Types of OCD

There are several subtypes of OCD, each with their own unique set of symptoms. Many of these symptoms are very complex, which makes it difficult for those who suffer from OCD to be able to express and explain their  symptoms; many of these symptoms can cause fear, guilt and shame. For these reasons many of those with OCD may suffer in silence if they are unable to understand their symptoms, and also may fear how others, even trained mental health professionals, could perceive them. 

Below I will summarize the main subtypes of OCD and give examples of some  of the symptoms of each subtype. The most important thing to remember while reading these subtypes and their symptoms, is that these symptoms are experienced as intrusive, disturbing, and unwanted to the OCD sufferer. 

Contamination (Cleaning) OCD

Contamination OCD essentially is excessive fear of uncleanliness or germs that could lead to contaminating oneself or others, which could lead to severe consequences (e.g. contracting a illness, disease, or even death). The individual with contamination OCD feels it is their responsibility to prevent these consequences from occurring. 

Examples of obsessions for Contamination OCD include fearful thoughts of:

• Public items, such as transportation and door knobs
• Bodily fluids, such as blood, urine, saliva, sweat, semen
• Illness- related associations, such as viruses, diseases, sick people, hospitals, homelessness

Examples of compulsions include:

• Cleaning and washing rituals (e.g. a strict regimen of washing hands a specific number of times, for a specific duration of time)
• Mental checking/reviewing if came in contact with contaminants and if cleaning rituals were completed correctly
• Avoiding contaminants or avoiding clean items or people when feeling contaminated
• Constant reassurance from others that they have not contracted a illness, virus or disease from a contaminant and/ or have not exposed others to these consequences as a result of coming into contact with a contaminant

I’ve heard people with OCD, myself included, say that the current Covid-19 pandemic exposed them to a real-life contamination OCD scenario. It was basically like watching people go into mad hysterics and act as “crazy” on the outside, as some or most of us OCD sufferers feel on the inside lol.  So, for people with anxiety and/or OCD, their mental health conditions either prepared them to deal with the pandemic, or their symptoms were heightened due to it. So, if you ever want to have an idea of what a person with contamination OCD might experience on a daily basis- just think back to what you felt or how you saw people react at the beginning of this pandemic

Checking/Responsibility OCD

Checking/Responsibility OCD is experiencing excessive fear that if one acts irresponsibility, whether purposefully or not, their actions could lead to a catastrophic consequence. For example, I often check and touch the stove knobs multiple times before I leave the house, to ensure that the house wouldn’t burn down, especially if I’m leaving my husband and son behind in the house. I rationalize it by telling myself, “If I don’t ‘properly‘ check the stove, and it was left on, and the house burned down with my family inside, their deaths would be my responsibility- all because I didn’t take the time to check the stove.” See the inflated sense of responsibility in that line of thinking? Beginning to understand how this type of thinking could impair someone’s daily functioning? Good. Let’s continue!

 Aside from this personal example, below are additional examples of obsessions and compulsions for Checking/Responsibility OCD.

Obsessions include excessive fear of:

• Leaving doors/other things unlocked
• Leaving appliances on
• Safety items not working correctly, such as car brakes

Compulsions include:

• Repeatedly touching/tapping items to make sure they are off or closed (e.g. the stove, refrigerator)
• Returning to home/location to make sure items are properly off or closed
• Needing constant reassurance that items were checked correctly and off/closed.

Symmetry and Ordering OCD (a.k.a Organizational, Perfectionism, or “Just Right” OCD)

Symmetry and Ordering OCD has to do with excessive fear that particular things are not as precise as desired.

Obsessions include:

• Feeling uneasy about an item not being in the correct location 
• Sensitivity about the symmetry of behaviors or objects in relation to other behaviors/objects
• Continuously feeling uneasy after finishing a routine

Compulsions include:

• The urge to even out a behavior on both sides of an object (e.g. tapping both side of arms or legs the same amount)
• Positioning objects so they appear “just right” (e.g. making sure items are aligned in a row)
• Repeating an activity or behavior until it feels “just right”  (e.g. repeatedly walking in a circle, opening and closing a door or drawer)

Harm OCD (a.k.a “Forbidden Thoughts”, or Taboo OCD)

This subtype of OCD includes unwanted and intrusive thoughts about harming oneself or others. Some of these thoughts may be violent, sexual or religious in nature. Again, for this subtype I think it is very important to highlight that the individual does not experience a desire to harm themselves or others; these thoughts are truly distressing and unwanted by the OCD sufferer, so much so that they will go to great lengths to prevent any possibilities of harm happening (i.e. going back to that false sense of total control and inflated responsibility discussed in the behavior and cognitive components of OCD.

Obsessions include excessive fear of:

• Harming a person, especially a vulnerable person or loved one, such as one’s child 
• Not “taking care” of violent thoughts correctly (i.e. through correctly completing compulsions/rituals “just right” to alleviate the thoughts) 
• Unconsciously harming someone without any recollection (e.g. doing so in sleep/sleeping walking)
• Past trauma or exposure to inappropriate material during childhood, predetermining you to be an abuser
• Sudden shift in personality causing one to enjoy harmful thoughts 
• Specific fear of causing an accidental hit and run, and being unaware of it until you are tracked down by law enforcement

Oh yeah, that last one- weirdly specific and real! Here is a personal example: one time I was driving home late at night, and I ran over a curb accidentally. A pretty common experience that the average person would shrug off.  Well, as I continued driving I had a random thought pop in my head- “ what if that wasn’t actually a bump? What if I just ran over a person??” That thought consumed my mind; I instantly thought about how I potentially killed a person, could get prison time for a hit and run, and my life would be over- all because I wasn’t more careful while driving. I scrutinized myself to no end. So naturally I had to circle back to that same spot to make absolutely sure that I did not hit a person and it actually was just a curb (i.e. the compulsion). However, after I checked, I questioned myself relentlessly- “ Did I check the area thoroughly? Am I sure I didn’t see a person? It’s dark, what if I missed the person, had an opportunity to save them and unknowingly left them for dead?? It was as if I couldn’t believe my own eyes and needed constant reassurance. The only problem was there was no one there with me, so the responsibility to reassure myself was on me. Let’s just say I couldn’t fall asleep that night…

I eventually was able to calm down, reorient myself with reality, and truly realize that I simply ran over a curb accidentally, a common experience, and did not harm anyone. I eventually was able to come to terms with this being another wretched OCD episode. 

