Types of OCD: Everything You Need to Know About the Subtypes of OCD

Obsessive-Compulsive Disorder, or OCD, is a nuanced, complex mental disorder characterized by intrusive thoughts and urges that result in repetitive behaviors to minimize anxiety.

Those who suffer from OCD feel that they must carry out their compulsive behaviors (whether physically or emotionally) to prevent something bad from happening. Many people with Obsessive-Compulsive Disorder recognize that these thoughts are excessive or irrational but feel as if they cannot control their behaviors.

OCD can severely impact an individual’s daily life, but the condition can be treated with medications, therapy, or both.

What are the Types of OCD?

There are several subtypes of OCD. Some individuals diagnosed with the disorder will experience symptoms from only one subtype, while others experience more severe obsessions and compulsions across many subtypes.

Contamination OCD

Contamination OCD is characterized by an excessive, irrational, and obsessive phobia of germs, disease, or mental contamination. According to scientific studies, about 10% of contamination OCD sufferers experience fear of mental contamination without fear of contact contamination.[1]

This type of OCD is what is most commonly associated with the disorder, comparing their desire to be clean or organized with obsessions and compulsions. However, not everyone who likes to keep a neat and orderly appearance and environment is obsessive-compulsive.

Some signs and symptoms of contamination OCD include:

• Excessive hand washing
• Repeated cleaning and re-learning of one’s home or environment on the same day
• Changing clothes frequently throughout the day
• Excessively seeking reassurance from others about cleanliness or safety
• Avoiding touching items believed to be contaminated
• Fear of using public restrooms or spaces
• A refusal to shake hands or hug others
• Disrupted daily functioning due to cleaning rituals
• Irrational fear of illness or disease, even without evidence of contamination

Not every individual with OCD is concerned about germs. Contamination OCD might also be a fear of being drugged or dosed, a phobia of loose hairs on their clothing, or even a fear that one’s immune system might be compromised from being “too clean.”

Checking OCD

This subtype of OCD involves incessantly checking and rechecking things, such as locks or appliances. For example, someone checking for OCD might lock the door, twist the doorknob to ensure the door is locked, walk away from the door, and then go back to double-check. This might happen several times.

Signs and symptoms of checking OCD include:

• Repeatedly checking locks, appliances, or other objects to ensure they are secure
• Constantly re-reading texts, emails, or other written material to ensure there are no errors
• Checking and rechecking to make sure nothing was forgotten, such as turning off the stove or unplugging a device
• Checking and rechecking personal health or physical symptoms, such as heart rate or breathing
• Repeatedly checking on loved ones to make sure they are safe or still alive
• Difficulty concentrating or completing tasks due to the need to check and re-check
• Spending significant amounts of time checking and performing rituals

Those with checking OCD fear making mistakes or causing harm due to their lack of checking. This type of OCD can be extremely detrimental to someone’s daily productivity, as well as handling simple life tasks.

Symmetry and Order OCD

Symmetry, balance, and exactness are the characteristics of symmetry and order OCD. One of the most common types of OCD, those with the disorder often become irrationally upset or anxious when things are not in order.[2]

• An overwhelming need for order in personal spaces such as one’s home, office, or car
• Compulsive arranging and rearranging of objects to achieve symmetry or balance
• The irrational need to do things “equally,” such as the need to touch an object for equal times with both the left and right hands
• Intrusive thoughts about negative consequences if things are not in their “right” place
• Difficulty completing activities of daily living due to preoccupation with symmetry and order.

Symmetry and OCD should not be confused with perfectionism or just being particular. The key differentiator between someone who simply likes things a certain way and someone who suffers from symmetry OCD is obsessive thoughts about whether or not things are precise enough and the constant worry that things are “wrong.”

Hoarding OCD

Hoarding OCD is a subtype of OCD that involves an obsession with accumulating or collecting things. Someone with hoarding OCD may have extreme difficulty parting with items even when they are broken, duplicates, or otherwise not useful or necessary.

Some signs and symptoms of hoarding related to OCD include:[3]

• Accumulating such a large quantity of possessions that living spaces are cluttered or pose safety risks
• Anxiety and distress at the thought of parting with or losing things
• Avoiding hosting friends or family due to the state of the living space
• Losing important items like money or bills in the clutter
• An intense feeling of overwhelm due to clutter and disorganization
• Inability to turn down free items
• Difficulty with daily living tasks due to hoarding behaviors
• Obsessive shopping habits for items that are not needed or even necessarily wanted.

Intrusive Thoughts OCD

Recurrent, unwanted, and disturbing images, thoughts, and impulsiveness may be a sign of intrusive thoughts OCD. These intrusive thoughts may be violent, graphic, sexual in nature, or reminiscent of past traumas.

