A Look Into Symmetry OCD
Ann-Marie D'Arcy-Sharpe
December 14, 2020
Dr. Dianne Stevenson
I am a Clinical Psychologist, with over 12 years experience working in private practice. I work with adults that are struggling with a range of mental health issues. These most commonly include OCD, anxiety, low mood, emotional dysregulation, trauma, relationship difficulties, and stress.
There are many themes or topics obsessive compulsive disorder (OCD) can centre around. Symmetry and order is one of these themes. We’ll take a look at what symmetry OCD is, how it affects an individual, and what can be done to tackle symmetry OCD symptoms.
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What is symmetry OCD?
Before we can look at symmetry OCD, we need to understand the cycle of OCD. OCD is a mental illness which is categorized by a cycle of obsessions, anxiety, and compulsions. Let’s start with obsessions. Intrusive thoughts are thoughts which can pop into your mind at any time. They’re often focused on themes which are disturbing or taboo, and which don’t typically reflect your true feelings. Everyone experiences intrusive thoughts. People without OCD might think an intrusive thought is strange, but they won’t dwell on it and so it will pass. Someone with OCD will be very distressed by their intrusive thoughts and will focus on them intently: these become obsessions.
Obsessions cause high levels of anxiety and emotional discomfort. This leads someone with OCD to desperately try to find a way to lessen these feelings and to deal with their obsessions. This is when compulsions enter the equation. Compulsions are repetitive or ritualistic actions the person with OCD carries out to try to deal with their obsessions. They can take up many hours of the day.
At first the compulsions may slightly ease the individual’s anxiety, but before long this anxiety will come back. It’s typically much stronger when it does. This drives the person with OCD to carry out increasing numbers of compulsions to desperately try to regain that relief.
This cycle of obsessions and compulsions can be debilitating.
As we mentioned at the start of this article, obsessions and compulsions can follow a range of themes. Obsessions and compulsions which focus on symmetry and order are often referred to as symmetry OCD. This is a nickname for the type of obsessions and compulsions the individual with OCD is experiencing. Symmetry refers in essence to two or more sides or ‘parts’ of something being identical. For example, at school we learn that if we draw a line down the middle of a shape and both sides mirror one another, then it’s symmetrical. The definition of symmetry is, “the quality of being made up of exactly similar parts facing each other or around an axis.”
Symmetry OCD causes an individual to be fixated on items and behaviours being symmetrical or ordered in a very specific way. Their obsessions with symmetry may make them feel very uncomfortable and distressed with anything that doesn’t meet their sense of order. They may fear what will happen if this order isn’t kept. Symmetry obsessions are fairly common in those with OCD, with between 36% and 50% of adults with OCD experiencing them.
Compulsions in symmetry OCD will focus on ordering, arranging, and generally ensuring that things are sticking to the strict symmetry rules that the individual’s OCD has set out for them. This article on the topic explains: “People with orderliness and symmetry OCD often display compulsive behaviour linked to arranging and ordering objects and the visual presentation of specific items.”
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How do symmetry obsessions present?
There are a few ways in which symmetry obsessions may present in an individual with symmetry OCD. It’s important to keep in mind that we’re all individuals, so we may all experience obsessions in different ways and to varying severities.
An urge to arrange and order
Someone with symmetry obsessions will feel an overwhelming urge to arrange items in a symmetrical way. This could be any items and objects within the home such as clothing in the wardrobe; objects on a shelf; or even food on their plate. They may also experience these urges in any other location they visit, such as a friend’s house, a workplace, or a supermarket.
Aside from the urge to make items symmetrical, they may also feel a strong urge to make behaviours symmetrical and ‘balanced’. For example, if they are sitting at their desk at work and move one foot, they may experience a powerful urge to move their other foot in the exact same way. If they’re picking something up, they may feel the need to ensure that they are doing so evenly with both hands. If they are walking, they may feel the urge to ensure they put the same amount of pressure on both feet. This might even extend to their posture, for example wanting their shoulders to be exactly even and level.
