Is my Need for Symmetry a Sign of OCD?

This article explains how an extreme need for symmetry can be a symptom of Obsessive-Compulsive Disorder (OCD). The article talks about common OCD symptoms, distinguishing between obsessions (e.g., fear of harm if things aren't symmetrical) and compulsions (e.g., arranging, evening up, re-doing tasks). It emphasises that while a general human preference for order exists, an extreme, distress-driven need for symmetry, coupled with functional impairment, can indicate OCD. 

An extreme desire for symmetry is a common symptom of OCD. Obsessive Compulsive Disorder is diagnosed when people have obsessions, compulsions or a mixture of both. Obsessions are unwanted, recurring, and intrusive thoughts, images, or urges which cause the person a lot of distress. 

To relieve this distress or get rid of these thoughts, people with OCD have the urge to perform a task compulsively. These are called compulsions, sometimes known as rituals. Performing these rituals can be time-consuming, which can thus interfere with their daily activities and, in turn, cause more emotional distress (American Psychiatric Association, 2024).

Signs and Symptoms of OCD

For a diagnosis of OCD, the person needs to have obsessions, compulsions, or both. Obsessions could look like thoughts (E.g., of contamination), images (E.g., of violent scenes) or impulses/urges (E.g., to stab someone). They cause the person anxiety, and the individual tries to ignore or suppress them, or sometimes looks to compulsions to neutralise these thoughts. Going ahead with these compulsions usually gives them a sense of completeness, which drives them to give in to compulsions again.

Compulsions could involve repetitive mental acts (E.g., mentally repeating specific phrases in order to prevent negative outcomes, mentally counting objects or reviewing a particular memory to make sure that they haven’t caused any harm). It could also include overt behaviours (E.g., repetitive washing, checking, ordering of objects).

One important thing to note is that in OCD, the compulsions might not make any sense to the viewer as to how they connect to the obsession itself. They need not be connected to the feared event in any realistic way, and even if they are, they are clearly excessive. For example, arranging items in a symmetrical way might be a compulsion which neutralises an obsession with thoughts of their loved one being harmed. 

Impairment in personal, family, social, educational, occupational and other areas of functioning is also necessary for this diagnosis to be made. If functioning is maintained, it is only through significant additional effort. They should also not be a symptom of another medical illness or due to the use of a substance (ICD-11 for Mortality and Morbidity Statistics, 2024).

What is symmetry in OCD?

Symmetry typically refers to the balance between two halves of an object or an organism, where one side mirrors the other. Even though symmetry is generally desirable and in human faces, it’s linked to beauty and health, excessive concern with symmetry can be an indicator of psychopathology.

We, as humans, have a bias toward symmetry. Research has linked feelings of disgust with asymmetry and possibly positive feelings with symmetry. We’re naturally made to react positively to symmetry and negatively to asymmetry, which is reflected in behaviour and neural responses (Evans et al., 2012).

A research study examined the preference a person has for order. It found that when a person with a high need for order was made to perform a task in a highly disorganised environment, they experienced high levels of anxiety. This anxiety was lower in people who didn’t have this need. Our takeaway from this study is that there is a general human preference for order and symmetry. Compulsive ordering and a drive for symmetry are only an extreme manifestation of this need (Radomsky & Rachman, 2004).

In Obsessive Compulsive Disorder, a common symptom is a need for things to be aligned perfectly. This is also called symmetry obsessions, and is often accompanied by compulsive behaviours such as arranging, aligning or tapping. These kinds of symptoms are linked to poorer treatment outcomes and a higher chance of co-occurring with other psychological disorders (Lochner et al., 2015).

Symptoms and Diagnosis of OCD Related to Symmetry

1. Obsessive Thoughts Related to Symmetry

Obsessions are recurrent and persistent thoughts, urges or impulses that are experienced as intrusive and unwanted. In Symmetry OCD, common symptoms related to obsessions include:

• Urge to arrange and order objects. The individual might feel compelled to organise things in a symmetrical fashion. This might include things on a desk or even pillows, clothes, etc., in various environments.
• Need for balance. This individual might have a need for all their behaviours to be very balanced, which could include exerting equal amounts of pressure on each foot while they walk, or it could be tying the lace of their right shoe with the same tension that they used to tie their left shoe with.
• Intense fear and anxiety. The person might have an obsession that something terrible would happen to either them or someone they love if an object is not perfectly aligned or symmetrical. They have a need for perfect order and have intense feelings of anxiety and dread about what would happen if things don’t line up with this need.
• Discomfort with anything asymmetrical. Asymmetry is often accompanied by a feeling of discomfort and uneasiness, and they have an intense distrust of asymmetry itself.
• A feeling of incompleteness. Along with the discomfort that comes with asymmetry, people also experience a sense of incompleteness or that things are ‘not right’. This might be in the form of a nagging feeling that things are ‘off’ or imperfect, which drives them to go through with the compulsions.