Behaviors and signs of intrusive thoughts may look like:

• Repetitive, ritualistic behaviors aimed at reducing the anxiety surrounding the intrusive thoughts or preventing them from coming true
• Fear of acting on the intrusive thoughts and impulses
• Shame, guilt, and embarrassment regarding the thoughts or compulsions
• Avoiding situations, people, or places that may trigger unwanted thoughts
• Difficulty sleeping due to a hyper-fixation on intrusive thoughts

Some intrusive thoughts are suicidal in nature. If you or a loved one are experiencing intrusive thoughts about harming oneself or others and believe you may act on these thoughts, seek emergency mental health services immediately.

Pure-O OCD (Obsessional OCD)

The “O” in Pure-OCD stands for obsessional, as this type of OCD is characterized by obsessions without the presence of external compulsions. An individual with Pure-O OCD will have unwanted intrusive thoughts but will not perform any physical compulsions as a result. However, mental compulsions are present.

Obsessive compulsions are a complex landscape, the following are some common obsessions found among those with Pure-O OCD: [4]

• Fear of causing harm, either intentionally or accidentally, to oneself or others
• Fear of inadvertently causing accidents or damage, like leaving the stove on or the door unlocked
• Fear of contamination from germs that can lead to distress and difficulty making decisions
• A compelling need for symmetry and order which can make simple things stressful

While individuals with Pure-O OCD primarily experience mental symptoms, the stress and anxiety caused by their condition can indirectly lead to physical symptoms such as fatigue, tense muscles, or headaches.

Harm OCD

Harm OCD is the obsession with the possibility of causing harm or destruction, even when there is no threat present. For example, someone with the harm OCD subtype might have a preoccupation that they might “snap” and attack someone, even though they harbor no ill will or and have no intentions of hurting someone.

Some common indicators of OCD-related harmful thoughts and behaviors can include:

• Intense anxiety surrounding their intrusive thoughts
• Checking to ensure they have not acted on their intrusive thoughts and harmed someone
• Seeking constant reassurance that they have not or will not harm themselves or someone else
• Compulsive behaviors such as counting, checking, or repetitive actions to reduce anxiety and to prevent harm from occurring

Just because someone has OCD does not mean that they will act on their intrusive thoughts if their rituals are not carried out. The belief that they are preventing negative consequences due to their intrusive thoughts by performing these rituals is a hallmark of OCD. This applies to all subtypes of OCD.

Sexual Orientation OCD

The sexual orientation subtype of OCD is characterized by an obsessive fear that someone’s sexual preferences are not aligned with their own beliefs.[5] Someone suffering from OCD might become obsessively concerned that their sexual orientation is vastly different from what it truly is, regardless of any evidence to the contrary.

Signs and behaviors that may be associated with Sexual Orientation OCD include the following:[6]

• Persistently seeking reassurance of their sexual orientation, whether they are straight, gay, bisexual, or another sexual orientation
• Avoiding situations, people, or places that might trigger their intrusive thoughts
• Significant emotional distress, shame, or anxiety surrounding their intrusive thoughts
• Feelings of isolation, confusion, and doubt over their sexuality.
• Compulsive sexual behaviors, such as repeatedly checking their sexual arousal to certain stimuli to reassure themselves of their sexual orientation

Heterosexual people with OCD may also feel a sense of intense shame or embarrassment, fearing that their obsession with not being gay is homophobic.

Sensorimotor OCD

This is a less common form of OCD where an individual obsesses over the feelings and sensations in their body. Someone with sensorimotor OCD may become hypervigilant of their breathing, blinking, heart rate, or swallowing. In turn, this hyperawareness can cause excessive worry and compulsions to repeatedly check their bodily sensations.

Signs that could indicate Sensorimotor OCD include:

• Extreme sensitivity to changes in bodily sensations, resulting in fear and anxiety when sensations change
• Avoiding activities that will cause changes in bodily sensations. Someone with sensorimotor OCD may have a fear of a raised heart rate or sweat
• Excessive worry about losing control over one’s bodily functions
• Repeated checking of blood pressure, pulse, or breathing pattern
• Compulsive behaviors like touching, tapping, or counting to counteract the anxiety and discomfort surrounding intrusive thoughts

An exact cause of sensorimotor OCD is not known, but a connection to abnormalities in brain activity or neurological dysfunction may exist.

Scrupulosity OCD

Scrupulosity OCD, also known as religious OCD, is a type of OCD where the individual has obsessive and intrusive thoughts related to their spirituality, morality, or religious beliefs. Someone with this type of OCD may be in a constant state of constant worry that they may be committing a moral or religious sin or are partaking in blasphemous behaviors.

Indicators of scrupulosity OCD can include:

• Persistent unwanted, unpleasant thoughts surrounding morality and beliefs, such as harming oneself or others, blasphemy, and sinning
• Constant seeking of reassurance that the individual is not a bad person or has sinned
• Compulsive praying, confessing, apologizing, or seeking forgiveness in an attempt to rid themselves of the anxiety surrounding intrusive thoughts
• Avoiding certain situations that may trigger intrusive thoughts, such as church or religious ceremonies
• Severe emotional distress and shame caused by their intrusive thoughts and behaviors

Scrupulosity OCD is not limited to those who consider themselves traditionally religious. People who consider themselves spiritual or are overly concerned with morality may also develop scrupulosity OCD.

