Is OCD more common in women? What the research says
If you've ever read a health article that was clearly written with men in mind, with one little line at the very end saying "women may also experience this", you'll understand why I wanted to write this one properly.
I'm Charlotte, an OCD specialist therapist in the UK, and the question of whether OCD is different for women comes up a lot in my work. The short answer is that the research suggests women are a little more likely to have OCD, that it can show up at different moments in a woman's life, and that the treatment works just as well. So let's go through what we actually know, and what we don't know yet.
I spent 12 years in NHS and community mental health services, including NHS Talking Therapies, before moving into private practice. Across all of it, one sentence comes up again and again when someone first tells me about their OCD: "I feel like I'm going mad." If that's how it feels for you, I really want you to know how many people have said those exact words to me.
First, what's normal
Almost everyone has unwanted thoughts. A study across 13 countries found that around 94% of people had at least one unwanted intrusive thought in the past three months, like a sudden image of something awful happening or a doubt about whether you locked the door. Plenty of people also like a tidy home, double-check an important email, or worry when someone they love is late. None of that on its own is OCD.
So when might it be OCD?
OCD is a cycle of obsessions (thoughts, images, urges or doubts that keep coming back, feel unwanted and cause real distress) and compulsions (things you do, out loud or in your head, to make the distress settle or to feel sure).
Clinicians usually start thinking about OCD when that cycle causes real distress, takes up a lot of time, often more than an hour a day, or gets in the way of daily life. Only a qualified professional can say whether it's OCD, so if anything here sounds familiar, it's worth asking rather than guessing.
Is OCD more common in women?
The research suggests it is, a little. A large review that pulled together 34 studies from around the world found that women were about 1.6 times more likely than men to have OCD at some point in their life, with roughly 1.5% of women and 1.0% of men affected (Fawcett and colleagues, 2020).
That pattern also seems to change with age. A review of gender differences in OCD suggests it may be slightly more common in boys during childhood, then more common in girls and women from the teenage years onwards (Mathes and colleagues, 2019). The researchers are honest that the findings are still mixed, and one of the directions they want to look at next is the role of reproductive hormones.
Can OCD look different in women?
OCD can be about anything a person cares deeply about, so there's no "women's OCD" and "men's OCD". That said, the same review picked up a few patterns that are useful to know about:
When it starts. Women more often describe OCD beginning during or after puberty, or during or after pregnancy.
What the fears are about. Women more often report contamination fears, and aggressive or harm-related intrusive thoughts, the kind that feel completely against who you are.
What comes alongside it. Women with OCD tend to report more depression and anxiety alongside the OCD.
That middle point matters a lot. Harm thoughts are some of the most frightening thoughts a person can have, and they're also some of the most likely to be kept secret. In one study, psychologists who were given short case descriptions of OCD missed it 38.9% of the time, and the ones about taboo thoughts were missed more often than the ones about contamination (Glazier and colleagues, 2013). When someone is too frightened to say the thought out loud, and the people around them don't recognise it, OCD can stay hidden for a long time.
Why hormones might matter
I know this one personally too. My own OCD has been at its loudest during times of big change, stress and insecurity, and hormonally, in pregnancy and after having my children.
Many women with OCD notice that it isn't the same all month, or all through life. In a study of 542 women with OCD, a big share said their symptoms got worse at particular points (Guglielmi and colleagues, 2014):
37.6% before a period
33.0% during pregnancy
46.6% after having a baby
32.7% around menopause
These are women looking back and describing their own experience, so it doesn't prove that hormones cause OCD, and lots of women in the same study noticed no change at all. What it does suggest is that if your OCD seems to get louder at certain times, you're far from the only one, and it's a really useful thing to tell your therapist. I've written more about each of these here:
What helps
The good news, and it really is good news, is that the review found no difference in how well treatment works for women and men. OCD is treatable and recovery is possible. The treatment NICE recommends first is CBT with exposure and response prevention (ERP), where we work together, at your pace, to gently face the doubt while you practise not doing the compulsion. Other approaches like I-CBT and ACT can help alongside it.
If you'd like to understand your own loop a little better first, my free guide Is this OCD? walks through the loop, the compulsions people often miss, and where to go next.
Other places to find support
your GP, who can talk through options and refer you
in England, NHS Talking Therapies, which you can refer yourself to
OCD-UK (ocduk.org), the national OCD charity
OCfree (ocfree.co.uk), the OCD support hub I co-founded with OCD therapist Jess Eden
Quick answers
Tap a question to open it.
How do I know if what I'm experiencing is OCD?
OCD usually involves unwanted thoughts, images or doubts that feel distressing, and things you do to try to feel better or more certain, such as checking, avoiding, seeking reassurance or going over things in your mind. Only an assessment can tell you whether it is OCD, and you don't need a diagnosis to get in touch.
Does CBT with ERP work for OCD?
CBT that includes Exposure and Response Prevention (ERP) is the treatment recommended for OCD in NICE guidance and by the NHS. Many people find their symptoms reduce with it. Everyone responds differently, so we review how it's going as we work.
Do I need a diagnosis or a GP referral?
No. You can contact me directly.
How much does private OCD therapy cost?
Sessions are 50 minutes and cost £120, or £660 for a block of six (£110 per session). A free 15 to 20 minute consultation by phone or video is available if you'd like one first.
When you're ready
I work with adults online across the UK, and I'm a BABCP accredited CBT therapist with 12 years in NHS and community mental health services. You don't need to have it all figured out before you get in touch.
For bite-sized OCD support most days, come and find me on Instagram at @the_floral_therapist.
Charlotte
Research mentioned in this post
Fawcett, E. J., Power, H., & Fawcett, J. M. (2020). Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. Journal of Clinical Psychiatry, 81(4), 19r13085.
Mathes, B. M., Morabito, D. M., & Schmidt, N. B. (2019). Epidemiological and clinical gender differences in OCD. Current Psychiatry Reports, 21, 36.
Guglielmi, V., Vulink, N. C. C., Denys, D., et al. (2014). Obsessive-compulsive disorder and female reproductive cycle events. Depression and Anxiety, 31(12), 979-987.
Glazier, K., Calixte, R. M., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25(3), 201-209.
Radomsky, A. S., et al. (2014). Part 1: You can run but you can't hide: intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269-279.
If you feel unsafe, or worried you might act on a thought, call 999 or go to A&E, call NHS 111 and choose the mental health option, or call Samaritans free, any time, on 116 123.
This post is educational and isn't a replacement for therapy. Please speak to an OCD specialist or contact your GP for further support.
Comments