Obsessive-compulsive disorder (OCD) is a serious mental health condition that can cause significant stress and affect daily life. Even though it may be mistakenly associated with personality traits like perfectionism or rigidity, it is a disorder that has specific diagnostic criteria and requires professional treatment.
OCD has many different types or forms. Obsessions and compulsions can be related to various objects or situations. Understanding these differences and distinct types of OCD aids in identifying symptoms, assessing risks, and creating tailored treatment strategies.
Keep reading to gain a deeper understanding of OCD, including its well-known and lesser-known subtypes.
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What Is Obsessive-compulsive Disorder (OCD)?
OCD is characterized by a repetitive cycle of distressing thoughts, known as obsessions, and ritualistic behaviors called compulsions. Compulsions serve as a way to alleviate anxiety brought on by obsessions but bring only temporary relief.
Obsessions and compulsions can be mild or severe. They are usually time-consuming and can disrupt a person’s daily life, leading to emotional distress. There is no single cause of OCD development; different genetic, neurological, cognitive, and environmental factors can contribute to it.
Types of OCD Obsessions
Obsessions are recurrent and distressing thoughts or impulses that cause excessive anxiety. These thoughts are often unreasonable, and individuals with OCD are typically aware of this irrationality. However, they are unable to control or dismiss these thoughts or urges through logical reasoning.
Common types of obsessions include:
- Fear of contamination from others or the environment.
- A compulsion for extreme order, symmetry, or precision.
- Persistent intrusive thoughts, such as sounds, images, words, or numbers.
- Intrusive sexual thoughts or distressing images.
- Apprehension about inadvertently uttering offensive words or insults.
- Fear of misplacing or discarding valuable items.
Types of OCD Compulsions
Compulsions are mental rituals or repetitive behaviors that patients perform in response to obsessive thoughts. These actions aim to reduce the distress associated with obsessions. Compulsions can either directly relate to the obsession (e.g., excessive hand washing to counter contamination fears) or may be unrelated to it altogether.
Common types of compulsions are the following:
- Excessive or ritualized hand washing, showering, tooth brushing, or toileting.
- Frequent cleaning or organizing of household items.
- Compulsive arranging or ordering of objects in a specific manner.
- Repeatedly checking locks, switches, or appliances.
- Seeking constant approval or reassurance from others.
- Counting to a particular number repeatedly.
Diagnostic Criteria for OCD
According to the Diagnostic and Statistical Manual of Mental Disorders
- Presence of obsessions, compulsions, or both.
- The obsessions or compulsions consume a significant amount of time (e.g., more than one hour per day) or cause significant distress or impairment in social, occupational, or other areas of life.
- Obsessive-compulsive symptoms are not caused by physiological effects (e.g., an addictive drug, a medication) or another medical condition.
- The symptoms of other mental disorders do not explain the disturbance better (e.g., excessive worries, anxiety disorders, preoccupation with appearance, body dysmorphic disorder, etc.).
Four Main Types of OCD
OCD exhibits itself in various forms, each stemming from the distinct nature of obsessive thoughts and the corresponding actions taken to cope with them. While these manifestations are not technically types of OCD, they are identified based on similarities in the nature of obsessions and compulsions. Below is a general overview of the four main categories.
Contamination and Cleansing
Among those with OCD, fears related to contamination are the most common manifestation. This type of obsession is characterized by intense worrying about being dirty or contracting germs from objects or people. For example:
- Never shake hands as one has an obsession with getting a virus from another person.
- Brushing teeth excessively or scrubbing hands for minutes on end out of fear of not feeling clean enough or feeling just right.
Such compulsions can lead to different mental and physical issues, such as anxiety, sleep disturbances, or skin irritation or damage.
Self-doubt and Checking
OCD often manifests as an overwhelming urge to repeatedly check things, driven by the fear of catastrophic outcomes. These compulsions can include:
- Repeatedly checking doors to ensure they are locked, driven by the fear of a break-in.
- Compulsively reviewing emails for perceived imperfections or offensive content.
The common theme among individuals with OCD is the profound fear of losing something precious, leading them to engage in compulsive acts to safeguard what they hold dear. OCD may reshape a person’s perceptions according to their fears.
Intrusive and Forbidden Thoughts
Intrusive thoughts are a normal part of human cognition, with fleeting worrisome ideas that can be easily dismissed. In OCD, however, these thoughts take on a more distressing character. They become repetitive and persistent, occupying the mind for extended periods. The topics of these obsessions can span a wide range, such as:
- Violent intrusive thoughts, involving fears of causing harm to oneself or loved ones.
