The symptoms of OCD can appear in many different ways. Some OCD symptoms are easy to recognise, such as repeated handwashing or repeatedly checking whether a door is locked. Others occur almost entirely inside the mind and may remain hidden from family, friends and colleagues for years.
A person with OCD may struggle with disturbing thoughts, persistent doubt, an excessive need for certainty or fears that something terrible could happen. In response, they may develop visible rituals or less obvious mental strategies intended to reduce anxiety or prevent a feared outcome.
The two central features of OCD are obsessions and compulsions. Their form and severity vary considerably between individuals, and symptoms can also change over time. OCD may consume substantial amounts of time and interfere with work, education, relationships and ordinary daily activities.
Understanding the different ways in which OCD can present is an important first step towards diagnosing the disorder and seeking appropriate assessment and treatment.
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What Are the Symptoms of OCD?
The two main symptoms of OCD are obsessions and compulsions. Most people with obsessive-compulsive disorder experience both, although one may be much more noticeable than the other.
Obsessions are recurring and unwanted thoughts, images, doubts or impulses that enter the mind and are difficult to dismiss. They commonly produce anxiety, fear, guilt, disgust or persistent uncertainty. Common OCD obsessions involve contamination, responsibility for harm, making mistakes, aggressive or sexual thoughts, religious or moral concerns, symmetry, order and the need for certainty.
Compulsions are repetitive behaviours or mental acts that a person feels driven to perform, usually in response to an obsession. They are intended to reduce distress, gain reassurance or prevent a feared event. Common OCD compulsions include excessive washing or cleaning, repeated checking, arranging objects, counting, repeating actions, seeking reassurance and performing mental rituals.
Obsessions and compulsions often reinforce each other. An obsessive thought creates anxiety, doubt or a sense of threat. Performing a compulsion may provide temporary relief, but the relief does not last. When the doubt or anxiety returns, the person feels an urge to perform the ritual again. This repeating pattern is known as the OCD cycle and helps explain why symptoms can become persistent and difficult to control.
OCD is therefore much more than being unusually tidy, careful or perfectionistic. Some people have obvious washing or checking rituals, while others spend hours analysing thoughts, reviewing memories or trying to achieve absolute certainty about something that can never be completely certain.
When Normal Thoughts and Behaviours Become OCD
Most people occasionally experience unwanted thoughts or double-check something important. A person leaving home may briefly wonder, “Did I turn off the cooker?” They might check once, feel reassured and continue with their day. This alone is not a sign of OCD.
For someone with OCD, the same doubt may become persistent. They check the cooker but remain uncertain. After leaving the apartment, the doubt returns: perhaps they did not look carefully enough. They go back and check again. Even after several checks, they may still be unable to achieve a lasting sense of certainty.
The important difference is not simply the act of checking but the intensity of the doubt, the repeated need for certainty and the difficulty stopping the behaviour. The compulsion temporarily reduces anxiety without resolving the underlying obsession. When uncertainty returns, the person feels driven to check again.
This pattern can develop around many different themes, including contamination, mistakes, responsibility, relationships, morality, religion, sexuality, health or fears of harming another person. What distinguishes OCD from ordinary worries and habits is the repetitive nature of the symptoms, the distress they cause and the extent to which they interfere with everyday life.
Many people with OCD recognise that their fears or rituals are excessive. However, understanding rationally that a fear is unlikely does not necessarily remove the emotional need to obtain certainty or perform the compulsion.
Common OCD Obsessions
OCD obsessions are repetitive, intrusive and unwanted mental experiences. They can take the form of thoughts, images, doubts or impulses that enter the mind involuntarily and are difficult to dismiss.
An important characteristic of obsessive thoughts in OCD is that they often conflict with the person’s values, beliefs or intentions. A peaceful person may experience disturbing images of harming someone. Another person may have unwanted sexual thoughts that are completely inconsistent with their wishes. Someone with strong religious beliefs may be distressed by intrusive blasphemous thoughts.
Because these thoughts feel disturbing or unacceptable, a person with OCD may attach excessive importance to them and begin questioning what they mean about their character, intentions or behaviour. The thought itself then becomes a source of fear.
Common OCD obsession themes include contamination or infection, persistent doubts about whether something was done correctly, fear of accidentally causing harm, intrusive aggressive or sexual thoughts, religious or moral concerns, a need for order or symmetry, fear of losing something important and worries about behaving inappropriately.
