Just Right OCD, also known as Perfectionism OCD, is one of the OCD presentations characterized by ongoing intrusive thoughts, urges, and compulsive behaviors around organization, balance, perfection, symmetry, and order – making things feel just right.
“Just Right OCD… The problem seems to either involve a feeling that something is off or incomplete, and needs to be fixed, because if it’s not fixed, completed, made even, or made ‘just right’, it’s going to make me feel uncomfortable for the rest of the day.”
Jon Hershfield, MFT, author of The Mindfulness Workbook for OCD
Just right” OCD symptoms are a bit different from typical OCD symptoms. Instead of feeling like something bad will happen if things aren’t done a certain way (which is common with regular OCD), with “just right” OCD, it’s more about feeling like things are “off” or “not complete” if they’re not done in a particular manner.
There is an underlying fear that something bad will happen behind the sense of discomfort when things are not right.
People with Just Right OCD feel frequent intrusive thoughts, or obsessions, around needing their physical surroundings to feel complete.
As a result, people with this type of OCD will compulsively fix, rearrange, touch, or count things until they feel comfortable or certain. Some people will spend hours a day engaging in compulsive behaviors, and others might avoid situations entirely so that they don’t have to deal with the time and stress required to make things just right.
Their compulsive behaviours may cause significant impairment on their daily functioning as a result.
The extent to which “just right” OCD symptoms affect a person’s life can greatly differ among individuals. For some, their specific triggers might minimally disrupt their daily life. However, people with more severe symptoms may find every step of their day challenging, from when they wake up to when they go to bed.
“For example, when I do groceries the items in my cart need to be placed in a just right way. If they aren’t just right then others will judge me and my children will think I am a terrible parent and they will move away and I will be abandoned and alone forever.”
Differences Between Perfectionism and OCD
A key difference between being a perfectionist and having OCD is how one feels about their behaviors and rituals. For people with OCD, the intrusive, repetitive, and recurring behaviors and thoughts are unwanted and cause significant distress, while people with perfectionist traits do not typically experience the same degree of unease.
For example, while a perfectionist may appreciate an organized closet or a color-coordinated bookshelf, a person with Just Right OCD will feel uncomfortable or tense if they don’t organize their closet or bookshelf in a certain way until they carry out their compulsion.
“There’s the other sort of presentation of just right that’s more of a magical superstitious quality to it and I need to line this up or fix it or make it symmetrical because if I don’t, it might somehow in some way cause some unwanted catastrophic thing to happen.”
Jon Hershfield, MFT, author of The Mindfulness Workbook for OCD
However, OCD and perfectionism can be interlinked, and it is not uncommon for one to suffer from both perfectionism and OCD. Research has shown that perfectionist tendencies can even be a predictor of OCD.
Personality traits, such as rigidity, or a high need for control, may predispose individuals to develop OCD.
Just Right OCD can manifest in a number of different ways. Some people with Just Right OCD may fixate on parts of their body, like making sure their fingernails are the exact same length, their hair is perfectly arranged, or their makeup is applied symmetrically.
Others might avoid stepping on cracks on the sidewalk or rereading every text or email repeatedly before and after they send it, to an extent that affects their daily life significantly.
Many people with Just Right OCD may feel anxiety from looking at a slightly crooked picture frame or an item not placed in its correct location.
Common Obsessions of Just Right OCD
People with Just Right OCD have an overwhelming need for things to look, sound, or feel “complete” or “just right.”
There could be countless triggers for incompleteness that set off feelings of tension. However, here are some broad groups that include common triggers of symptoms of Just Right OCD:
Sight
- Avoiding stepping on cracks in the sidewalk or making sure you are stepping on an even number of cracks.
- A strong urge to rearrange objects so that they are symmetrical or organized in a particular way.
- Distress about sights, smells, sounds, textures, tastes, or feelings that don’t seem right to you.
Sound
- Repeating words, movements, or actions until something feels right.
- Needing to hear a certain sound a specific number of times or for a certain duration to feel “right”. For example, you might need to listen to a song until it feels “just right”, or the sound of a car door closing might need to be heard several times before it feels satisfactory.
- Having a certain phrase or word repeated aloud until it sounds “just right”. This could involve saying a word a specific number of times or pronouncing it in a particular way until it sounds perfect to you.
Touch
- Touching your left shoulder if someone accidentally touches your right one to make it even.
- Touching or picking up items in a certain way or in a certain order.
- Tying the shoe on their right foot to match the tension of the shoe on their left foot.
- Unlocking and relocking the front door a dozen times before leaving the house.
Personal Experience
- Checking a text or email 20 times before sending it to be sure that there are no mistakes and the words are perfect.
- Counting out the exact number of coffee beans when making coffee in the mornings.
- A nagging, persistent feeling that things are incomplete or simply not right.
- Being unable to identify exactly why something feels off, incomplete, or incorrect.
- A fear of the consequences of making mistakes or anxiety that harm will come to oneself or others if things are not done perfectly.
Common Compulsions of Just Right OCD
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. Compulsions often reduce discomfort, unease, or dissatisfaction when something feels incomplete.
However, the reduction in anxiety or tension is only experienced short term, as compulsions in OCD reinforce irrational fears or emotional tension, escalating the cycle of obsessions and repetitive behaviors.
Fixing
Fixing behaviors is one of the most common compulsions for this subtype of OCD. These compulsions result from obsessions with symmetry and order.