Sexual OCD

Sexual OCD is a type of OCD in which an individual has intrusive, persistent, obsessive thoughts related to sexual behaviors or acts. These thoughts may be considered taboo or socially unacceptable, causing even more anxiety.

Some internal and external signs of sexual OCD might include:

• Engaging in compulsive behaviors to check or alleviate anxiety related to sexual thoughts rather than compulsively partaking in sexual activities.
• Avoiding people or situations that may trigger intrusive thoughts, such as socializing or dating
• Fear that the individual may act on inappropriate or harmful sexual behavior
• Severe emotional distress related to sexuality

Many people with sexual OCD delay getting treatment due to the taboo around sexual behaviors, which can worsen their obsessions and compulsions.

What Disorders Are Related to Obsessive-Compulsive Disorder?

Some of the mental conditions related to Obsessive-Compulsive Disorder, as categorized by the DSM-5, include:[7]

• Trichotillomania (Hair-Pulling Disorder): Mental health disorder in which an individual experiences recurrent and irresistible urges to pull out hair from the scalp, eyebrows, or other parts of the body.
• Excoriation Disorder(Skin-Picking Disorder) This mental health disorder is characterized by compulsions to pick at one’s own skin, regardless of how raw, open, or painful the skin might be. This often results in significant skin damage.
• Body Dysmorphic Disorder: Commonly referred to as body dysmorphia, this condition is a mental health disorder in which an individual is preoccupied with perceived flaws in one’s appearance.
• Substance-Induced Obsessive-Compulsive Disorder: A disorder characterized by the presence of obsessive-compulsive symptoms as a result of taking a substance, medication, or drug. This condition may also occur when withdrawing from a substance.

This is not an exhaustive list of the conditions related to Obsessive-Compulsive Disorder and related disorders, and anyone concerned should consult their provider.

What are Some Common Misconceptions About OCD?

There are many misconceptions about OCD, and some of the misinformation surrounding the disorder is harmful to those who actually suffer from the condition. Two of the most common misconceptions about OCD are that the disorder is a simple personality “quirk” and that it can be easily cured by “just stopping” the compulsive behaviors.

For those with OCD, it’s more than a desire to be clean and organized: it is an oppressive mental disorder that can control every aspect of an individual’s life and cause extreme distress. This is why it is harmful to people to call themselves “OCD” when they are just particular or well-organized.

What Treatment Options Are Available for Obsessive Compulsive Disorder?

While there is no cure for OCD, there are treatments available, and many are long-term. Some of the treatment options for Obsessive-Compulsive disorder include Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), Medications, Deep Brain Stimulation, and Transcranial Magnetic Stimulation.

Cognitive-behavioral therapy (CBT) for OCD

CBT is a type of psychotherapy with the goal of changing negative thoughts and behaviors through coping strategies and techniques that help manage OCD symptoms. CBT for addiction treatment can be used alone or in combination with other interventions.

Exposure and Response Prevention (ERP) Therapy for OCD?

ERP involves gradually exposing an individual with OCD to the things that trigger their obsessions and intrusive thoughts while teaching them to resist compulsive behavior.

Deep Brain Stimulation for OCD

As an invasive treatment for OCD, deep brain stimulation is a surgical procedure that involves implanting electrodes in the brain to stimulate certain areas that are associated with OCD symptoms.

Transcranial Magnetic Stimulation for OCD

Transcranial Magnetic Stimulation is a non-invasive OCD treatment that uses magnetic fields to stimulate nerve cells in the brain, which may help to reduce the symptoms of OCD.

Medications for Treating OCD

Medications are often the first line of treatment for symptoms of Obsessive-Compulsive Disorder (OCD). Some of the medications that are typically prescribed include:[8]

• Fluvoxamine (Luvox®)
• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)
• Paroxetine (Paxil®)
• Citalopram (Celexa®)
• Clomipramine (Anafranil®)
• Escitalopram (Lexapro®)
• Venlafaxine (Effexor®)
• Duloxetine (Cymbalta®)

(Note: these medications are generally not considered a first-line treatment due to the high risk of dependence and withdrawal.)

Medication alone is not typically sufficient for treating OCD. For the most effective treatment of OCD symptoms, medication therapy should be paired with other interventions.

Not everyone with OCD will require all of these treatments. Some people will see a dramatic and acceptable reduction of symptoms while only partaking in ERP, or with a combination of CBT and medication, whereas others need more intensive treatments.

Get Help For Obsessive-Compulsive Disorder

Incessant worry, intrusive thoughts, and compulsive behaviors and rituals are physically and mentally exhausting and can keep you from feeling like you’re truly living your life.

There is help available. Contact Alpas Wellness and learn more about how you can live your life free of the confines of obsessions and compulsions.