8 signs of high functioning OCD – how to spot them in yourself and others
The signs of high-functioning OCD are often subtle and easy to miss. Here's what you should be looking out for.
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Many people with high functioning OCD don’t even realise they have the condition, preventing them from seeking the support they need. Here’s how to spot the signs.
On the outside, everything might appear to be completely fine. But beneath the surface, your mind is constantly battling obsessions, compulsions and intrusive thoughts.
This is the reality for those living with high functioning OCD, a form of obsessive-compulsive disorder that often falls under the radar and regularly gets mistaken for perfectionism, dedication or high ambition.
We caught up with Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic, to find out more about what high functioning OCD is and how to spot the signs in yourself and others.
What is high functioning OCD?
‘There isn’t a clinical distinction between high functioning OCD and other types,’ Dr Elena explains. ‘What we’re really talking about is someone whose obsessions and compulsions are just as intrusive, but who has developed such effective coping strategies that the consequences haven’t yet disrupted their work, relationships or daily life.’
While the coping strategies might be firmly in place, it’s important to note that this doesn’t mean the person is struggling any less. ‘The distinction isn’t about less severe symptoms. It’s about a particular capacity to mask things, which can actually delay seeking help,’ Dr Elena adds.
‘Someone might be running on empty internally, battling intrusive thoughts all day and performing rituals for hours, while appearing to everyone around them, including their loved ones, that everything is fine.’
What are the signs of high functioning OCD?
Unlike other forms of OCD, where compulsions and behaviours might be more visible, those with high functioning OCD often use rigorously practiced coping strategies to mask their behaviours. This means the signs are often hard to spot.
‘The signs of high functioning OCD are very often subtle enough that they can look like conscientiousness or dedication,’ Dr Elena explains. ‘Someone might be endlessly revising their work before sending it, for example. Or, they might be seeking constant reassurance from partners that the relationship is “right”.’
Another common trait is high levels of perfectionism. ‘You might notice excessive perfectionism in the person, for example through hypervigilance to detail or constant over-preparation for things in a way that seems to go beyond what the situation calls for,’ adds Dr Elena. ‘Often these patterns are mistaken for ambition, care, or conscientiousness, which is precisely why they’re so easy to miss.’
Signs to look out for:
- – Checking things multiple times
- – Obsessive levels of perfectionism
- – Regular intrusive thoughts
- – Constantly revising work before submitting
- – Hypervigilance to detail
- – Over-preparation for situations
- – Seeking constant reassurance
- – Performing rituals in private (e.g. hand washing, checking etc.)
What do to if you’re struggling
If the signs of high functioning OCD are ringing true for you – or someone you know – it’s understandable to feel shocked or confused. Many people with high functioning OCD think their behaviours are simply part of their personality, not signs of clinical OCD.
On the flip side, you might also be feeling relived to finally have a name for what you’ve been experiencing. ‘One of the most striking things about high functioning OCD is how incredibly isolating it can feel,’ says Dr Elena. ‘People are often very relieved to discover their experience has a name, because they’ve been carrying this internally for years without realising it was treatable.’
If you’re struggling, know that help is available. ‘If intrusive thoughts are regular, if rituals or mental compulsions are happening daily or if there’s a sense of significant internal distress beneath an outwardly fine exterior, it’s worth considering professional help,’ Dr Elena recommends.
The first step is to seek a diagnosis. Then, you can explore effective treatment options. ‘The diagnosis itself requires a proper clinical assessment,’ Dr Elena adds. ‘Reaching out to a GP or finding a private psychotherapist who has specific training in OCD is the first step.’
Treatment options
The good news is, there are effective treatment options available for those with obsessive compulsive disorder – including high functioning OCD.
‘Exposure and Response Prevention (ERP) is a specific type of cognitive behavioural therapy for OCD. It is backed by decades of research that shows it helps people gradually face feared situations and resist the compulsions that temporarily relieve the anxiety,’ Dr Elena explains. ‘Acting on such compulsions would reinforce the cycle, so you can think about ERP as essentially training yourself out of that cycle.’
‘There’s also emerging evidence for approaches like metacognitive therapy, which could help people change their relationship with intrusive thoughts rather than fighting them,’ she adds.
Along with different therapy options, some people also benefit from medication. ‘There are medications such as SSRIs (selective serotonin reuptake inhibitors) that can help reduce the intensity of obsessive thoughts for many people,’ says Dr Elena, ‘though these need to be assessed and prescribed by a qualified healthcare professional such as a psychiatrist or GP.’
Do I need to ‘treat’ my high-functioning OCD?
Some people with high functioning OCD might feel hesitant about receiving help. This is sometimes due to a fear that it might ‘change’ who they are.
‘There’s a kind of double bind, where the same perfectionism and conscientiousness that characterises the OCD is often what’s made someone so successful (for example, in their career). This can make it harder to imagine life without it,’ says Dr Elena. ‘But getting good help isn’t about losing those good qualities; it’s about reclaiming your internal freedom.’
If you’re hesitant about seeking help, Dr Elena emphasises that treatment does work – and that you don’t have to continue living like this. ‘Treatment works – the research is solid,’ she explains. ‘But it does require someone to show up honestly about what’s really going on beneath the functioning. That vulnerability is usually the hardest part.’
Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic. She works with adults and couples facing a wide range of challenges, including depression, anxiety, stress, personality disorders, OCD, eating disorders, adjustment difficulties, relationship difficulties, substance misuse and complex emotional difficulties. Find out more at thechelseapsychologyclinic.com.
