an eating disorder also have symptoms of OCD. And that’s why it’s important to seek help from a therapist who is qualified at diagnosing and treating OCD, as well as other mental health issues.

What’s the best treatment for OCD? 

If you think you have OCD, Kilduff recommends reaching out to a specialist for a formal assessment. Kilduff recommends connecting with NOCD or using the International OCD Foundation directory to find a clinician who specializes in working with people who have OCD, like the therapists here at NOCD. 

In terms of treatment, the gold standard is a type of therapy called exposure and response prevention (ERP). It’s been studied for decades, and has been found to be the most effective treatment for OCD. As the name suggests, there are two primary parts to this therapy: exposure and response prevention. For the exposure piece, you’ll deliberately expose yourself to triggers to bring up anxiety. (Don’t worry, your therapist will guide you, and you’ll start with small fears first.) For the response prevention piece, you’ll learn how to prevent yourself from acting on typical compulsions that are associated with your triggers. 

With ERP, the goal isn’t to stop intrusive thoughts entirely, because we can’t control our thoughts. But you can control your behavior, so the focus of ERP is on breaking the cycle of trigger → obsession → compulsion → temporary relief when the desire to act on a compulsion arises. 

To get started, you and your therapist will make a master list of all of your obsessions and compulsions. Then, you’ll gradually expose yourself to a hierarchy of triggers—again, beginning with ones that cause you the least distress and working your way up to more challenging situations. For example, if you have harm OCD, you may start by imagining yourself holding a knife, and eventually be able to hold a knife in real life. 

“The key is to learn in your brain and body that when your anxiety goes up, you don’t have to do anything special to make it go away,” says Kilduff. “Your anxiety will dissipate with time—because all emotions do. They are temporary states.” 

Determining whether or not you fit the bill for an OCD diagnosis is the first step to getting the care and support you deserve, no matter what you’re struggling with. Don’t hesitate to reach out.