The individual will find these urges very hard to ignore. It’s likely that they will be very focused on these feelings, to the point that they may feel overwhelming. For some, it may feel like an itch they need to scratch and can only resist for so long. If they encounter something which does not meet their idea of order, they are likely to feel very distressed.
Fear and extreme anxiety
Someone who experiences these obsessions will experience a great deal of fear and very high levels of anxiety. Anytime they come across a situation which triggers their obsessions, such as walking into a family members home and seeing a shelf of unorganized items, they will find their anxiety rising to very high levels.
It’s likely that someone who experiences symmetry obsessions will hold high levels of fear about what will happen if things don’t line up with their need for order. They might fear something terrible will happen to themselves or someone they love. They may have a deep set sense of fear of something awful happening, but be unable to pinpoint exactly what that could be. Even if they know logically that these fears are not grounded in reality, they will still experience those emotions.
Discomfort with anything asymmetrical
As well as the fear caused by their obsessions, someone who has symmetry OCD will also experience a general discomfort with anything they come across which is asymmetrical. This can happen even in situations they don’t find triggering. They will still notice asymmetry and find it uncomfortable. This article from Beyond OCD explains that someone with symmetry OCD will experience, “an intense reaction to anything believed to be asymmetrical – words on a page, shoelaces on shoes, or any number of things that “don’t line up evenly.”
A feeling of incompleteness
Some people with symmetry OCD will feel a sense of incompleteness or simply feel that something isn’t right when things are asymmetrical. This feeling can drive the urge to carry out compulsions and make things symmetrical. They might experience this feeling alongside fears of what will happen if they don’t carry out compulsions, or they might experience it instead of that fear.
This 2020 article on the topic explains that for some people, “there’s no elaborate obsessional belief structure or feared outcome that drives these behaviors, but rather, intense somatic (physical) and/or psychological tension or discomfort, often described as something feeling incomplete or ‘not right.’”
Symmetry compulsions
Symmetry compulsions can present themselves in a number of ways. Just as we mentioned with the obsessions, we’re all different so compulsions can affect us in various ways and may be experienced differently. We’ll cover some of the basic ways symmetry compulsions can be experienced.
Even if the individual is aware that their compulsions are not logical, they will feel driven to carry them out anyway, either for fear that something bad will happen if they don’t, or because they feel incredibly uncomfortable. Compulsions can take up a lot of time, getting in the way of daily functioning and becoming severely debilitating.
Arranging and ordering
As you might expect, many symmetry compulsions focus on arranging and ordering items to meet the individual’s idea of ‘just right’ or ‘perfect symmetry’. As we mentioned earlier, this can be literally any item, in any location. It may be items in the home, objects on the desk at work, items on a supermarket shelf, words the individual is writing on a page, and so on.
The individual may focus on arranging items in a specific order, such as by colour, size, or number. If they’re focused on exact numbers of items, they may throw away certain items or buy new ones to ensure they are exactly as they ‘should be’. An individual might have their own ordering method and rules which their OCD has set out in their mind.
‘Evening up’ items
Some compulsions may focus on ‘evening up’ items, which simply means ensuring that they are evenly spaced or balanced. As with arranging and ordering, this can apply to any item. It may be arranging food on a plate, for example lining up chips next to each other to ensure they’re all facing the same way and are evenly spaced. It could be adjusting books on a bookshelf, so that the spines all form one even line. The list goes on.
‘Evening up’ behaviour
As well as evening up items, this can also apply to behaviour. If someone with these compulsions touches a surface with one hand, they may immediately need to even this behaviour up, by touching the same surface in the exact same place with their other hand. This article states: “Even autonomous actions, such as walking, can become a cause for concern. Somebody with symmetry OCD may deliberately focus on applying the same amount of pressure on the ball of each foot when putting one foot in front of the other.”
An individual might also have a specific number of times they need to carry out certain behaviours. For example, they might need to touch or tap a surface each time they pass it 10 times with both hands. It’s easy to see how this can become time consuming and distressing.
