What types of OCD are common?

Are there different types of OCD?

Although all kinds of OCD have symptoms in common, the way these symptoms present themselves in daily life changes a lot from person to person. As we’ll see, the content of a person’s obsessions isn’t the important part for treatment. But it’s certainly what feels important in the moment. Someone’s subtype is really just the particular way their OCD affects them– it’s kind of like a theme that the obsessions have in common. Subtypes are relatively stable over time, though new symptoms can appear and old ones might disappear.

First, OCD experts divided symptoms into four larger categories:

1) Contamination Obsessions
2) Harm Obsessions with Checking Compulsions
3) Obsessions Without Visible Compulsions
4) Symmetry Obsessions

Though most people fit into one or two of these broad categories, researchers call conditions like OCD heterogeneous because symptoms vary so much from one person to the next. Still, because there are noticeable clusters of symptoms that they’ve noticed, some researchers have proposed that these four larger categories of OCD can be further divided into specific subtypes.

Treatment methods usually aren’t affected by the particular subtype a person seems to have. Most types of OCD treatment focus on changing patterns of thought and behavior, not the thoughts themselves. As it turns out, changing your thoughts is extremely difficult, and trying to do so often makes OCD symptoms worse.

But, while it usually doesn’t affect treatment strategies for OCD, knowing their subtype can help people feel less alone. It’s great when things get tough to know that other people out there are dealing with similar types of obsessions and compulsions. Also, when a practitioner recognizes their patient’s subtype, they might get a shortcut into understanding their patterns of triggers, obsessions, and compulsions.

And, of course, the subtype will affect the actual content of the treatment. Someone with harm OCD might be asked not to apologize to anyone for one day, but this intervention wouldn’t make any sense for someone whose compulsions have nothing to do with saying sorry.

What are common OCD subtypes?

Harm OCD

causes people to be deeply disturbed by the violent thoughts that just about everyone has experienced. While most people are able to shrug off these thoughts, those with Harm OCD can become completely overwhelmed by them.

Obsessions

• I could jump in front of the train right now
• I could stab my husband with this knife
• What if I drove into that person?
• What if I killed my nephew and I just can’t remember?

Compulsions

• Refusing to stand near train tracks
• Keeping all knives hidden away somewhere
• Repeatedly going back to check if you ran someone over
• Calling your sibling to check if your nephew is safe and sound

Homosexual OCD

involves obsessions about one’s sexuality. The name is actually a bit outdated, because you can obsess about having any sexual orientation, not just being homosexual.

Obsessions

• I was attracted to that guy back there. This means I’m gay.
• Other people can detect that deep down I’m into women
• Was I really into her when we dated? Or am I more into guys?

Compulsions

• Looking at pictures of women to see if you’re attracted to them
• Asking people repeatedly if you seem straight to them
• Avoiding people of the same sex altogether to avoid confusion

Pedophilia OCD

is especially prone to stigma because of how strong people’s feelings are about pedophiles. However, as with all types of OCD, these obsessions are not desires. In fact, people are so distressed by these thoughts because they don’t reflect what they really want.

Obsessions

• What if I have sexual thoughts about the kid I’m babysitting?
• I just had a sexual thought when I was around my cousin’s kid, am I attracted to them?
• What if I molested a kid and I just can’t remember?

Compulsions

• Looking online for stories of real pedophiles so you can find evidence you’re not one
• Staying away from kids altogether
• Repeatedly beating yourself up in your head for these thoughts

Relationship OCD

leaves people completely unable to tolerate the uncertainty of intimate relationships, giving them obsessions about the “rightness” of their own relationship and the countless other possibilities that daily life brings.

Obsessions

• Is this the right person for me?
• Couldn’t there be someone better out there?
• Are we meant for one another?
• What if we’re not meant to be but we still end up stuck together?

Compulsions

• Taking relationship quizzes online
• Looking up other people on social media to see if their relationships
seem better
• Remembering situations over and over: did we really have fun together
on vacation that time?

“Just Right” OCD

is a little different from these other subtypes, in that it’s difficult to identify a specific fear, or set of fears, underlying it. Instead, it’s usually more like a strong feeling that something just isn’t right when things aren’t a certain way. It’s one of the more caricatured forms of OCD, in TV shows, movies, and jokes.

Obsessions

• Something is just not right with this
• I need to start this over to make itperfect
• This just doesn’t feel right

Compulsions

• Performing any action over and over, e.g. closing doors
• Rearranging, reordering, organizing things repeatedly
• Changing wording many times in emails or notes

Contamination OCD

is probably the most stereotyped form of OCD. People with this subtype are afraid of getting sick, or infecting someone they care about, after coming in contact with serious bacteria.

Obsessions

• Oh no, this time I’ve really gotten AIDS
• I just gave my sister’s baby a serious illness when I held him
• This whole place is full of bad bacteria, I can just tell

Compulsions

• Repeatedly washing hands, sanitizing things
• Always cleaning different sources around the house
• Avoiding being in public, doctor’s offices, being around kids

Pure-O

or Pure Obsessional OCD, isn’t really the best name for this subtype, because people with Pure-O also have compulsions, even though they’re mental. A variety of obsessions can appear about sex, sexuality, religion, harm, personal health, romance, and so on. Basically, this subtype can include obsessions from any of the other subtypes above, but without the visible compulsions.

Obsessions

•What if I’m actually not a good person?
• How do I know that life is even worth it?
• What if I go over there and push that guy off this bridge?
• If I don’t clean my mess up well enough someone will get slip and get seriously hurt because of me

Compulsions

• Making sure to spend time only with people who will tell you you’re a good person
• Always thinking through the “meaning of life” question
• Looking for signs in your mind that you would never push someone off a bridge
• Trying repeatedly to remember a situation because you haven’t done it correctly if you’ve missed a detail

There are plenty of other subtypes, but these common ones should provide a good idea of what lots of people with OCD struggle with on a daily basis. It’s not worth struggling too hard to figure out exactly what someone’s subtype is, but it can be comforting to know there are others going through something similar.

For a small number of people, OCD symptoms become so severe that suicide is a risk. If you ever consider suicide, call your local suicide hotline or emergency number right away. In the United States, this number is 1-800-273-8255.

 

These resources were developed with:

Michael A. Jenike, MD

Founder, OCD Institute at McLean Hospital
Professor of Psychiatry, Harvard Medical School

Christopher Pittenger, MD, PhD

Director, Yale OCD Research Clinic
Associate Professor of Psychiatry and in the
Child Study Center, Yale School of Medicine