OCD (obsessive-compulsive disorder) is a mental health condition that is defined by two main types of symptoms: obsessions and compulsions. People who have OCD experience overwhelming and distressing intrusive thoughts, images, urges, sensations, or feelings, and then turn to compulsive actions (mental or physical) as a way to cope with the discomfort that those triggers bring. It’s a distressing condition that can leave the people who suffer from it locked in a constant cycle of fear and ritualistic behaviors.
Research on OCD is an ever-evolving field, and we’re constantly learning more about the impact that this condition can have on the people who have it. One specific area of interest that researchers are still studying is how OCD is likely to present in people of different genders. In this article, we’ll explore the unique symptoms that women with OCD tend to struggle with more often, and why those differences might exist.
Must-know stats about women and OCD
- Women are 1.6 times more likely to have OCD than men.
- In general, men with OCD are more likely to start developing symptoms during childhood, but women are more likely to start in adolescence and adulthood.
- Women with OCD tend to have significantly more depression and anxiety than others.
- Women are more likely to have obsessions that center around themes like contamination and cleaning than other people.
- Women are also more likely to report symptoms of somatic OCD, a kind of OCD that focuses on physical sensations like breathing, blinking, or swallowing.
- OCD is more common in people who are pregnant and postpartum than in the general population.
- When comparing men and women, research suggests that men with OCD are more likely to be single while women with OCD are more likely to be married.
- Some studies have indicated that about 20-42% of women experience worsening OCD symptoms in the week before their periods.
Factors that affect OCD symptoms in women
Though OCD is diagnosed based on the same criteria for all genders (looking for the presence of long-term obsessions and compulsions that negatively impact your quality of life), it’s also an individualized condition that can have many different fears and themes depending on the unique values of the person who has it. It’s also clear that there are some marked differences and trends in the way that women tend to experience OCD versus others. But why might this be?
The explanation for this difference appears to be multi-faceted. While more research still needs to be done to determine the exact reasons that women experience OCD differently than others, these differences may be, in part, due to both nature and nurture. There is evidence that hormones can play a role in OCD and how it manifests in women, and there is also reason to believe that it can be further influenced by societal expectations and lifestyles.
Hormones
Hormones can be thought of as chemical messengers that your body uses to communicate. They play a number of important roles throughout your body including mood management. Some research suggests that the hormone fluctuations unique to women may influence the symptoms and severity of OCD in women.
The hormones estrogen and progesterone are good examples of this. While estrogen and progesterone are necessary parts of everyone’s hormonal profile, the levels tend to be especially significant in women. Estrogen and progesterone levels aren’t steady; in fact, they fluctuate every month in women who menstruate. Their levels can also change, sometimes dramatically, during various life stages including puberty, pregnancy, and menopause.
As it turns out, these fluctuations can also play a role in your mood. For example, the week before a period, estrogen and progesterone tend to drop, and this change is thought to be linked to symptoms of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) like anxiety and mood swings.
Even more interestingly, these fluctuations also appear to influence how women experience mental health conditions like OCD. According to the Anxiety & Depression Association of America, both estrogen and progesterone levels can play a role in managing your anxiety levels. As a result, there’s evidence that they can directly influence the severity of OCD symptoms in women during periods in which their hormone levels are irregular, and symptoms can become more severe depending on where a woman is in her menstrual cycle.
This is further highlighted in other cases like premenstrual dysphoric disorder (PMDD). PMDD is a severe and diagnosable form of PMS. People who have PMDD report having severe symptoms in the week before their period including irritability, mood swings, hopelessness, depression, feeling overwhelmed, anxiety, and/or a decreased interest in their usual activities.
Licensed therapist with NOCD April Kilduff, LCPC, LMHC explains that she sees some patients with OCD who also have PMDD, and the PMDD symptoms in the week before their periods often coincide with worsening OCD symptoms as well.
“The week before their periods, their OCD and anxiety are through the roof. We can tell where in the cycle they are based on how much their anxiety presentation changes,” she explains.
In addition to their monthly cycles, estrogen and progesterone levels also fluctuate wildly during and in the months following pregnancy. As a result, this may also be a potential explanation as to why people who are pregnant or postpartum tend to be at a higher risk of developing OCD than others.
Estrogen and progesterone aren’t the only hormones involved in this phenomenon, either. Some researchers hypothesize that another reason OCD may manifest during this time is because pregnancy can lead to an increase in the “stress hormone” cortisol and DHEA. The changes in these hormones can then lead to a decrease in the brain chemical serotonin, which is also linked to OCD symptoms.
External factors and social expectations
Social expectations and lifestyle factors are other factors that may influence how OCD affects women differently than men.
The reason that OCD can be so debilitating is that it tends to latch on to the things that people with OCD care about most, triggering doubt, uncertainty, and fear around some of the most important things in their lives. As a result, therapists will sometimes see certain trends in the kinds of fears that their female patients have.