The specific content varies considerably between individuals. The underlying pattern, however, is similar: an unwanted thought, image or doubt produces distress and uncertainty, followed by attempts to gain certainty, neutralise the thought or prevent the feared outcome.
Intrusive Thoughts in OCD
Intrusive thoughts are among the most misunderstood symptoms of OCD. They appear involuntarily and may be disturbing, frightening, offensive or completely inconsistent with a person’s personality and values.
Intrusive thoughts also occur in people without OCD. The difference is often how much significance the person gives the thought and how they respond to it. Someone without OCD may notice a strange or disturbing thought and allow it to pass. A person with OCD may become preoccupied with understanding why the thought occurred and what it could mean.
Questions such as “Why did I think this?”, “What does this say about me?” or “What if I lose control?” may then become repetitive. The person may begin to fear that simply having a thought somehow increases the likelihood that they will act on it.
This can be particularly distressing when OCD intrusive thoughts involve aggression, sexuality, religion or other personally sensitive subjects. Having an unwanted intrusive thought does not mean that a person wants it to happen or intends to act on it. In OCD, the distress frequently arises precisely because the thought conflicts with the person’s wishes and values.
Trying to obtain complete certainty can intensify the problem. A person may repeatedly monitor their thoughts, analyse why a particular thought occurred, check their emotional reactions or seek reassurance that the thought is meaningless. Attempts to suppress the thought can also make it more noticeable.
The more attention and significance the intrusive thought receives, the more prominent and distressing it can become.
Contamination OCD and Fear of Contamination
Fear of contamination is one of the most common and recognisable OCD symptoms. Contamination obsessions may involve germs, viruses, bodily fluids, chemicals, dirt or other substances that the person believes could cause illness, harm or contamination.
In contamination OCD, the perceived threat can extend far beyond reasonable concerns about hygiene. Touching a door handle, for example, may create an intense feeling of being contaminated. The person may then fear that touching a phone will contaminate the phone, which could transfer the contamination to other objects and eventually spread it throughout the home.
Contamination fears are not always driven by fear of infection or illness. Some people experience intense disgust or a persistent feeling that an object, place or part of their body is somehow dirty or unclean, even when they recognise that there is little or no objective risk.
As the perceived contamination spreads, the person may increasingly avoid certain objects, places or people. They may also feel compelled to wash, clean or decontaminate themselves and their surroundings. These behaviours provide temporary relief but can strengthen the underlying fear and make the perceived threat of contamination increasingly important.
Harm OCD and Fear of Causing Harm
Fear of causing harm is another common form of OCD obsession. The person may become excessively concerned that something they did, or failed to do, could cause an accident, injury or other serious consequence.
Someone may repeatedly doubt whether they switched off an electrical appliance and fear that it could cause a fire. Another person may worry that they left a tap running and could be responsible for flooding a building. The possibility continues to feel threatening even when the person remembers checking and there is no evidence that anything is wrong.
A characteristic example is hit-and-run OCD. While driving, a person may suddenly wonder whether they could have hit a pedestrian without noticing. A bump in the road, an unexpected sound or simply passing a pedestrian may trigger intense doubt. Despite having no evidence that an accident occurred, the person may struggle to dismiss the possibility and may feel compelled to retrace the route or search for reassurance.
At the centre of many harm-related OCD symptoms is an exaggerated sense of responsibility combined with difficulty accepting ordinary uncertainty. The person wants complete certainty that nobody has been harmed. Because absolute certainty is rarely possible, the doubt repeatedly returns.
Common OCD Compulsions
Compulsions are repetitive behaviours or mental rituals that a person with OCD feels driven to perform. They usually develop in response to an obsession and are intended to reduce anxiety, gain certainty or prevent a feared consequence.
From the person’s perspective, performing the compulsion may feel necessary even when they recognise that it is excessive. In some cases, they understand that there is little or no realistic connection between the ritual and what they are trying to prevent. Nevertheless, resisting the compulsion can produce considerable anxiety, tension or doubt.
OCD compulsions can be visible behaviours or entirely mental rituals. Some follow strict rules. An action may need to be performed in a particular order, repeated a specific number of times or continued until it feels “just right.” If the ritual is interrupted, the person may feel compelled to start again.
