High-functioning OCD: Symptoms, Causes, and More

OCD is a chronic and debilitating mental illness affecting millions worldwide. The disorder is characterized by obsessions (intrusive, unwanted thoughts) and compulsions (unwanted urges to perform behaviors). While most people are familiar with common obsessions like contamination or symmetry, many other types of obsessions can occur in patients with OCD.

One such type is “high-functioning” OCD, a subtype of OCD where the sufferer experiences symptoms that may not fit the classic definition of OCD. While it can be similar to other forms of the disorder, it also has unique characteristics that distinguish it from other types of obsessive-compulsive behavior. Let’s take a deep dive into it.

What Is High-functioning OCD?

High-functioning obsessive-compulsive disorder (H-OCD) is an anxiety disorder where someone has OCD symptoms that is not as severe as low-functioning OCD. The person can still function normally without significant disruption in daily life or work activities.

People with H-OCD tend to be less affected by their obsessions compared to those with low-functioning OCD, although they still experience some level of distress. The symptoms may also vary from one person to another depending on how severe their condition is and how much stress it causes them.

What Are the Symptoms of High-functioning OCD?

The symptoms of high-functioning OCD can be more challenging to diagnose because they tend to be less evident than those of other types of obsessive-compulsive disorder.

People with high-functioning OCD can often maintain their daily routines despite obsessions and compulsions, making it difficult for others to notice anything wrong. Some people even go years without treatment for their OCD because they hide their symptoms so well.

High-functioning OCD symptoms can vary from person to person, but they usually fall into two categories:

Obsessions. 

These are unwanted thoughts or impulses that cause significant distress and anxiety. People with high-functioning OCD may obsess over germs, dirt, contamination, religious or moral beliefs, sexual thoughts; orderliness; perfectionism; control issues, and other topics related to functioning.

Compulsions. 

These repetitive behaviors or rituals are meant to reduce anxiety caused by obsessions. For example, suppose you are obsessed with cleanliness and fear getting sick from touching something dirty. In that case, you might constantly wash your hands until they’re raw, even though there’s no evidence that washing will prevent illness.

High-functioning OCD usually appears as a milder disorder in which people experience intrusive thoughts. Still, they don’t perform compulsions or rituals to try to reduce those thoughts. 

For some people with this type of OCD, their obsessions never become strong enough for them to need to perform compulsions. Other people with high-functioning OCD may perform compulsive behaviors when their obsessions start and then stop performing them once they get used to having the thoughts.

What Causes High Functioning OCD?

There is no single cause of high-functioning OCD. A combination of factors can result in symptoms, including:

Genetics.

A family history of obsessive-compulsive disorder (OCD) or other mental illness may increase the risk of developing the condition.

Environment. 

Stressful events and trauma are linked with an increased risk of developing OCD.

Brain differences. 

Brain scans show that people with OCD have different brain activity than healthy people when they think about something that makes them anxious or upset. This suggests that their brains may be wired differently from other people’s brains.

Apart from the causes mentioned earlier, high-functioning OCD can be caused by the following:

Stress.

Stress can make high-functioning OCD symptoms worse. If you have high-stress levels in your life, your risk of developing high-functioning OCD goes up significantly.

Anxiety.

People with anxiety disorders often experience similar symptoms as those with high-functioning OCD — including intrusive thoughts and compulsions — so it can be difficult to tell whether someone has one or both of these conditions. Some studies suggest that having one anxiety disorder increases your risk of developing another — like high-functioning OCD — later.

How Is High-Functioning OCD Different From Other Forms of OCD?

High-functioning OCD is often confused with other obsessive-compulsive disorder (OCD) forms. It’s essential to understand how it differs from the other forms of OCD so you can get the proper treatment.

Some key differences are:

• You may know your obsessions and compulsions but not identify them as problematic.
• You might be able to control your symptoms by using specific strategies, like avoidance or distraction.
• You might be able to manage your symptoms by using positive affirmations or self-talk.

There’s no clear line between high-functioning and low-functioning OCD; instead, it’s a continuum or spectrum in which some people experience milder symptoms while others experience more severe ones. The clinical severity of OCD is measured by an instrument known as Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the treatments are usually based on the scale’s score thresholds.

How to Treat High-Functioning OCD?

It’s essential to realize that high-functioning OCD is an actual condition that needs to be treated. The good news is that there are effective treatments for high-functioning OCD, including:

Cognitive behavioral therapy (CBT)

​​Cognitive behavioral therapy (CBT). CBT helps people with various mental health conditions by teaching them how to change their thoughts and behaviors. This type of therapy may include exposure and response prevention (ERP). ERP is a type of exposure therapy aimed at helping you overcome fears and phobias. For example, if you have contamination fears, ERP will help you confront the things that trigger your worries so that they become less potent over time.

Medication

CBT often uses medications to help manage anxiety symptoms and reduce compulsive behaviors. Examples of common medications used to treat high-functioning OCD include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and antipsychotics or mood stabilizers.

Final Thoughts

It’s hard to imagine how difficult it must be to live with a disorder like OCD. And it’s even harder to conceptualize what a “high-functioning” variation of OCD might look like. Hopefully, as more awareness about this type of condition increases and more people come forward about their experiences, we’ll continue to understand better how this works. 

In the meantime, if anyone suspects that they or someone they know may have severe forms of OCD, they must learn all they can learn about treatment options and available resources.

References

• Brock, H., & Hany, M. (2022). Obsessive-Compulsive Disorder. In StatPearls. StatPearls Publishing.
• Storch, E. A., De Nadai, A. S., Conceição do Rosário, M., Shavitt, R. G., Torres, A. R., Ferrão, Y. A., Miguel, E. C., Lewin, A. B., & Fontenelle, L. F. (2015). Defining clinical severity in adults with the obsessive–compulsive disorder. Comprehensive Psychiatry, 63, 30–35. https://doi.org/10.1016/j.comppsych.2015.08.007