| Fears of germs or contamination |
- Repeatedly washing hands, bathing, showering, using anti-bacterial wipes or hand-sanitizer
- Excessively changing clothes, washing clothing or surfaces; asking parents to wash clothing more than once to get it “clean”
- Avoiding touching “dirty” surfaces such as doorknobs
- Avoiding touching others, not playing with classmates or siblings
- Avoiding being touched
- Avoiding contact play or sports - either because of a fear of catching a disease or a fear of contaminating another person or child
- Seeking reassurance that they or others are not “sick” or “dirty”
- Avoiding certain products or surfaces because they may contain “poison” (such as cleaning products, chemically-treated lawns)
- Avoiding public places, especially public washrooms
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Fears that harm, illness, or death will befall oneself or others; fear of causing harm to oneself or others including violent or aggressive obsessions (fears of killing or injuring oneself or another person; molesting a child**)
**Note: Individuals with OCD who have violent/aggressive thoughts neither have a history of violence nor act upon these ideas or urges
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- “Checking” behavior such as making sure doors and/or windows are locked
- Checking that parents are OK
- Making sure the stove is turned off, that appliances such as a coffeemaker or toaster are unplugged or that lamps and light switches are turned off
- Returning to a location repetitively to check that a person or animal has not been harmed. For example, a young child riding a bicycle may become convinced that he or she ran into a dog or bird, and circles back over and over again to the spot where this may have occurred to make sure no animal is lying there injured or dead.
- Reading a paragraph over and over again to prevent harm from coming to a pet
- Unreasonable avoidance of ordinary places, objects, situations, animals or people that may trigger fears of harm (avoiding clay because it might be "contaminated")
- Unreasonable avoidance of people or animals, for fear of causing them harm (e.g., avoiding a parent for fear of stabbing him or her; avoiding a child for fear of inappropriate sexual interactions with that child)
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| Fears/feelings/urges related to having something "just right," "just so," or "perfect" |
- Repeatedly revising the way words are written to make them look "just right"
- Extreme slowness with activities, chores or school work due to time spent ritualizing
- Repeating something until it looks, sounds or feels "just right" or is in a certain order or pattern
- Repeating actions over and over again because of an urge to do so
- Avoiding a hallway in which one must walk repetitively until it feels "just right"
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| Fears/feelings/urges related to discarding something (e.g., fears that something bad will happen or feelings of incompleteness if something is thrown away); fears of contamination that prevent an individual from touching an item; need to buy items in multiples of a particular number (OCD-based hoarding) |
- Saving useless items--scraps of paper, candy wrappers, bottle caps, broken items; being unable to part with things that are not needed any more
- Holding on to items that might be needed sometime in the future, such as books, toys, food, school papers, clothing
- Buying items in multiples of a certain number (e.g., child buys pencils in multiples of 3 because it's his "magic" number)
- Accumulating items/objects in an area (e.g., bedroom floor) because they are "contaminated"
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| Excessive fears of violating religious or moral rules (scrupulosity) |
- Praying; saying prayers/mantras a certain number of times; excessive praying to atone for being "bad"
- Repeatedly confessing perceived "sins" or bad behavior (e.g., cheating, lying)
- Repeatedly asking if something has been done wrong
- Avoiding answering questions for fear of telling a lie
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| Fears/feelings/urges related to symmetry or order |
- Constantly evening up items or groups of items, such as books on a shelf; aligning edges to be "just right" or "even;" tying shoelaces until they are both "perfect"
- Rearranging items to be in a certain order to prevent harm, e.g., shoes on the closet floor, CDs on a shelf, arranging clothing in a specific order or in certain color groups
- Getting dressed or eating breakfast in a precise order
- Avoiding a room with square tiles; seeing the tiles would necessitate tracing each of the edges with the eyes
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| Fears/feelings/urges related to numbers, e.g., "good" numbers, "bad" numbers, "magical" numbers |
- "Counting" behavior such as counting up to a "good" number; touching or saying words a certain number of times to "magically" keep harm from coming to another; silently counting or counting items with the eyes
- Brushing hair a particular number of times in order to "feel right"
- Avoiding "bad" numbers on a worksheet
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| Fears/feelings/urges/images related to sexual content |
- Seeking reassurance that one is not gay or lesbian, even though the individual is heterosexual
- Excessive praying to atone for having inappropriate sexual thoughts
- Avoiding magazines, TV programs, etc., for fear of seeing something sexually-related
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| Excessive doubting/dread of uncertainty |
- Checking a backpack excessively to be certain all the necessary items are in it
- Returning home several times after leaving to ensure that the door is really locked
- Staying away from a school locker to avoid having to check the lock over and over again
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