The defining feature is not simply that a behaviour is repeated. Compulsions are difficult to resist and can become increasingly time-consuming. Because performing the ritual temporarily reduces anxiety, the person becomes more likely to repeat it when the obsession returns.
Checking Compulsions
Repeated checking is one of the most common OCD compulsions. It is usually driven by doubt and the need to be certain that nothing dangerous, harmful or inappropriate has happened.
A person may repeatedly check doors, windows, electrical appliances or switches before leaving home. Checking can also involve work and communication. Someone may reread an email many times before sending it because they fear having written something offensive or inappropriate. Another person may repeatedly review their work because they are afraid that a mistake could have serious consequences.
Paradoxically, repeated checking often creates more doubt rather than greater certainty. After checking something many times, the person may become less confident about what they actually saw or did. This uncertainty produces an urge to check once more.
As checking becomes more extensive, ordinary activities can take much longer than necessary. Leaving home may take half an hour instead of a few minutes, while completing a simple task at work can require repeated reviews.
People with checking OCD often recognise that another check is unnecessary. The difficulty lies in tolerating the uncertainty that appears when they try to stop checking.
Washing and Cleaning Compulsions
Washing and cleaning compulsions commonly occur in people with contamination-related OCD. A person may wash their hands repeatedly, shower for unusually long periods, change clothes frequently or clean objects and areas of the home according to rigid rules.
These rituals may have to be performed in a particular sequence or repeated until the person feels sufficiently clean or safe. If they believe they touched something contaminated during the process, they may feel that the entire cleaning routine has been invalidated and needs to begin again.
In more severe contamination OCD, washing and cleaning can occupy substantial parts of the day. Excessive handwashing or showering may also cause physical consequences, including irritated, cracked or damaged skin.
The rituals can extend beyond the individual. Family members may be asked to wash their hands repeatedly, change clothes, avoid particular rooms or follow strict rules intended to prevent contamination from spreading through the home. In this way, OCD cleaning compulsions can affect the daily life of the entire family.
Ordering, Symmetry, Counting and Repeating
Not every compulsion is related to contamination or checking. Some people experience a strong need for objects to be arranged in a particular way. Items on a desk, shelves or furniture may have to be positioned precisely, and moving something can create considerable discomfort until the arrangement is corrected.
Others repeatedly count or perform an action a particular number of times before it feels complete. Words, movements and ordinary activities may also have to be repeated according to specific internal rules.
Some rituals appear unrelated to the feared consequence. A person may believe that stepping on a crack, using a particular number or performing actions in the wrong sequence could somehow cause something bad to happen to a loved one. This pattern is sometimes referred to as magical thinking.
For other people, there may be no clearly defined feared consequence. Instead, they experience a powerful feeling that something is incomplete or “not right” and repeat or rearrange an action until the uncomfortable sensation disappears.
Mental Compulsions and “Hidden” OCD
Not all compulsions are visible. A person may appear calm while carrying out complicated rituals internally.
Mental compulsions can include counting silently, repeating words or phrases, reviewing past events, replacing a disturbing thought with a “safe” thought or mentally checking whether something happened. These rituals can be particularly difficult for relatives and colleagues to recognise because there is no obvious external behaviour.
For example, a person troubled by an aggressive intrusive thought may spend hours analysing whether they could ever lose control. Someone worried about having behaved immorally may replay a conversation repeatedly, trying to establish exactly what they said, what they meant and whether they might have caused offence. Another person may silently repeat particular words or numbers because they believe doing so could prevent a feared event.
Although these compulsions occur internally, they can be just as exhausting and time-consuming as visible rituals. This is one reason why OCD can remain undetected even when symptoms are severe.
Avoidance and Reassurance Seeking
OCD is not limited to obsessions and obvious rituals. Avoidance and reassurance seeking can also become important parts of the obsessive-compulsive cycle.
A person afraid of contamination may stop using public transport or touching objects in public places. Someone with aggressive intrusive thoughts may avoid knives or being alone with family members because they fear what their thoughts could mean. A person afraid of making the wrong decision may avoid making decisions altogether.
Avoidance may initially reduce anxiety because the feared trigger is removed. Over time, however, more situations may come to feel dangerous, and the person’s everyday life can become increasingly restricted.