That takes us to compulsions. Some compulsions include:

• Mentally checking/reviewing thoughts to make sure they are all appropriate, especially as it relates to people/loved ones.
• “Thought neutralization“- If there is even a hint of “inappropriateness” in thoughts, the individual may feel the impulse to immediately replace the thought with an irrefutable positive thought
• Avoidance of media/information, people, activities, places that may trigger the unwanted harmful thoughts 
• Mentally checking/reviewing memories and thoughts to ensure that you did not accidentally harm someone and reassure yourself that you would not harm someone purposefully.
• ”Compulsive flooding”- Forcing oneself to think about violent thoughts/images, in order to reassure self and prove that they are disgusted by these acts and would never do them
• Needing constant reassurance from others/self that one would never harm themselves or others 

I chose to elaborate on this specific OCD subtype, because I feel like it is more likely to be misunderstood. Additionally, any individual who struggles with this type of OCD may feel especially shameful, confused, and imprisoned by their thoughts, to a degree that they feel they could never disclose these thoughts, for fear of being misjudged. I think contamination or symmetry OCD are less challenging for the average person to understand, and are the common forms of OCD that come to mind when one thinks about OCD. So it is very important to shine a light on harm OCD, to provide deeper understanding and strongly emphasize that these thoughts are nothing more than symptoms- not any more than a cough is to a cold.

It is important that those who struggle with harm OCD, and for those who don’t, to understand that these thoughts are truly unwanted, and these individuals do not have a desire to harm anyone; honestly they would go to greater lengths than the average person to ensure the safety and wellbeing of those around them because they so strongly disagree with their OCD thoughts. So, if you are an individual who struggles with harm OCD, I want to reassure you of this: you are not crazy, you are not a bad person, and there is help out there for you, so you don’t have to struggle in silence. 

Scrupulosity OCD (a.k.a. Religious OCD)

Scrupulosity OCD has to do with putting extreme importance on morals, religion, or philosophy, and excessive fear of not upholding these values.

Obsessions include excessive fear of: 

• Judgement and condemnation for not upholding ones religion perfectly
• Negative, or perceived negative thoughts about religion icons (i.e. God, Jesus, Satan, etc.)
• Misinterpreting religious text
• Specific words, numbers, or events signifying condemnation (e.g. the number 666)
• Uncertainty if behavior is always ethical, and needing it to be perfect at all times
• Being An innately bad person

Compulsions include:

• Mental checking/reviewing of religious thoughts and practices 
• Prayers that are ritualistic and repetitive 
• Replacing/correcting religious thoughts that are negative or perceived as negative in nature (i.e. thought neutralizing) 
• Avoiding or oversensitivity religious triggers (i.e. materials or symbols associated with cruxifixction or Satan)

Hyperawareness OCD

Hyperawareness OCD has to do with being acutely aware of normal things that passively occur, such as feelings and sensations in the body, which causes extreme distress.  

Obsessions include acute awareness of:

• Blinking, swallowing, breathing, heart beating, or other bodily sensations
• Positioning of body parts in relation to other parts of the body, or to the environment (e.g. how one is seated; how leg or arm is positioned)
• Normal or disturbing memories or images ( which can include things seen on television, movies, etc.)
• One’s process of thinking (thinking about thinking relentlessly which causes distress)

Compulsions include:

• Avoiding triggering situations where hyperawareness may occur (e.g. social activities)
• Reviewing/checking triggering behaviors (i.e. breathing and other bodily sensations
• Needing reassurance that hyperawareness is not the result of a different condition and will subside within a certain duration of time. 

Tic- related OCD

Behavioral tics are believed to alleviate the distress associated with obsessions; ironically, these tics can become apart of compulsive behaviors. It is especially common for children to experience Tic-related OCD, however because children tend to exhibit behavior that is perceived as silly or corky, this may not be obvious to the child or surrounding adults. 

Behavioral tics include:

• Blinking
• Clearing the throat
• Sudden vocal noise (e.g. screeching)
• Twitching
• Shrugging 
• Clenching (muscle tightening, appearance of bracing self or holding breath)

For Your Consideration

It is possible for individuals to experience multiple subtypes of OCD. Symptoms may look different among children and adults as well. Typically resistance of these OCD symptoms- thoughts, sensations, or images-  unfortunately make the symptoms come back stronger. So, although compulsions typically provide some temporary relief, they ultimately perpetuate the OCD cycle. This is why, if deemed appropriate, it is so important to reach out and get professional help from a trained mental health professional, if you are finding that your symptoms are impairing your daily functioning. Please see possible treatment options and coping strategies below. 

There are additional OCD subtypes alongside the subtypes listed above , which include Sexual Orientation OCD, Relationship OCD, and Hoarding-related OCD. For more information about the above listed OCD subtypes or the additional subtypes, please refer to The Mindfulness Workbook for OCD, and Healthline and NIH websites, listed below in references.

Remember, everyone has crazy, weird, and obscure thoughts from time to time- the only difference is that these thoughts cause greater distress and are perceived as more profound to the OCD-wired person, making it much harder for the person to let those thoughts go.