- Sexual intrusive thoughts, including distressing ideas about causing sexual harm to others or questioning one’s sexuality.
- Religious obsessions, featuring fears of committing sins or excessive analysis of religious beliefs.
Symmetry and Orderliness
This aspect of OCD presents itself through an obsession with achieving balance and order, often involving meticulous organization. Unlike those who simply appreciate symmetry, individuals with this type of OCD are driven by a relentless need for things to “feel” right:
- Organizing books and possessions meticulously.
- Ensuring clothes are folded and hung with precise uniformity.
To individuals with OCD, what appears orderly to others may still feel inherently wrong, creating an unshakable sensation that propels them toward compulsions. Regrettably, these compulsions offer only momentary relief, as obsessions persist, leading to a relentless cycle of repetitive thoughts and actions.
Lesser-known Types of OCD
OCD can also present itself in other unique forms, characterized by differences in the content of obsessions and corresponding compulsions. While the fundamental cycle of OCD remains consistent, the nature of this disorder is diverse. Here are some less widely recognized and rare forms of OCD.
Relationship OCD
Relationship OCD or R-OCD entails persistent, intrusive doubts and compulsive behaviors surrounding the stability of a romantic relationship. Those with R-OCD constantly question their relationships, despite minimal evidence to justify their uncertainties. Obsessions may include:
- Recurrent doubt regarding self-worth in the relationship.
- Concerns about the partner’s happiness.
- Comparisons to others’ relationships.
- Fear of making a long-term commitment in a romantic relationship.
To alleviate these distressing thoughts, individuals may engage in compulsive behaviors, such as seeking reassurance from friends, repeatedly analyzing past experiences, avoiding conflicts at all costs, or testing and questioning a partner’s attitude.
Religious or Scrupulosity OCD
- Constantly ruminating over perceived sins.
- Engaging excessive prayers to seek repentance.
- Worrying about not reciting prayers perfectly.
- Battling unwanted, unholy thoughts and images.
Existential Obsessions
Existential obsessions involve incessant pondering of unanswerable philosophical questions, such as the meaning of life or one’s place in the universe. One becomes consumed by these inquiries, often spending hours seeking answers. Common existential questions include:
- Identity-related queries, like “Who am I really?”
- Contemplating the vastness of the universe and human insignificance.
- Thoughts about mortality and being forgotten
Sensorimotor or Somatic OCD
Sensorimotor OCD arises when individuals become excessively aware of bodily functions, often driven by health-related concerns. They may fixate on involuntary actions, leading to compulsive behaviors like:
- Hyper-focus on blinking frequency.
- Excessive swallowing, often unrelated to thirst.
- Conscious monitoring of breathing patterns.
Harm OCD
Harm OCD encompasses intrusive, distressing thoughts or violent images directed towards oneself or others. These thoughts can be deeply troubling, with individuals experiencing obsessions such as:
- Fear of losing control and harming others.
- Worries about committing acts of violence against loved ones.
- Disturbing images of causing harm to pets.
Compulsions often involve reviewing past actions or avoiding situations that could trigger these thoughts.
Postpartum OCD
Postpartum OCD is a subset of OCD that affects some new mothers; it may manifest before or after childbirth. It involves repetitive, distressing thoughts about the baby’s safety, including:
- Concerns about grievous outcomes to the baby.
- Imaginations of accidentally harming the baby.
- Persistent thoughts of the baby in distress.
Compulsive behaviors may include seeking reassurance from others or healthcare professionals excessively.
Conditions Related to OCD
The latest version of the Diagnostic and Statistical Manual of Mental Disorders includes a category of OCD-related disorders. Therefore, the related conditions can be viewed as OCD spectrum disorders. However, it’s important to note that while their symptoms bear similarities, they are not identical to those observed in OCD.
Hoarding Disorder
Hoarding is the persistent collection of items, often with little to no monetary value, even when space is limited. These items can range from less valuable objects to more valuable ones. People who hoard often have an emotional attachment to these items.
The most common hoarded objects include newspapers, mail, magazines, books, notes, and clothes. Hoarding may result in poor sanitation and cause health problems, especially if hoarding of animals is involved.
Body Dysmorphic Disorder (BDD)
- Frequent self-comparisons to others.
- Excessive mirror-checking or avoiding mirrors altogether.
- Using heavy makeup or extreme dieting to hide or alter perceived flaws.
Trichotillomania (Hair-pulling Disorder)
Trichotillomania is the compulsive urge to pull hair from the scalp, eyelashes, or eyebrows. In severe cases, this condition can result in noticeable hair loss. People with trichotillomania may experience tension before pulling and relief afterward, and these compulsions may interfere with daily life.