Reassurance seeking works in a similar way. Someone may repeatedly ask a partner, “Are you sure I locked the door?” or “Do you think I did something wrong?” The answer provides temporary relief, but uncertainty soon returns and reassurance is needed again.
Repeated reassurance can therefore function much like a compulsion. It temporarily reduces anxiety without allowing the person to tolerate uncertainty.
How OCD Symptoms Affect Daily Life
The severity of OCD cannot be judged only by the type of obsession or compulsion. The amount of time consumed, the distress caused and the effect on everyday functioning are equally important.
Some people spend several hours each day dealing with obsessive thoughts and rituals. Constant repetition can produce exhaustion, nervousness and persistent tension. Morning routines may take hours. A person may repeatedly return home to check something and arrive late for work. Reading can become extremely slow because sentences have to be repeated, while emails may remain unsent because they never feel completely correct.
Relationships can also suffer. Family members may gradually become involved in rituals, provide repeated reassurance or adapt their behaviour to avoid triggering anxiety. As OCD becomes more dominant, the freedom of everyone in the household can become restricted.
Social withdrawal may develop because of contamination fears, avoidance or embarrassment about the symptoms. In severe cases, OCD can affect a person’s ability to work, study, maintain relationships or manage ordinary daily responsibilities independently.
Shame and Hiding OCD Symptoms
A person may ask themselves why they cannot simply stop. Some worry that others will think they are irrational or misunderstand what their intrusive thoughts mean. This can be particularly difficult when obsessions involve aggression, sexuality, religion or morality.
As a result, OCD symptoms can remain hidden for years. People may perform rituals only when nobody is watching, invent explanations for being late or avoid discussing why simple activities take so long. Someone experiencing disturbing intrusive thoughts may be especially reluctant to tell another person what is happening in their mind.
The absence of obvious symptoms therefore does not necessarily indicate mild OCD. Someone can continue working, socialising and appearing outwardly functional while privately spending hours each day managing obsessions and mental rituals.
OCD Symptoms by Age and Gender
OCD symptoms can occur at different ages and in both women and men, although the way they appear and affect everyday life may vary. Children and teenagers may show repeated washing, checking, counting or rigid routines that interfere with school and family life. In adults, OCD often becomes particularly noticeable through its impact on work, relationships and daily responsibilities. Women and men experience the same fundamental obsessions and compulsions, but individual circumstances can influence the content of obsessive fears. Regardless of age or gender, the key features remain intrusive, distressing thoughts and repetitive behaviours or mental rituals used to reduce anxiety or uncertainty.
OCD Symptoms in Adults
OCD symptoms in adults can affect many areas of life, but they are not always obvious to other people. Adults often develop ways of accommodating or hiding their symptoms, particularly when they have lived with OCD for many years.
A colleague may appear unusually careful or perfectionistic without others realising that they repeatedly check their work. Someone may avoid certain responsibilities because they trigger intrusive thoughts, while another person may privately spend long periods reviewing conversations, decisions or memories.
As a result, outward functioning does not always reflect the severity of OCD. A person may continue working, maintaining relationships and socialising while privately spending substantial amounts of time managing obsessions, compulsions and mental rituals.
OCD Symptoms in Women
The fundamental symptoms of OCD in women are the same as in men. Women may experience contamination fears, repeated checking, intrusive thoughts, mental rituals, symmetry concerns, reassurance seeking and other obsessive-compulsive symptoms.
However, individual circumstances can influence the content of obsessions. Concerns involving children, relationships, health, pregnancy or household responsibilities may become incorporated into the OCD cycle. For example, ordinary concerns about a child’s safety can develop into persistent doubts followed by repeated checking or reassurance seeking.
What matters clinically is not whether a particular obsession appears typically “female” or “male”, but whether the thoughts are intrusive and distressing and whether they lead to compulsions, avoidance or repeated attempts to obtain certainty. The content of OCD may vary considerably between individuals, while the underlying obsessive-compulsive mechanism remains similar.
OCD Symptoms in Men
The symptoms of OCD in men can include contamination fears, repeated checking, ordering, counting, mental rituals and intrusive aggressive, sexual or religious thoughts.
Some symptoms can be particularly difficult to disclose. Aggressive or sexual intrusive thoughts may cause considerable shame because the person fears that others will misunderstand what these thoughts mean. As a result, some men may initially describe anxiety, stress, concentration difficulties or problems at work without revealing the obsessive thoughts and rituals behind them.
