Obsessive-Compulsive Disorder (OCD) is more common than many people realize. Researchers estimate that around one in forty adults meets the diagnostic criteria for the condition, characterized by obsessive thoughts and compulsive behaviors intended to reduce the anxiety and doubt those thoughts provoke.
Family history, traumatic events, and differences in brain chemistry are all factors that may increase the likelihood of someone developing OCD. In this article, however, we’ll investigate whether gender can play a role too. We’ll also discover whether the signs and symptoms of OCD may be harder to spot in men or women, and look at whether men or women tend to respond differently to exposure and response prevention therapy (ERP)—the gold standard treatment for OCD.
What is OCD?
Before we look at how gender may affect the prevalence, diagnosis, and treatment of OCD, let’s get a handle on the common yet highly misunderstood disorder.
Though often casually tossed around to describe a desire for order, symmetry, or cleanliness, OCD is, in reality, a serious mental health condition that was first described back in 1877. It can be highly debilitating, often impacting the areas of people’s lives that mean the most to them.
The OCD cycle
Obsessions and compulsions, the two primary symptoms of OCD, contribute to a vicious cycle that tends to get worse when left untreated:
- Obsession: A specific thought, image, situation, or feeling that evokes anxiety or distress. This trigger leads to obsessions, which are intrusive and persistent thoughts, images, or urges that create significant distress. The obsessions are typically irrational, unwanted, and inconsistent with the person’s values or beliefs. Common obsessions include fears of contamination, doubts about safety, or concerns about harming oneself or others.
- Anxiety. The presence of obsessions triggers intense anxiety or fear.
- Compulsion: People engage in compulsive behaviors or mental rituals to alleviate this distress. Compulsions are repetitive actions or mental acts that people feel compelled to perform. Examples include excessive hand washing, checking, counting, or seeking reassurance. These compulsions are often done in an attempt to reduce anxiety or prevent perceived harm.
- Relief. The compulsions provide temporary relief, reinforcing the person’s belief that performing the compulsive behaviors is necessary to prevent harm or alleviate anxiety. The cycle repeats, strengthening the association between triggers, obsessions, and compulsions, and making symptoms worse over time.
As we mentioned above, OCD symptoms are experienced on a spectrum and can range from mild to completely debilitating. They can also take any number of forms, called themes or subtypes. Here are just a few more common examples:
- Contamination OCD: Excessive fear of contamination or germs, leading to compulsive cleaning, avoidance of certain objects or places, and heightened hygiene rituals.
- Order and Symmetry OCD: Obsessions with symmetry, order, and exactness, resulting in compulsive behaviors like arranging objects in a particular way or repeating tasks until they feel perfect.
- Perfectionism OCD: Uncomfortable feeling that things are not “just right” or are incomplete, leading to repetitive actions or rituals until a sense of completion or satisfaction is achieved.
- Harm OCD: Persistent and intrusive thoughts or fears of harming oneself or others, accompanied by compulsive behaviors to prevent harm.
- Relationship OCD: Obsessive doubts, fears, or uncertainties about romantic relationships, leading to repetitive reassurance-seeking, analyzing behaviors, and seeking proof of love or compatibility.
Now that we’ve gotten a general understanding of the disorder, it’s time to return to our main topics: the ways gender might impact OCD’s prevalence, symptoms, severity, and treatment.
OCD prevalence and gender
“Whether OCD shows up in one gender more than the other is a valid question given that many conditions, physical or mental, demonstrably do,” says Dr. Patrick McGrath, NOCD’s Chief Clinical Officer. “With OCD, the answer to that question is a little more nuanced.”
McGrath explains that OCD shows up in more young boys than young girls, but by the time children come into their adolescence, more females present with symptoms, essentially catching up with the boys. “As kids approach adulthood, it’s pretty much evened out,” he says.
Other ways gender may relate to OCD
But that doesn’t mean that gender doesn’t impact how people experience conditions in other ways. One example offered by Dr. McGrath is some women report that their OCD symptoms can feel worse at specific points in their menstrual cycle, suggesting that hormones may play a role.
McGrath explains that unlike ADHD—a mental health disorder that often shows up differently in boys and girls, there’s little evidence to suggest that OCD symptoms manifest differently depending on gender. Some research has shown, however, that there are gender-based differences concerning OCD subtypes.
Specifically, boys and men tend to exhibit a higher prevalence of obsessions related to harm or sexual themes, as well as compulsions related to symmetry, perfectionism, and counting. On the other hand, females are statistically more likely to have obsessions related to contamination fears and compulsions centered around maintaining cleanliness and organization. Furthermore, the onset of OCD after the birth of a child (often called postpartum OCD) is twice as likely to occur in women than in men.
There may also be gendered differences in how OCD affects people’s lives. One large study conducted in Brazil found that men with OCD were more likely to be single (61% of men compared to 47% of women), unemployed (20% compared to 14%), and living with their family or in assisted living facilities (50-66% compared to 20-40%). Some studies, however, suggest that women generally experience more severe OCD symptoms, while others have found no significant differences at all.
Another gender difference with OCD is coexisting or co-occurring conditions. Men with OCD are more likely to experience substance-related disorders, whereas women with OCD are prone to experience mood and anxiety disorders.
And, while people of all genders generally respond the same to ERP—the first-line treatment for OCD—there is a marked gender difference in the number of people who seek treatment. That shouldn’t come as too much of a shock: studies have shown that women are more likely to turn to a professional for all kinds of medical help than men, and do so sooner.
This means that, en masse, more women than men are taking back control of their lives with ERP. Our goal is for everyone to conquer OCD with effective, evidence-based treatment, regardless of gender.
ERP: The gold standard treatment for OCD
Exposure and Response Prevention (ERP) therapy is highly effective in treating OCD in men and women, leading to successful results in 80% of people who go through treatment.
ERP involves gradually exposing you to situations that trigger obsessive thoughts or fears while preventing you from engaging in compulsive or avoidant behaviors. ERP aims to help you develop more other ways of coping with your distress that reduce the power of your obsessive fears rather than reinforcing them and making them stronger over time.
In ERP, you’ll be exposed to situations that trigger your anxiety, such as reading about a rare illness online and then preventing yourself from checking your body for signs of it. As you progress through treatment, you and your therapist will move on to more difficult exposure exercises, continuing to resist compulsions as you go.
Soon, you’ll learn to tolerate the distress associated with uncertainty and develop more reasonable approaches to keeping yourself healthy. This will allow you to live life as you want, according to your knowledge, values, and decisions, rather than being ruled by fear and compulsive behaviors. Moreover, significant improvements can often be seen in as few as 12 weeks of ERP.
If you think you might have OCD and are interested in learning how it’s treated with ERP, schedule a free 15-minute call with the NOCD Care team to learn how it can help you.
The gender diversity of the NOCD Therapy network helps all therapy members find the right match for them, and all of our therapists specialize in OCD and receive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.