Avoidance
Avoidance is a common compulsion in all forms of OCD. People tend to avoid anything which may trigger their obsessions. A ‘trigger’ refers to any situation which may remind them of their obsessions or evoke the negative emotions associated with their obsessions. Once obsessions are triggered, the need to carry out compulsions will soon follow. While it may seem logical to avoid triggers, the behaviour is a compulsion in itself because it perpetuates the cycle of OCD. By avoiding obsessions, it reinforces to the brain that they are important and to be feared.
Someone with symmetry OCD may try to avoid situations they know may be distressing, such as environments which have the potential for asymmetry. For instance, they may withdraw socially and avoid going to visit friends and family, for fear they will see asymmetrical items in their loved ones home. They might avoid going to a shop for the same reason. This article explains that they are also likely to avoid, “a particular area or room with floors or walls containing symmetrical geometric shapes such as bathroom tiles; seeing the tiles would necessitate tracing each of the edges with one’s eyes.”
Re-doing
Self doubt is a common theme in people with OCD. Many compulsions focus on the need to re-do or re-check actions to ensure they have been done, often because the individual doesn’t trust themselves or their memory. Those with symmetry OCD often need to re-do arranging, ordering, and evening up actions until they feel ‘just right’ or until they can be certain that they’ve done them correctly. This re-doing action can continue for minutes or even hours at a time.
How does symmetry OCD affect daily life?
How severe the symptoms are for each individual will vary, as will the impact on their daily life. For some who have more specific triggers, they may find that their symptoms are easier to manage. For others with more general triggers or triggers which are experienced in many daily situations, they might find that their OCD feels overwhelming. In all cases, living with OCD is very challenging and can be difficult to manage. Where symmetry OCD is severe and left untreated, it can infiltrate every aspect of an individual’s life.
When obsessions are all consuming, they can make it difficult to focus on what else is happening in the moment. This can affect your ability to concentrate at work for example, or when in a conversation with a loved one. We’ve already discussed how compulsions can take up a great deal of time. There might be many compulsions which are carried out at different points throughout the day. This can make you late for life commitments, such as work, meeting up with friends, appointments and so on. Understandably this can lead to problems with functioning.
Being regularly late and struggling to focus can cause problems at work and school. It might also be that compulsions take over in these environments, meaning that the individual needs to stop a task and carry out compulsions. It’s easy to see how this could cause issues. The International OCD Foundation states: “Productivity can be greatly affected – as can attention (e.g., if the individual is more focused on the sound quality of a speaker’s voice, or the rhythm of the words being spoken, than the content of a presentation).” These issues can cause people with symmetry OCD to find it difficult to keep a job or stay in school. It can also be difficult to set goals for the future when your performance is so greatly impacted.
Many people with the disorder withdraw socially, whether it’s due to the avoidance compulsions we talked about or because their anxiety is too high. Some people find that their obsessions and compulsions take up so much of their attention, that they don’t have time or energy for socializing. Often loved ones find it difficult to understand symptoms and may become frustrated if you are not giving them your full attention. This can lead to tense connections with others and often social isolation.
Living with such a difficult disorder can lead to reduced confidence and a confused sense of self. It’s common to be very hard on yourself. Someone with the disorder might not recognise who they are and what their life has become in comparison to before they had symmetry OCD. The impact that symmetry OCD has can lead to depression and a lack of hope for the future. It’s vital to note here that things are far from hopeless: there are effective treatments which can help you to get your OCD under control. We’ll discuss treatments later in this article.
What causes symmetry OCD?
There is no one known definitive cause of OCD. However, there are multiple promising theories of what causes OCD in general. For symmetry OCD specifically, there are a few factors which seem to make symmetry obsessions and compulsions more likely. The first is gender. Symmetry symptoms seem to be more prevalent in men generally. It also seems that those who develop OCD at an earlier age are more likely to struggle with symmetry obsessions.
Symmetry in OCD has also been linked with an increased comorbidity with tic disorders, such as Tourettes. We’ll discuss this in more detail soon. It also seems that there is a link between high rates of suicidal ideation and suicidal behaviours in those with symmetry OCD.
OCD has a strong genetic basis, which means that it often runs in families. Findings suggest that symmetry OCD has high levels of genetic underpinnings. This article states: “familial OCD (compared to sporadic OCD) has also been found to be associated with increased compulsions, particularly ordering, i.e., one aspect of the symmetry symptom dimension.”