2. Compulsive Behaviours Related to Symmetry

Compulsions are behaviours or rituals that the individual performs in order to alleviate the anxiety caused by the obsessions. They might be done to neutralise fears, keep things safe or even prevent bad outcomes. The individual is usually unable to stop performing the compulsion just because they understand it doesn’t have a logical link. They are fueled by their fear or distress, and it helps in regaining a feeling of control. Common compulsions in Symmetry OCD include:

• Arranging and ordering. This could include ordering items by size, colour or symmetry. This could include books that are kept in alphabetical order or clothes that are sorted according to colour.
• Evening up. This could include behaviours such as touching the left knee to balance out something bumping against the right knee, writing the exact number of words on each line of the page, or lining up food on a plate to ensure it is all facing the same way and is evenly spaced.
• Avoidance. People with OCD tend to avoid certain situations in which they know their OCD will be triggered, for fear of the anxiety that it will cause them. This could include avoiding rooms with uneven tiling or crooked lines, or rounding numbers up or down to avoid odd numbers.
• Re-doing. Due to most people with OCD also having high levels of self-doubt, they re-do several tasks until they feel they are certain or that it feels right to them. This could include rewriting a page until there are no visible imperfections in the writing, or rearranging the pantry until it feels just right to them and then checking again to make sure it is how they left it (Simkus, 2024).

Assessing the Need for Symmetry

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is generally used to assess obsessive-compulsive symptomatology. It is clinician-administered and cannot be taken by the individual themselves. It has a semi-structured interview format and includes 16 core items, providing insight into the aspects of obsession and compulsion, as well as their severity (Moritz et al., 2002).

Relationship between Symmetry and OCD

People who show symptoms related to order and symmetry have a higher likelihood of developing OCD earlier, have a gradual development of compulsions, more severe depression, as well as sensory issues (Vellozo et al., 2021). People with symmetry-related OCD also have a higher chance of developing higher severity, spending longer periods of time with the illness, as well as having a larger number of other psychiatric disorders. There was a higher chance that Obsessive Compulsive Personality Disorder (OCPD) or Post Traumatic Stress Disorder (PTSD) is present in the person as well.

Genetics might play a role in symmetry-related OCD, however. A possible connection between a specific gene (ANKK1 rs1800497) and certain symmetry-related OCD symptoms was found. However, more research is needed in this area for us to be sure of it (Lochner et al., 2015).

A study looked at whether the need for symmetry could be linked to people’s sensitivity or skill in recognising visual symmetry, that is, people with a higher sense of aesthetics. People with a high feeling of incompleteness were very concerned with symmetry, and this was not impacted by their ability to assess the objective aesthetic value of the image at all. This suggests that their preference for symmetry comes from their internal need for balance, rather than any special artistic ability (Summerfeldt et al., 2015).

What are the differential diagnoses for OCD?

• Autism Spectrum Disorder. The obsessions and compulsions that are characteristic of OCD might be difficult to differentiate from the restricted, repetitive and inflexible patterns of behaviours, interests and activities that people with ASD exhibit. The key difference is that in OCD, the person follows through with these behaviours to reduce anxiety or achieve a sense of completeness. The other chief characteristic of ASD, which is difficulties in initiating and sustaining social communication and reciprocal social interactions, is not a feature of OCD (Haghighi, 2022).
• Body Dysmorphic Disorder. Symmetry obsessions in OCD are related to a need for order or balance, while in BDD, the focus is on appearance-related symmetry, such as a perceived asymmetry in their facial features (Hart & Phillips, 2013). 

Symmetry-related OCD is a complex manifestation of obsessive-compulsive disorder that involves an intense need for order, balance, and completeness. Though this need for symmetry and alignment is inherent in human beings, an extreme manifestation of this need is an indicator of psychopathology. People with symmetry-related OCD are driven by their internal distress and sense of incompleteness rather than aesthetic skill. Further research into the biological, psychological, and social underpinnings of symmetry-related OCD can help inform more effective treatments and interventions.