Patients with OCD present obsessive symptoms, compulsive symptoms, or a combination of both. Obsessions are repeated thoughts, mental images, or urges that cause the patient anxiety. For example, a patient may experience a fear of germs, aggressive or harmful thoughts, symmetry and order, and unwanted forbidden thoughts of a sexual or religious nature. Compulsions are behaviors that a patient feels the need to complete over and over again. These may include ordering and arranging items in a specific way, repeatedly checking on things like whether or not the door is locked or the oven is off, counting, cleaning or hand washing. It is important to understand that not all rituals are compulsions and the desire to double check that you locked the door is not a sign of this mental health disorder. OCD is typically diagnosed with these thoughts and behaviors are uncontrollable and excessive to the point of getting in the way of everyday life. People with OCD do not typically experience pleasure when performing their compulsive behaviors.