Excoriation (Skin-picking) Disorder
Excoriation disorder is characterized by repeated picking of the skin, severe enough to cause lesions. The most common area of skin pricking is the face followed by hands, fingers, arms, and legs. The compulsive habit of skin picking can be so severe that it may lead to physical disfigurement.
What Is the Best Treatment for OCD?
Depending on the severity of your symptoms, treatment of OCD can be long-term or short-term. Note that there is no complete cure for OCD, but it’s possible to take symptoms under control and learn to deal with obsessions as well as use healthier techniques for stress relief instead of compulsive behaviors. So, the goal of the treatment is to lower the severity and frequency of symptoms. Below are the treatment approaches and some tips to help your OCD symptoms fade.
Medical Treatment Approaches
- Medications: Selective serotonin inhibitors (SSRIs) like fluoxetine, paroxetine, sertraline, and fluvoxamine, are the preferred pharmacological options for OCD treatment.
Clomipramine [4*] , a tricyclic antidepressant, is also an FDA-approved medication, specifically prescribed for OCD. The response rate to different medications can vary from patient to patient. - Psychotherapy: Cognitive-behavioral therapy (CBT) is beneficial for many patients with OCD.
Exposure and response prevention (ERP) [5*] therapy, a branch of CBT, gradually exposes individuals to their fears and teaches them how to resist compulsive behaviors. It’s a systematic process guided by a professional.
Tips for Managing OCD Symptoms
Certain stress management techniques can also mitigate the severity of OCD symptoms:
- Mindfulness: Staying present and focusing on the task at hand can reduce OCD’s grip on your thoughts and actions.
- OCD journal: Maintaining a journal helps track triggers, identify OCD patterns, and provide more time for self-reflection.
- Refocusing attention: When obsessions or compulsions arise, physically or mentally shift your attention. Try walking, humming a song, using a fidget toy, or petting a furry animal.
- Rewarding yourself: Acknowledge and celebrate your progress in managing OCD. Set achievable goals and reward yourself as you reach them.
Remember that overcoming OCD is a journey, and it’s essential to find a balance that works for you in terms of treatment and self-care.
Summing Up
OCD has different types and can manifest in many ways. However, coping with OCD isn’t an easy thing to do. With professional help, you can set clear treatment goals, identify your OCD triggers, get pharmacological support if deemed necessary, and improve your overall well-being under the supervision of a qualified healthcare professional.
FAQ
How many types of OCD are there?
OCD is generally divided into four main types with numerous subtypes. It can manifest with the focus on:
- Symmetry and orderliness
- Fear of contamination
- Checking
- Rituals
Can you have multiple types of OCD?
What is the rarest form of OCD?
As there are various forms of OCD, it’s difficult to pinpoint its rarest form, and scientific data does not back up any specific type of OCD as being the most unique one. However, the following OCD subtypes are considered to be more rare than others:
- Harm OCD
- Religious OCD
- Magical thinking OCD
- Existential OCD
- Somatic OCD
- Postpartum OCD
What type of OCD is the most common?
The most common type of behavior pattern seen in OCD is obsession with contamination and washing. It affects around 46% of OCD patients. The feared objects can be germs, dirt, urine, feces, or other things, and the patients try to avoid them at all costs. In this type of OCD, patients believe that the slightest touch can spread the contamination.
What are the stages of the OCD cycle?
OCD is characterized by various stages throughout its course. The typical OCD cycle mainly has the following four stages:
- Obsessions: The cycle starts with intrusive, disturbing, and unwanted thoughts. People with OCD are usually aware that these thoughts are excessive and irrational but still unable to control them.
- Anxiety and distress: Overwhelming obsessions typically cause significant distress among OCD patients. It becomes challenging to divert attention from unwanted thoughts that increase anxiety levels.
- Compulsions: Ultimately, to overcome obsessions, OCD patients revert to specific compulsions or rituals. The goal is to satisfy disturbing thoughts that may decrease distress.
- Temporary relief: Satisfying obsessions through engaging compulsions brings relief. However, it is temporary, and the cycle restarts eventually.
What is OCD commonly mistaken for?
OCD is a complex mental health condition and can be mistaken for other psychological illnesses due to similar characteristics. The most common mental health disorders with overlapping symptoms associated with OCD are:
- Generalized anxiety disorder (GAD)
- Phobias
- Depression
- Psychosis
- ADHD
- Autism
- Tourette syndrome
