Obsessive-Compulsive Disorder 239
ordering, and counting compulsions); forbidden or taboo th oughts (e.g., aggressive, sexual,
or religious obsessions and related compulsions) ; and harm (e.g., fears of harm to oneself
or others and checking compulsions). Some individuals also  have difficulties discarding
and accumulate (hoard) object s as a consequence of typical obsessions and compulsions,
such as fears of harming othe rs. These themes occur across different cultures, are rela-
tively consistent over time in adults with th e disorder, and may be as sociated with differ-
ent neural substrates. Importantly, individu als often have symptoms  in more than one
dimension. 
Individuals with OCD experience a range of  affective responses when confronted with
situations that trigger obsessions and compul sions. For example, many individuals expe-
rience marked anxiety that can include recurren t panic attacks. Others report strong feel-
ings of disgust. While perfor ming compulsions, some individuals report a distressing
sense of “incompleteness” or uneasiness unt il things look, feel, or sound “just right.” 
It is common for individuals with the disorder to avoid people, places, and things that
trigger obsessions and compulsions. For example, individuals with contamination con-
cerns might avoid public situat ions (e.g., restaurants, public  restrooms) to reduce ex-
posure to feared contaminants; individuals with intrusive thoughts about causing harm
might avoid social interactions. 
Prevalence
The 12-month prevalence of OCD in the United St ates is 1.2%, with a similar prevalence in-
ternationally (1.1%–1.8%). Females are affected  at a slightly higher rate than males in