“I know it doesn’t make any sense to you and it doesn’t make any sense to me but it still feels like if my mom gets sick and I know I didn’t fix this picture frame, it’s gonna be because I didn’t fix the picture frame and I’m not willing to tolerate that level of guilt.”
Jon Hershfield, MFT, author of The Mindfulness Workbook for OCD
Some people will spend hours rearranging things in their environment so that they feel symmetrical or “perfect.”
Others might have a ritualistic compulsion, such as needing to turn a light switch on and off 5 times before leaving each room.
Checking
People with Just Right OCD will often engage in checking compulsions to make sure that things are just right, even after they have already fixed them.
For example, they might rearrange their fridge or pantry over and over again until it feels perfect and symmetrical. And then even after arranging it in a way that feels right, they might go back and check again to make sure that things are as perfectly arranged as they left them.
In another example, people might reread a text message dozens of times even after they have already sent it.
Reassurance Seeking
People with Just Right OCD may engage in compulsive reassurance-seeking with friends or family to be sure that something is perfect even though their OCD is telling them that it isn’t.
They might repeatedly ask friends for a second opinion on an email to ensure it sounds good and is grammatically correct.
Additionally, some people might ask those around them if they also feel like something is off to try to assure themselves that they are not the only ones who feel that something is not right.
Touching
People with Just Right OCD often compulsively touch things, especially in a specific pattern or with a particular frequency.
For example, if something bumps their left knee, some with Just Right OCD may have the intense urge to bump their right knee against something just so that things feel symmetrical.
Or, someone might feel the compulsion to touch a certain object or open and close a door a certain number of times before they feel like things are complete.
Counting
Another common compulsion is counting things to ensure that things are symmetrical or “perfect.” For example, someone with Just Right OCD might count their steps to ensure that they’ve stepped exactly the same amount of times with their right foot as with their left foot.
Or, they might count out the exact number of coffee beans each morning before making their coffee.
Avoidance
Because people with Just Right OCD experience high levels of anxiety and stress when things appear to be incomplete or uncertain, they might avoid certain situations or places where they know their OCD will likely be triggered.
For example, if sending a text message or email consumes hours of a person’s day because they have to read it repeatedly, they may decide it’s best to stop texting and instead call someone on the phone.
In other cases, someone may feel like the color red is “just wrong,” and thus compulsively avoid the color red by refusing to wear red clothing or eat red foods.
Exposure and Response Prevention (ERP) Therapy
Like with most types of OCD, the best course of treatment for harm OCD is Exposure and Response Prevention (ERP) therapy.
ERP is a type of Cognitive-Behavioral Therapy considered the first-line psychotherapy for OCD. It has been found effective for 80% of people with OCD.
ERP has two main components:
- Exposure: purposely doing activities that are designed to elicit your anxiety
- Response Prevention: actively resisting the urge to complete a compulsion
In ERP, people are exposed to feared situations or objects meant to set off their compulsions. This therapy is intended to purposely invoke more anxiety in attempts to disrupt the neural circuit between the processing and action parts of the brain.
Over time, people learn to resist the urge to perform compulsive rituals and manage their OCD thoughts and actions. By staying in a feared situation without anything terrible happening, people learn that they don’t need their compulsions to cope, and that their fearful thoughts have no power over them.
For example, someone with Just right OCD might be asked to look at or do something that feels wrong or off to them.
If they have symmetry obsessions, they might be guided by their ERP therapist to only touch their right shoulder without touching their left.
They would need to resist the urge to touch their left shoulder to balance things out and sit with the anxiety that this wrongness or incompleteness brings. For people who suffer from OCD, exercises like these could feel incredibly difficult but not impossible.
You should only complete exposures if you can maintain good response prevention. Even the most challenging, high-level exposures will be ineffective if you are not maintaining good response prevention.
ERP takes time, effort, and practice, but patients learn to cope with their thoughts without relying on ritualistic behaviors.
The compulsion to avoid anxiety is a powerful driver of OCD. Still, ERP is one of the most powerful tools available for treating OCD because it directs the patient to live with the anxiety and see that nothing bad will happen.
Sources
Antony, M. M., & Swinson, R. P. (2009). When perfect isn’t good enough: Strategies for coping with perfectionism. New Harbinger Publications.
Foa E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in clinical neuroscience, 12(2), 199–207. https://doi.org/10.31887/DCNS.2010.12.2/efoa
Frost, R. O., Novara, C., & Rhéaume, J. (2002). Perfectionism in obsessive compulsive disorder. In Cognitive approaches to obsessions and compulsions (pp. 91-105). Pergamon.
Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85–S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18
Hettema, J. M., Neale, M. C., & Kendler, K. S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158(10), 1568-1578.
Sadri, S. K., Anderson, R. A., McEvoy, P. M., Kane, R. T., & Egan, S. J. (2017). A pilot investigation of cognitive behavioral therapy for clinical perfectionism in obsessive compulsive disorder. Behavioral and Cognitive Psychotherapy, 45(3), 312-320.
Fergus, T. A. (2014). Are “not just right experiences”(NJREs) specific to obsessive‐compulsive symptoms?: Evidence that NJREs span across symptoms of emotional disorders. Journal of Clinical Psychology, 70(4), 353-363.
Pozza, A., Albert, U., & Dèttore, D. (2019). Perfectionism and Intolerance of Uncertainty are Predictors of OCD Symptoms in Children and Early Adolescents: A Prospective, Cohort, One-Year, Follow-Up Study. Clinical neuropsychiatry, 16(1), 53–61.