For example, this seems to play a major role in instances of OCD in pregnant and new mothers. While the hormone levels may play a role in the development or worsening of OCD symptoms, the actual experience of pregnancy and motherhood may influence the kinds of fears that pregnant and postpartum women experience.
Kilduff explains that she has seen several women who are postpartum or pregnant who have OCD, and they also often experience specific subtypes of OCD like Harm OCD and Pedophilia OCD (POCD). With both of these OCD subtypes, the mother will experience intrusive thoughts that they may somehow hurt their own children which, unsurprisingly, can be incredibly distressing.
However, it’s important to note that people who have themes of harm or pedophilia in their OCD do not mean that the mother wants to hurt their children—in fact, it’s likely the exact opposite.
Because the fears that people with OCD experience are often related to their top priorities and values, Kilduff theorizes that a potential reason that new moms with OCD will have Harm or Pedophilia OCD may be because of how important motherhood is to them. “Part of this can come from the ‘mom’ role and being the caretaker and making sure nothing bad happens to their kids,” explains Kilduff. “They really, really value their kids, and we know that OCD goes after what you value. So it’s not really a surprise when I see moms with Harm and Pedophile OCD. I tell them it’s just a sign of how much you actually love and care about your kids, and that’s why OCD has picked on it.”
The same societal and familial expectations may also be a potential explanation for why women reportedly tend to experience more contamination and cleaning themes in their OCD. While Contamination OCD is one of the most commonly known kinds of OCD, studies suggest that women are more likely to have these kinds of obsessions while men tend to have more themes of sexual, religious, and checking fears in their OCD. Therefore, if one of the roles that someone has in their household is to keep their house clean and their family safe, they might experience more OCD-related fears that lead to compulsive cleaning and checking.
Top OCD themes or subtypes that affect women
While OCD is a highly individualized condition whose symptoms can vary based on what a person values most, there are some trends that both therapists and researchers have seen specifically in women.
For example, studies have consistently shown that Contamination OCD is one of the more common forms of OCD experienced by women, and it is also one of the best-known forms of OCD in general. People with this kind of OCD will have obsessive and intrusive thoughts about potential contamination by germs, either of themselves or of others, and they may respond with compulsive behaviors like excessive hand washing and cleaning.
As mentioned before, Harm OCD and Pedophilia OCD are also fairly common subtypes in women, especially in pregnant or post-partum mothers. People with Harm OCD will typically have unwanted intrusive thoughts about hurting others around them. Meanwhile, Pedophilia OCD is a subtype in which people may have intrusive thoughts about whether or not they are attracted to children. Again, these two trends are often seen in mothers who highly value their children and motherhood as a whole.
Additionally, there are also some other trends that Kilduff has seen in her practice that specifically surround relationships. “I have pretty consistently seen more women with Relationship OCD and Sexual Orientation OCD,” she says. People with Relationship OCD will have fears that focus on their relationships, their partners, or both. Meanwhile, people with Sexual Orientation OCD will have intrusive thoughts that question their own sexual orientation.
She describes treating several women patients of hers who fear that they may be lesbians despite being in heterosexual relationships. “It’s simply because they have relationships with men that they care so much about,” she says. “OCD comes in and says, ‘Wait, what if you’re not even into men? What if you need to break up with your boyfriend and start all over again?’” Once again, these fears target people’s values—in this case, their relationships.
OCD treatment for women: Is it unique?
Even though women can sometimes experience different trends when it comes to the themes and subtypes of OCD, the best treatment methods are exactly the same as they would be for anyone else.
Exposure and response prevention (ERP) therapy is the gold standard treatment for OCD no matter your gender. People who have OCD often have a hard time accepting discomfort and anxiety, but ERP therapy aims to help them better deal with it. ERP involves confronting your triggers in a safe environment and learning how to better deal with the anxiety and distress that your intrusive thoughts bring, rather than engaging in compulsive behaviors. By working with a therapist trained in ERP, you can gradually face your fears and ultimately break the vicious cycle of OCD.
ERP works extremely well for all different kinds of OCD, making it suitable for most OCD patients, no matter what their core fears and worries are about.
The only potential difference in treating women might be to check for co-occurring hormonal issues like PMDD, says Kilduff. If you have a co-occurring issue like PMDD that may be exacerbating your OCD symptoms, working with a therapist to address both issues concurrently may help more than ERP alone.
Get on the road to recovery, no matter your gender
OCD can feel scary and overwhelming, but the good news is that it is highly treatable and there is hope out there. Regardless of your gender or any other aspect of your identity or background, you can recover from OCD and regain the parts of your life that the condition has taken away.
If you or someone you know may be struggling with OCD, NOCD can help. NOCD Therapists work with a diverse group of patients, helping address their unique fears and anxieties no matter what they are. I recommend learning more about NOCD’s accessible, evidence-based approach to OCD treatment.