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A psychologist shares 4 subtle signs a patient has OCD, even if they don't realize it

A young woman looking at her partner and deep in thought
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  • Roughly 2-3 million US adults are believed to have obsessive-compulsive disorder (OCD).

  • Some forms of OCD have no outward compulsions, making OCD harder to diagnose.

  • A psychologist shared some of the more subtle symptoms of OCD.

Obsessive-compulsive disorder (OCD) is believed to impact roughly 2-3 million US adults. Yet, there are still misconceptions about what it can look like. If a person doesn't have the symptoms most often depicted in pop culture, such as a fear of contamination, their OCD can go undiagnosed.

Dr. Levi Riven, a clinical psychologist specializing in OCD treatment, told Business Insider that OCD is broadly defined by having obsessions around "distressing, unwanted themes or thoughts" that can drive them to doubt themselves and perform rituals and compulsions.

The reason symptoms like excessive hand-washing get noticed more is because they're more visible. "There is also a wide swath of experience that happens underneath the surface for people with OCD," Riven said. "It's very common to see individuals with OCD experience a lot of distress that can go entirely undetected by people in their lives because it's all happening privately in the mind."

For example, people with "pure OCD" can have mental obsessions, such as silent counting or repeating phrases in their head, but no external compulsions, making their OCD potentially harder to diagnose.

Riven said the majority of his clients don't exhibit many outward symptoms and have "obsessional doubt concerning the possibility of causing harm to others, committing sexually violent or taboo acts, or repressing their true sexual orientation."

He shared some of the lesser-known OCD symptoms, many of which can be subtle or tricky to spot.

1. Deeply analyzing intrusive thoughts

Riven said one of the major types of OCD is harm OCD, "where someone may have random, intrusive, violent thoughts or images."

He said everyone has intrusive thoughts, such as steering your car into the opposite lane, from time to time. But "someone with harm OCD may take the presence of the thought like that as a cause for doubt," he said.

To distinguish if it's a possible symptom of OCD, Riven asks questions to understand how much a patient analyzes those intrusive thoughts. Do they interrogate themselves about if they actually want to drive their car into the opposite lane? Do they worry about what it says about them that they had this thought in the first place? Do they feel terrified that they'll lose control and do something harmful to you or someone else?

"From that point, a person may try to reduce that distress by performing certain mental checks on themselves, by monitoring themselves to see if that's something they really want to do," he said. "So it's not dissimilar from checking a stove to make sure that it's off."

It's just that it's less noticeable to other people, but causes the patient consistent anxiety and interferes in their life.

2. Seeking lots of reassurance

According to Riven, one of the most common OCD compulsions that he sees is reassurance-seeking, "where a person may experience doubt and may turn to some external source to obtain certainty of some kind," he said.

For example, if a person has relationship OCD, they can experience frequent anxiety about being in the "right" partnership even when they love their significant other and logically know they're in a healthy relationship.

Riven said seeking reassurance can come out in different ways. Some people might constantly ask their friends to weigh in on their relationship, while others might compulsively scour Google, Reddit threads, or TikTok for information that validates how they feel.

While it's common to seek reassurance sometimes, Riven said the disorder is judged by how repetitive these compulsions are. If a person often asks their partner for "proof" that they love them (and keeps doing it no matter how many times their partner says "I love you"), that can be a possible sign of OCD.

3. Taking longer to get ready or finish tasks

Riven said that a disorder is usually defined by how much it interferes with the person's day-to-day life. For some people with OCD, he said a common symptom is "needing to perform a complex set of rituals" before leaving the house, thus causing them to be late or take a lot longer to get things done.

"That's a good indication that something is beginning to develop as a disorder, because it's becoming debilitating or disrupting the person's functioning," he said.

For example, an NICU nurse with OCD would take an extra 30-45 minutes to check that appliances in her home were turned off up to a dozen times. The daily ritual shortened her sleep schedule and ultimately impacted her mood.

4. Relationships are clearly impacted

Even if your obsessions never leave your mind, Riven said "OCD almost always influences relationships, because a person being under considerable distress does impact the people around them."

For example, he said a person with contamination OCD might make demands about cleanliness that feel stifling to their family members, or a person with relationship OCD might express constant doubts about the relationship, making their partner feel unloved.

OCD doesn't have to feel "severe" enough to be real

Because OCD can vary in severity, Riven said it can "go unnoticed for a really long time" and that it's not uncommon for someone to have a milder form of OCD that later becomes more prevalent after an external stressor, such as giving birth.

Additionally, "there are people who experience stigma and shame who may actively hide it or mask it," he said. They might not share obsessing over their intrusive thoughts or relationship doubts.

Some people don't get diagnosed with OCD until they're well into their 30s, even though they've had symptoms all their life. If you suspect you have OCD, it's good to seek out an official diagnosis so you can find the right treatment plan.

Read the original article on Business Insider