This can delay diagnosis and treatment. A careful psychiatric assessment should therefore provide an environment in which disturbing or embarrassing thoughts can be discussed openly without assuming that an unwanted thought represents a person’s wishes or intentions.
OCD Symptoms in Children and Teenagers
OCD can begin during childhood, although onset during adolescence and young adulthood is also common. OCD symptoms in children and teenagers may include repeated washing, checking, counting, ordering or asking the same questions repeatedly.
Young people may take unusually long to prepare for school, complete homework or go to bed because activities have to be performed according to particular rules. Parents can gradually become involved by answering repeated questions, checking things for the child or participating in rituals intended to reduce anxiety.
OCD can also interfere with education. Intrusive thoughts may make concentration difficult, while compulsions can consume substantial amounts of time. When symptoms become persistent, OCD can affect emotional development, social relationships, school performance and everyday family life.
CHMC assesses adolescents and adults from the age of 16. Younger children with possible OCD should be evaluated by an appropriately qualified child and adolescent mental health specialist.
How OCD Symptoms Can Change Over Time
OCD symptoms can change over time, both in their intensity and in their content. At some stages of life, symptoms may be relatively manageable, while at others they can become more intrusive and time-consuming. Some people experience periods of substantial improvement followed by a recurrence or worsening of symptoms.
The content of OCD can also change. Someone who previously struggled mainly with contamination fears may later develop repeated checking or obsessions involving responsibility for harm. Although the theme has changed, the underlying pattern may remain the same: an intrusive thought or doubt creates anxiety or uncertainty, followed by compulsions or other attempts to gain certainty and reduce distress.
Periods of increased stress can make OCD symptoms more prominent. Professional pressure, relationship difficulties or major life changes may increase intrusive thoughts and strengthen the urge to perform compulsions. Rituals that previously occupied a relatively small part of the day may gradually become more time-consuming.
Stress does not explain every case of OCD, but it can influence symptom severity. Understanding these fluctuations is important because an improvement or change in symptoms does not necessarily mean that OCD has disappeared. The disorder can become less noticeable for a period and become more prominent again later.
OCD and Other Mental Health Conditions
OCD does not always occur alone. Depression, anxiety disorders and tic disorders can occur alongside obsessive-compulsive disorder, and some patients have symptoms associated with other conditions within the obsessive-compulsive spectrum.
Anxiety is naturally a prominent feature of OCD because obsessions frequently produce fear, tension and uncertainty. However, OCD and anxiety disorders are not the same condition. Distinguishing between them can be important when establishing the correct diagnosis.
Some people with OCD also have repetitive movements or vocalisations associated with tic disorders. These may include blinking, facial movements, movements of the head or shoulders, throat clearing, sniffing or other repetitive sounds.
Co-existing conditions can also influence how OCD appears. A person with both OCD and depression, for example, may become increasingly withdrawn and lose motivation while also spending substantial amounts of time dealing with obsessions and compulsions.
When several types of symptoms occur together, self-diagnosis can be unreliable. A comprehensive psychiatric assessment therefore considers whether obsessive-compulsive symptoms are present, whether another condition could better explain them and whether several disorders are occurring at the same time.
When Should You Seek an OCD Assessment?
Not every repetitive thought or habit indicates OCD. Most people occasionally double-check something important, worry about contamination or experience an unwanted thought. The important question is whether these experiences have become persistent, distressing, time-consuming and difficult to control.
An OCD assessment should be considered when intrusive thoughts repeatedly return despite attempts to dismiss them, when rituals consume increasing amounts of time or when avoidance begins to restrict normal activities. Assessment may also be appropriate when reassurance from other people is repeatedly needed or when everyday tasks take much longer because they must be performed according to rigid rules.
Possible warning signs include excessive washing or cleaning, repeated checking, distressing thoughts that cannot easily be dismissed, unusually long periods needed to complete everyday activities, and persistent concerns about order or symmetry. Mental rituals, repeated reassurance seeking and extensive avoidance can be equally important even though they may be less visible.
The effect on everyday life is particularly important. A professional assessment considers how symptoms affect work or education, relationships, social activities, independence and quality of life rather than looking only at whether an individual obsession or compulsion is present.
