When someone mentions OCD, what’s the first image to pop into your mind? Washing your hands too many times, perhaps, or repeatedly checking the oven before you go to bed? These common notions aren’t inaccurate, but unfortunately they show only one side of what’s actually quite a multifarious disorder: they’re the symptoms that occur most commonly in women. By contrast, men experience OCD in very different ways: their obsessive thoughts and repetitive behaviors don’t focus as often on themes of contamination, but instead on violence, sex, or religious blasphemy (to name a few). And this gender discrepancy creates other problems, too, making the experience of OCD a unique challenge for many men.
Broadly, the diagnosis of OCD shows huge differences according to sex: men are much more often misdiagnosed than women. Last year’s analysis by the International OCD Foundation (Deusser, 2025) found that nearly twice as many women as men had received an OCD diagnosis. The study went on to conclude that the inconsistency couldn’t be explained by the disorder itself, which doesn’t discriminate by sex. Neither was it due to any failure to seek help by OCD sufferers (as a study by Wongbusarakum et al. found in 2025). Instead, the gender difference in OCD incidence appears to be caused by a bias in the way men and women are diagnosed. To put it plainly, the OCD symptom constellations occurring most often in men are harder for their doctors to recognize, so the diagnosis is often not applied. Men with OCD then end up living with the disorder for a long time before it’s recognized: according to the IOCDF, delays between the onset of men’s symptoms and the establishment of a diagnosis often last as long as seven years, and can even go as high as seventeen — meaning that a large number of men end up struggling alone with their symptoms for over a decade.
As I noted above, OCD more often presents differently in men. According to a 2019 study in Current Psychiatry Reports, while women more frequently experience obsessions related to contamination, men tend to obsess over the possibility of doing harm to others, transgressing sexual boundaries, or behaving in ways that their religions would condemn. The symptoms reported by men with OCD generally focus more narrowly, as well, while women present for evaluation with more wide-ranging obsessions and compulsions (Mathes et al., 2019). This means that men are more likely than women to be deeply tormented by their intrusive thoughts without showing obvious compulsive behaviors. For example, they may worry constantly about causing harm to people they care about, but then compulsively perform internal, thought-based rituals — that are very difficult for others to notice — to defuse that anxiety. And also, if the men coping with thoughts and fears like these do not understand that they are experiencing the symptoms of a well-understood disorder, they may instead begin to believe they are bad or immoral people. These fears, too, may cause delays in the search for appropriate treatment, or the assignment of a correct diagnosis.
The powerful and repeated unacceptable thoughts I have mentioned can comprise the least obvious, most stigmatized form of OCD. Unacceptable-thought OCD (sometimes called UT-OCD) is far more likely than contamination-based OCD to be wrongly identified; Coles et al. (2023) reported that these recurring thoughts were wrongly diagnosed (as something other than OCD) at a rate of 59.9% — in contrast to contamination OCD, which was only misidentified 27.1% of the time. Moreover, because intrusive thoughts about causing harm or acting out sexually are also the most highly stigmatized by others, misdiagnoses such as paraphilia or psychosis can themselves cause significant, additional psychological distress. Obsessions over one’s sexual orientation, which can be powerfully unsettling, also occur in men more often than in women (Williams & Farris, 2011). These intrusive thoughts, too, can be deeply shameful, which places further obstacles in the path of seeking help.
Another layer of complexity, over and above the challenge of disclosing these thoughts and feelings, also works to silence men with OCD: our society’s cultural norms for masculinity. Men are traditionally expected to be strong in generic ways — self-reliant and stoic — which means that asking for help, or even admitting to themselves that something might be wrong, can seem “unmanly.” One of the biggest barriers to treatment, according to a 2024 article in the British Journal of Clinical Psychology, is the shame generated by this perceived lack of masculinity. Worse, the disorder of OCD is exacerbated by the secrecy and avoidance caused by shame; men feeling this way, the thinking goes, are less likely to confront their own intrusive thoughts. Some of them will fear being rejected by their friends and families if their intrusive thoughts were to become public, and the only apparent solution may be to hide these thoughts away — making it impossible to disconfirm them. Similarly, if men cannot tell their doctors the truth about their thoughts, they won’t get appropriate treatment. What results from this interaction between shame and avoidance is a doubling-down of the disorder: if untreated, OCD’s intrusive thoughts and compensatory behaviors get worse, which creates more shame, which in turn redoubles the avoidance.
Of course, the picture isn’t completely hopeless; the good news is that OCD treatment outcomes show no significant differences according to gender (Mathes et al., 2019). Therapy for OCD, which usually involves a controlled exposure to anxiety-producing stimuli coupled with the prevention of the patient’s avoidant or anxiety-neutralizing behaviors, works just as well for men as it does for women. Exposure and response prevention (or ERP, as it is known), means gaining through experience the knowledge that one’s thoughts do not perfectly represent one’s intentions, and that the distress one may feel when experiencing intrusive violent or sexual images actually means one is less likely to act out those thoughts. (One of my old supervisors often said he would trust his OCD patients with his life, as they were the people who expressed the most concern over protecting others.) People who suffer from OCD, no matter their gender, stand to benefit a great deal — and to overcome a lot of suffering — if they can find a way to seek treatment despite their fears and feelings of shame.
Men with unacceptable-thought OCD may believe they are awful human beings; they may hide their symptoms from the people in their life; they may suffer in silence for years. But if mental health clinicians can learn to better recognize the atypical presentation of UT-OCD, the gap in diagnosis may begin to change — and just the same, if men can learn to challenge conventions about traditionally masculine stoicism and cut down on the shame that increases the intensity and harm of OCD, this obstacle to treatment can also be minimized. If you recognize yourself in these descriptions of unacceptable-thought OCD, no matter how distressing it has been to you, I earnestly encourage you to find a way to talk to someone you trust.
