Mind & Mood Clinic

Neuro-Psychiatry | Deaddiction | Sexology | Counseling

Indian woman reflecting on mental health in a serene setting

OCD in Women: How It Manifests Differently and Why It’s Overlooked

Obsessive-Compulsive Disorder (OCD) is often misunderstood, and when it comes to women, it’s frequently misdiagnosed or overlooked altogether. Why? Because the symptoms women experience are often shaped by cultural, societal, and biological influences that make them harder to recognize. Let’s dive into the details—symptoms, etiology, epidemiology, history, and pathogenesis—while also addressing why these differences matter.


Symptoms of OCD in Women

Women with OCD may present symptoms differently, often influenced by hormonal cycles, pregnancy, and societal pressures. Common symptoms include:

  1. Intrusive Thoughts: Disturbing, unwanted thoughts about harm, contamination, or moral transgressions.
  2. Perfectionism: A compulsive need for order and symmetry, often paired with anxiety over making mistakes.
  3. Contamination Obsessions: Fear of germs or uncleanliness, leading to excessive washing or cleaning rituals.
  4. Relationship OCD: Doubts about love, fidelity, or whether their feelings for a partner are “right.”
  5. Parenting OCD: Extreme fears about accidentally harming their child or being a “bad” mother.
  6. Postpartum OCD: Obsessive fears related to the baby’s safety or intrusive, distressing thoughts.
  7. Ritualistic Behaviors: Repeating certain actions like counting, touching, or checking to prevent perceived danger.
  8. Somatic OCD: Obsessions about body functions like breathing or heartbeat.

These symptoms are often masked by societal norms, where behaviors like cleanliness or perfectionism are labeled as “normal” for women.


Etiology

The causes of OCD are complex, involving a mix of genetic, neurological, and environmental factors:

  • Genetics: A family history of OCD increases susceptibility.
  • Neurobiology: Abnormalities in brain circuits, particularly in the orbitofrontal cortex and basal ganglia, contribute to OCD symptoms.
  • Hormonal Changes: Fluctuations during menstruation, pregnancy, and menopause can worsen OCD.
  • Stress and Trauma: Major life events or prolonged stress can act as triggers.
  • Cultural Influences: Societal expectations about women being “perfect” caretakers or partners amplify obsessive-compulsive tendencies.

Epidemiology

OCD affects approximately 2-3% of the global population, with women slightly more likely to be diagnosed than men. In India, where cultural and familial expectations weigh heavily, women may underreport symptoms due to stigma.

Key stats:

  • Women with OCD often experience onset during late adolescence or early adulthood.
  • Postpartum OCD affects around 2-8% of new mothers.
  • Hormonal-related OCD (e.g., during menstruation or menopause) remains under-researched but is gaining recognition.

History

OCD has been described in medical literature for centuries, but the gendered aspects were rarely discussed until recent decades. Historically, behaviors like excessive cleaning or hypervigilance in women were dismissed as “neuroses” or even “hysteria.”

In the 20th century, the DSM (Diagnostic and Statistical Manual of Mental Disorders) categorized OCD under anxiety disorders, later giving it its own classification. Women-specific research gained traction only in the last 30 years, highlighting how pregnancy, hormones, and cultural roles influence OCD.


Pathogenesis

The pathogenesis of OCD involves:

  1. Brain Circuit Dysfunction: Hyperactivity in the cortico-striato-thalamo-cortical (CSTC) loop causes persistent intrusive thoughts.
  2. Neurotransmitter Imbalance: Low levels of serotonin play a significant role.
  3. Cognitive Biases: Women may have heightened fear responses or moral reasoning, intensifying OCD symptoms.
  4. Hormonal Sensitivity: Estrogen and progesterone fluctuations impact serotonin and brain function, worsening OCD symptoms.

Why Women’s OCD Is Overlooked

Cultural expectations often dictate that women’s obsessive behaviors (like cleaning or worrying) are “normal.” This normalization delays diagnosis. Additionally, postpartum OCD is often mistaken for postpartum depression, leaving women untreated or misdiagnosed.


Personal Perspective

One of my patients, Sneha, a 30-year-old mother, came to me complaining about constant intrusive thoughts of harming her baby. She was terrified, ashamed, and isolated. Initially dismissed as “just stress,” her symptoms worsened. Through therapy and education, Sneha understood she wasn’t alone or “bad.” This transformation is why awareness is critical.


Alternatives to Manage OCD

  • CBT (Cognitive Behavioral Therapy): Especially Exposure and Response Prevention (ERP).
  • Lifestyle Adjustments: Sleep hygiene, mindfulness, and exercise can complement therapy.
  • Social Support: Joining support groups helps normalize experiences.
  • Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) are often effective.

If you or someone you know is struggling with OCD, particularly as a woman, don’t hesitate to seek help. Early intervention can make a world of difference.

Contact Mind & Mood Clinic, Nagpur, to book a consultation with Dr. Rameez Shaikh, MD (Psychiatrist & Counsellor). Call us at +91-8208823738 or visit us in person.

Leave a Comment

Your email address will not be published. Required fields are marked *

Open chat