Seeking an assessment can be especially important when symptoms are being hidden because of embarrassment. Intrusive aggressive, sexual or religious thoughts can feel frightening, but discussing them openly with a psychiatrist can help determine whether they are part of OCD and whether treatment is needed.
For OCD Assessment Contact Our Consultant Psychiatrist:
Frequently Asked Questions About OCD Symptoms
What are the most common symptoms of OCD?
The main symptoms of OCD are obsessions and compulsions. Obsessions are recurring, unwanted thoughts, images, doubts or impulses that cause distress. Compulsions are repetitive behaviours or mental rituals that a person feels driven to perform to reduce this distress or prevent a feared outcome.
Common symptoms include contamination fears, excessive washing or cleaning, repeated checking, intrusive aggressive or sexual thoughts, concerns about order and symmetry, counting, repeating, mental rituals and reassurance seeking.
However, OCD can take many forms. A person does not need to have cleaning or checking compulsions to have obsessive-compulsive disorder.
How do I know whether a thought is an OCD thought?
An obsessive thought in OCD is typically unwanted, repetitive and difficult to dismiss. It may cause significant anxiety, guilt, disgust, fear or uncertainty and can conflict strongly with the person’s actual beliefs, intentions and values.
This is one reason aggressive, sexual or religious obsessions can be particularly distressing. The person does not want the thought and may make considerable efforts to understand why it occurred or prove that it does not reflect who they are.
The reaction to the thought is therefore important. Someone with OCD may repeatedly analyse the thought, monitor their reactions, avoid situations associated with it, seek reassurance or perform mental or behavioural rituals to feel safe again.
Does Having Violent Intrusive Thoughts Mean I Am Dangerous?
Not necessarily. Aggressive intrusive thoughts can occur as part of OCD and should not automatically be interpreted as an intention to act. In OCD, people are often deeply frightened by these thoughts precisely because they conflict with what they want and with their personal values.
However, thoughts about harming oneself or others can occur in different clinical situations. If there is uncertainty about their nature, a psychiatric assessment is important to distinguish OCD-related intrusive thoughts from thoughts associated with other mental health conditions or an actual intention to cause harm.
Can You Have OCD Without Visible Compulsions?
Yes. Some OCD compulsions are entirely mental and therefore invisible to other people. A person may silently count, repeat phrases, review memories, replace disturbing thoughts with “safe” thoughts or mentally check whether a feared event occurred.
Another person may repeatedly analyse an intrusive thought in an attempt to determine what it “really means.” Reassurance seeking and avoidance may also be less obvious than traditional washing or checking rituals.
This is one reason OCD can remain unnoticed by relatives, friends and colleagues. The absence of visible rituals does not mean that compulsions are absent.
Is Repeated Checking Always a Sign of OCD?
No. Checking something once or twice can be completely normal, particularly when the consequences of a mistake could be important.
In OCD, checking becomes repetitive, difficult to resist and disproportionate to the actual risk. More importantly, checking fails to provide lasting certainty. A person may look at a locked door, know that it is locked and still feel compelled to check it again.
Repeated checking becomes clinically significant when it causes substantial distress, consumes excessive amounts of time or interferes with everyday functioning.
Why Do People With OCD Keep Performing Rituals When They Know They Don’t Make Sense?
Because understanding something rationally and feeling certain about it are not always the same thing. A person may know that washing their hands again is unnecessary but still experience intense contamination anxiety. Another may know that the cooker is switched off while feeling unable to leave home without checking it again.
Performing the ritual temporarily reduces anxiety, tension or uncertainty. This short-term relief reinforces the behaviour, making the person more likely to repeat the ritual when the obsession returns. Trying to resist a compulsion can initially increase anxiety and tension, which helps explain why simply deciding to stop the ritual can be extremely difficult.
Can OCD Symptoms Become Severe?
Yes. OCD ranges from relatively mild symptoms to severe symptoms that occupy many hours of the day.
Severe obsessions, compulsions and avoidance can make an ordinary daily routine extremely difficult. OCD may interfere with work, education, relationships, social activities and independent living. In particularly severe cases, a person may become increasingly isolated or unable to complete essential everyday activities.
For this reason, the severity of OCD should not be judged only by how unusual a particular thought or ritual sounds. The amount of distress, time consumed and impairment in everyday functioning are often much more important indicators of severity.