A large range of scientific data has shown that the neurotransmitter dopamine is involved in OCD. Neurotransmitters are like little chemical messengers: they play lots of vital roles and keep important parts of our brain and nervous system in communication with one another. The neurotransmitter dopamine is responsible for helping us to regulate our emotions and enabling us to feel pleasure. It also plays a vital role in how we think, assess situations, concentrate, and plan. You can see how when levels of dopamine are effected, it could contribute to symptoms of OCD. In particular, animal studies have revealed that levels of dopamine are specifically involved in symmetry and the perception of symmetry.
Tic disorders vs symmetry OCD
Tic disorders, the most well known being Tourettes, and OCD are commonly comorbid, which simply means they occur together. In fact, this article explains that: “Over a lifetime, 30% of people with OCD will experience a tic disorder as well, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).” Research suggests that genetics could play a significant part in causing this overlap of disorders, as well as aspects of how the brain and nervous system work within these patients.
Tics can be described as, “sudden, rapid, repetitive, nonfunctional motor behaviors (motor tics) or vocalizations (phonic tics), which are often preceded by premonitory (warning) sensations.” Essentially, a tic disorder causes a build of tension within the body that must be relieved by a tic being expressed.
Tic disorders and symmetry OCD share some similarities. Both disorders create a sense of physical discomfort, which then requires a physical action to relieve the sensation. Often tics and symmetry compulsions may look very similar from an outside perspective. However, there are distinct differences between the two. Tics are involuntary, uncontrollable movements. Compulsions, although distressing and despite often feeling out of control, are behaviours which are actively ‘decided on’ as a result of the OCD cycle. This article on the matter explains that, “Tics are considered involuntary compulsions – OCD compulsions are habitually learnt behaviours that are repeated over time to achieve that ‘just right’ feeling.”
What to do if you have symptoms of symmetry OCD
If you think symptoms of symmetry OCD it can be a worrying time, particularly if you are not already diagnosed or getting treatment. It’s important to remember that although it can be difficult, you can get things back under control and gain relief from your symptoms. There is hope.
Track your symptoms
It’s always a good idea to track your symptoms by noting them down. You could use a diary, a note pad, or even your phone. Keep track of things like what symptoms you’re experiencing; how they affect you; how regularly they occur; and anything else you feel is important. This helps both you and any doctors you see to get a clearer view of what you’re experiencing.
Talk to someone you trust
Living with symptoms of OCD can be very isolating. Talking to someone you trust, like a friend or family member, can help you to feel less alone. They may be there to support you as you seek help and learn how to manage your disorder. Opening up to someone can sometimes feel like a weight has been lifted off your shoulders.
Do some research
Doing some research about the symptoms you’re experiencing can help you to figure out what you’re going through. It can allow you to understand the reasons behind what you’re experiencing and aid you in getting help. The more you know about your disorder, the better equipped you will be to cope with it.
Seek treatment
Although the idea of seeking treatment can be really frightening at first, it’s so important that you do. Remember that getting treatment is how you can reclaim your life and overcome your OCD. You can seek treatment by going to your doctor or speaking to a mental health professional if you’re already under the care of a mental health service. You may be able to self-refer for some psychological therapies depending on where you live. Other options include seeking treatment privately or using an online OCD treatment programme. Take your time to figure out what fits in with your budget, your needs, and what’s best for you.
Learn how to self manage your symptoms
Once you have begun treatment, it’s important you are very proactive. Treatment for OCD takes hard work and dedication. You need to ensure that you attend all of your sessions and that you are actively involved. Ensure that you do any ‘homework’ you’re given between sessions. Be sure to speak up if you have questions.
It’s also extremely important you learn how to self-manage your symptoms so that you can continue managing your OCD in the long term. You’ll learn a lot of these skills during therapy and can continue applying them after your sessions are over. You can also choose to do extra reading to get more informed. You’ll learn over time to be more aware of your symptoms and you’ll begin to identify your triggers. This will help you to deal with triggers head on and regulate your emotions before they reach a crisis point.
