OCD symptoms in women: why it's so often missed
Updated: 6 days ago
If you've been called "a bit of a worrier" so many times you've started to think it's your middle name, and something in you has always wondered whether there's more to it, this one's for you.
I'm Charlotte, an OCD specialist therapist in the UK, and one of the things I hear most from the women I work with is that it took years for anyone to name what was going on, usually somewhere after being told to try a nice bath and some chamomile tea. So let's talk about why that happens, and what to look out for.
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 (Radomsky et al., 2014), like a sudden image of something terrible happening, or a doubt about whether you locked the door.
Plenty of people also like things tidy, double-check an important email, or worry when someone they love is late home. 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, like work, relationships, sleep or parenting. Only a qualified professional can say whether it's OCD, so if this sounds familiar, it's worth asking rather than guessing.
Why OCD in women gets missed
It often looks like anxiety from the outside. Many compulsions happen quietly, in your head: replaying a conversation, checking how you feel, reviewing whether you did something wrong, or asking for reassurance in a way that just sounds like normal worry. Without the full picture, it's easy for anyone, including you, to call it anxiety.
It gets mistaken for a personality. Needing things to feel "just right", re-reading a message five times, or feeling responsible for everyone's safety can get filed under "that's just how she is", so the distress underneath goes unseen.
It can arrive alongside depression or postnatal depression. When someone is exhausted, low or overwhelmed, the OCD loop underneath can be missed, and the treatment that tends to help OCD most (CBT with exposure and response prevention, or ERP) may never be offered.
The thoughts can feel too frightening to say out loud. Many women with OCD have thoughts that go against everything they care about, about their baby, their partner, their faith or their own goodness. It makes complete sense to keep those quiet, and that silence is one of the biggest reasons OCD stays hidden.
When OCD can get louder for women
Research suggests OCD can start or get louder around big life and hormonal changes, such as:
puberty and the teenage years
pregnancy and the months after birth, often called perinatal or postpartum OCD
big jumps in responsibility, like a new job, a promotion, moving in together or a wedding
perimenopause and menopause
In my work I often find OCD feels more acute and intense in the luteal phase, the second half of the cycle, and in my own life it's been loudest at times of big change, in pregnancy and after having my children.
In pregnancy and after birth, the thoughts are often about the baby, and the compulsions can include checking on them again and again, avoiding being alone with them, or avoiding things like bath time or the stairs. If that sounds familiar, I've written more about perinatal OCD here: Perinatal OCD therapy.
OCD, ADHD and autism
More women are now being recognised as autistic or as having ADHD later in life, and these can sit alongside OCD or look a little like it from the outside. Repetitive routines, for example, can bring comfort and calm for an autistic person, while OCD compulsions are usually driven by fear or doubt and bring only brief relief. Telling these apart is a job for a specialist assessment, and you deserve one that looks at the whole of you.
What helps
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 what OCD makes you fear 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. Get the free guide here.
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.
Do I need a diagnosis or a GP referral?
No. You can contact me directly.
Can OCD be cured?
OCD is treatable and recovery is possible. There isn't a guaranteed cure, and I'd never promise one. With the right therapy, many people find OCD takes up far less of their life, and they know what to do when it flares up.
Do you offer OCD therapy online?
Yes. All sessions are online, so you can work with me from anywhere in the UK.
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
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. If you've recently had a baby and suddenly feel very unwell or not like yourself, please contact your GP, midwife or health visitor today.
This post is educational and isn't a replacement for therapy. Please speak to an OCD specialist or contact your GP for further support.
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