A Guide to the Different Types of Obsessive Compulsive Disorder

By: Suzanne Feinstein, PhD

Obsessive compulsive disorder (OCD) impacts 2–3% of people in the United States. It is classified as an anxiety disorder and features two primary components: obsessions and compulsions. Obsessions are recurring, intrusive thoughts, feelings, images or preoccupations that cause significant distress in one’s everyday life. Compulsions are repetitive behaviors that are carried out to prevent or reduce the distress that is caused by the obsessions. The compulsions only offer a short-term relief and, in actuality, only reinforce the long-term distressing nature of the disorder. Unfortunately, over time people need to perform longer and more frequent compulsions in order to get their ‘fix’. 

Obsessive Compulsive Disorder does not manifest in the same way for everyone. The content of one’s obsessive thoughts and subsequent compulsions will vary widely depending on their OCD subtype.

What are the different types of Obsessive Compulsive Disorder? How do you know if you or a loved one has this condition? What are the next steps for OCD sufferers? In this article, we will guide you through the specific subtypes, motivations and characteristics of OCD. 

The Most Common Obsessive Compulsive Disorder Subtypes

According to the Diagnostic and Statistical Manual for Mental Disorders (DSM), in order to meet criteria for OCD, a person must spend at least one hour per day consumed by some type of obsession and/or compulsion. OCD causes anxiety and distress and significantly interferes with one’s daily functioning. 

It is unfortunately all too common for people to call themselves or others “a little OCD” without a true depth of understanding of the struggle sufferers must endure. For example, being highly organized or valuing a clean home is not the same as having an actual OCD diagnosis. OCD is incredibly time-consuming and impairs functioning academically, at work and/or socially.

Compulsions can be overt, meaning specific physical behaviors are carried out to ward off tension and anxiety. Some examples include cleaning, ordering, arranging, rereading, rewriting, checking, counting, touching, tapping, blinking, and staring. Compulsions can also be covert, meaning there are mental rituals that take the place of the physical ones. Covert rituals include rehearsing conversations in one’s head, silent repetitive prayer, mental counting, mental comparisons, and mental list making to name just a few. 

The motivations behind obsessions are specific to each individual. Practitioners have divided obsessive compulsive disorder into several subcategories to account for these differences. In general, people perform  rituals to either ward off the fear of threat or danger or to decrease the level of physical tension that lives inside their bodies. Sometimes people report a mixture of both fear and physical tension. Below, we talk about some of the most common OCD subtypes and how they differ.

Harm OCD

Harm OCD (HOCD) features obsessive thoughts about hurting others or oneself. People with HOCD may fear engaging in unintentional violence. And some individuals fear their own capacity for intentional violence.

 For example, people may have obsessive thoughts about “snapping” and becoming violent. They may compulsively avoid knives or weapons. They may also frequently check that others are unharmed to alleviate their intrusive and fearful thoughts.

Contamination OCD

Contamination OCD features obsessions with cleanliness and hygiene. Individuals with this subtype may avoid social gatherings or leaving home. They may compulsively clean their house, their belongings, or their body. Contamination OCD can be triggered by a fear of spreading or catching an illness or disease. Or it can be triggered by an overall feeling of disgust with respect to dirt and germs.

Mental contamination and metaphysical contamination also fall into this OCD subtype. These conditions feature intense anxiety about “bad thoughts” and negative spiritual energy, respectively. People may try to cleanse their minds of anything negative or judgmental. They may try to neutralize “bad” words with “good” words or hold their breath so as to not inhale anything with a contaminated aura.

Relationship OCD

Relationship OCD (ROCD) features obsessions with relationships, typically romantic ones. People with ROCD may have more general thoughts that plague them repeatedly. For example, they may wonder, ‘what is a relationship supposed to be like? Or they may ask themselves, ‘is my partner right for me?’ or ‘ How do I know if I really love this person?” This is known as partner-focused OCD (POCD).

ROCD may manifest as an avoidance of deep connections. POCD may also feature intimacy issues. Or the person may constantly compare their partner to other people they find attractive.

Other Types of Obsessive Compulsive Disorder

The OCD subtypes we listed are common but many other subtypes are recognized by mental health professionals, including:

  • Responsibility OCD: Featuring obsessions about being irresponsible and causing harm to others
  • Suicidal OCD: Featuring obsessions about being or becoming suicidal
  • ‘Just Right’ OCD: Featuring the compulsion to repeat tasks until they feel ‘just right’
  • Scrupulosity OCD: Featuring obsessions about being morally or religiously pure or good
  • Sensorimotor OCD: Featuring obsessions with bodily functions (e.g., heart rate, breathing, etc.)
  • Existential OCD: Featuring obsession with questions about existence and other philosophical inquiries
  • Perinatal OCD: Featuring obsession with the safety of one’s unborn child
  • Post-Partum OCD: Featuring obsessions about the safety of one’s newborn child
  • False Memory OCD: Featuring obsessions with having inaccurate memories
  • Sexual Orientation OCD: Featuring obsessive thoughts that do not align with one’s sexual identity
  • Magical Thinking OCD: Featuring obsessions that one’s thoughts can magically influence the external environment
  • Real Events OCD: Features obsession about something bad happening due to past misdeeds

Some practitioners also recognize a subtype known as ‘pure O’ OCD. The phrase ‘pure O’ refers to thoughts that are purely obsessional and are not accompanied by any physical compulsions. With pure O, the content of the obsessions often changes over time. One day, someone may experience relationship obsessions. The next day, they may start to worry about their sexual orientation.

With pure O, the content of the obsessions often changes over time. One day, someone may experience relationship obsessions. The next day, they may start to worry about their sexual orientation.

The good news is that treatment can help with these symptoms. When administered by an experienced behavioral therapist, exposure and response prevention (ERP) therapy is a safe and effective way to treat different obsessive compulsive disorder subtypes.

Need Help With Obsessive Compulsive Disorder in NYC?

Obsessive compulsive disorder (OCD) manifests in many different ways and in a multitude of subtypes, including harm OCD, contamination OCD, and relationship OCD. There are multiple highly effective treatment options available to those struggling with obsessive compulsive disorder and its effects.

Are you or a loved one searching for OCD treatment in New York? Advanced Behavioral Health LLP offers ERP and other types of supportive therapy in the NYC area. Contact Advanced Behavioral Health to schedule your first appointment.

 

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