Remember to be kind to yourself along the way. This is a learning process, which means you will make mistakes and have setbacks. Setbacks do not mean you are failing! They are part of learning. It’s how you continue on after a setback and what you learn from it that’s important.
Find support
Having support is really important. The more support you have, the better! You can seek support from your loved ones. Open up to them, let them know what you’re going through, and allow them to be there for you. They might offer practical help, such as taking you to appointments. They might just be there to listen. If you feel comfortable with it, close loved ones might even be able to get involved in your therapy so that they can learn how to help you more effectively.
You can also find support from local support groups. Talking to other people who are going through similar struggles can help to reduce that sense of isolation. You can be there for one another and even form ongoing friendships. You could also find support online through social media or mental health forums. Finally, if you need someone to talk to and don’t have someone you feel you can turn to, you can utilize helplines. Many mental health charities provide free helplines you can call to talk to someone. You can do a quick internet search which can let you know what is available in your area.
Treatment for symmetry OCD
There are a range of treatments available for symmetry OCD. Some research shows that treating symmetry OCD can be more challenging than some other forms of OCD, but that doesn’t mean it isn’t possible. The psychological treatments we’ll discuss are proven to be effective and can help individuals with symmetry OCD to reduce their symptoms and live a full, happy life.
Medication
Medication is not typically prescribed as the sole method of treatment for OCD, however it may be prescribed alongside psychological therapy to help patients get the most out of their therapy. The medications usually given for OCD are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). They help to correct chemical imbalances within the brain. They can help to lessen anxiety and treat any symptoms of depression at the same time. In this report on the topic, the International OCD Foundation states: “Antidepressant medicines can help, either together with CBT or before starting CBT (to reduce overall levels of anxiety).”
Cognitive behavioural therapy (CBT)
CBT is the first line of treatment for OCD.This article states: “CBT (cognitive behavioural therapy) is a tried and tested treatment method for many types of OCD, including orderliness and symmetry OCD.” CBT is a talking therapy which helps patients to identify thought patterns and behaviours which are feeding into their OCD cycle. Once they have learnt to recognize these thoughts and actions, they’re taught how to change them. Ultimately, CBT will lead to patients replacing negative patterns with positive, helpful thoughts and behaviours to help them overcome their OCD.
Exposure and response prevention (ERP)
ERP is a form of CBT which is used to help patients break the OCD cycle. During ERP, patients are guided through facing their fears. They’ll gradually face situations which trigger their obsessions, without reacting with compulsions. This is done by starting with the least feared scenario and working up.
With each situation experienced without reaction with compulsions, the individual is able to see that nothing bad happened. In the case of symmetry OCD, they are also able to see that they were able to withstand the feeling of discomfort experienced. With this success, gradually the anxiety caused by these situations will lessen. Over time, patients begin to feel more in control and able to reduce their OCD behaviours.
Mindfulness
Mindfulness is a relaxation technique which allows you to be present in the moment, experiencing everything in a non-judgemental way. Mindfulness is proven to reduce anxiety and stress, to help with emotional regulation, to improve sleep, and so much more. Mindfulness techniques can involve breathing exercises, meditation, and guided visualization. Mindfulness is often integrated into the other psychological therapies we’ve mentioned, to help patients get the most out of their therapy.
References
Christine Lochner, Nathaniel McGregor, Sian Hemmings, et al, (2015), “Symmetry symptoms in obsessive-compulsive disorder: clinical and genetic correlates”. Brazilian Journal of Psychiatry, Rev. Bras. Psiquiatr. vol.38 no.1 São Paulo Jan./Mar. 2016 Epub Aug 18, 2015.
Access CBT, (2020), “Orderliness and Symmetry OCD”.
Beyond OCD, (2019), “Extreme Need for Symmetry or Exactness”.
Marla Deibler, PsyD, (2020), “”Just Right” OCD”. Very Well Mind.
Jeannette Reid, M.S., Eric Storch, Ph.D.,Adam Lewin, Ph.D, (2009), ““Just Right” OCD Symptoms.” International OCD Foundation.
Anxiety House Brisbane, (2017), “OCD vs Tics – What’s the Difference?”
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