Common Types of Obsessive Compulsive Disorder (OCD)

What Is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder (OCD) is a condition that involves repeated intrusive thoughts (obsessions) and ritualistic behaviors or mental acts (compulsions). Most people with OCD report that their obsessions cause them excessive anxiety and distress. However, engaging in their compulsive behavior temporarily relieves that stress. Over time, compulsions can become more complicated and time-consuming, interrupting a person’s routine and impairing their ability to function.^1,7,8

While obsessions and compulsions are hallmark symptoms of OCD, these symptoms don’t occur the same way for everyone with the disorder. Specific obsessions and compulsions vary by OCD subtype. However, they consistently lead to high levels of discomfort, stress, and impairment.

OCD Vs. Anxiety

Because symptoms of anxiety are usually a part of OCD, it used to be classified as an anxiety disorder. However, due to some of OCD’s unique features, like intrusive thoughts and repetitive behaviors, it has since been given its own category.^1,7 Comorbid anxiety and OCD frequently occur together, and it’s estimated that over 90% of people with OCD have another comorbid condition.⁸

Are There Different OCD Types?

While still not universally agreed upon, a growing number of studies suggest OCD subtypes do exist. These subtypes may impact a person’s specific symptoms and treatment recommendations.^2,3,5,8 Some studies even suggest that there are neurological differences in the brains of people who struggle with different kinds of OCD.^2,9 Despite these studies, no subtypes of OCD have been officially recognized as diagnosable conditions.^1,7

Common OCD Subtypes

The most common OCD subtypes are contamination OCD and checking OCD, which account for nearly 75% of cases. Luckily, these are also the types of OCD that are easiest to treat. The next most common types of OCD are hoarding and compulsions involving symmetry and order, which can be more difficult to treat.^3,4,5,8

Contamination OCD

People with contamination OCD often have a phobia of germs, bacteria, and/or viruses. Contamination types of OCD can lead to compulsive hand-washing, cleaning, disinfecting, or taking health precautions that seem excessive to those around them. Some people with contamination OCD are afraid of contracting an illness or disease, and others are just bothered by the idea of germs. Hygiene and OCD cleaning rituals can become very time-consuming and difficult to maintain for people with this subtype.

Studies suggest that contamination OCD tends to respond well to exposure therapies and is one of the easier types of OCD to treat.^3,4,8

Contamination OCD Obsessions

Contamination OCD involves a range of intense and unique obsessions, including:

• Fear of certain foods or categories of food
• Fear of bugs or animals being in the home
• Fear of foods spoiling
• Fear of touching items like toilets and doorknobs
• Fear of spreading infectious diseases
• Fear of sharing items with people like cups, hair brushes, or bottles
• Fear of feces and urine

Contamination OCD Compulsions

Contamination OCD can produce life-changing compulsions that can greatly affect someone’s health and well-being, like:

• Bleaching surfaces multiple times daily
• Engaging in extreme hygiene behaviors following bowel movements
• Showering and handwashing excessively
• Throwing away anything thought to be contaminated
• Smelling and frequently checking foods
• Not allowing loved ones to go places that are associated with being “unclean”

Checking OCD

Checking OCD is the most common subtype and involves compulsively checking and rechecking to make sure something is complete, accurate, safe, or normal.^3,8 Examples of checking compulsions include repeatedly checking locks and appliances, re-reading emails for mistakes, repeating medical tests and labs, or continuously asking a loved one if they’re angry. People with checking OCD usually don’t trust the results of the first check, which causes them to keep checking over and over again.

Checking OCD is highly treatable and often responds well to exposure and response prevention (ERP).⁴

Checking OCD Obsessions

Some common checking OCD obsessions include worrying about:

• The stove being on
• Doors being unlocked
• Windows being open
• Car engine running
• Baby’s breathing being disrupted

Checking OCD Compulsions

Some common checking OCD compulsions include checking:

• The stove
• Door locks
• Windows
• Car engine
• Baby’s breathing

Symmetry OCD or “Just Right” OCD

People with symmetry OCD need things to be even, symmetrical, arranged, or done in a specific order. When something isn’t aligned or completed in a preferred way, it can cause significant discomfort. This common OCD subtype can lead to compulsive organization, correcting mistakes, or redoing things that weren’t done a specific way. People with symmetry obsessions have very specific and exact preferences that might apply to some or all objects, places, or tasks, which is why this subtype can be related to “Just Right” OCD.

Symmetry OCD is the third most common subtype and can often be treated with exposure and response prevention.^4,8

Symmetry OCD Obsessions

Symmetry OCD can involve any number of obsessions that seem mostly unrelated to the compulsions. Symmetry OCD obsessions can include thinking that:

• Someone will become very sick
• Someone will die
• The house will burn down
• The world will end
• Someone will have an accident

Symmetry OCD Compulsions

Symmetry OCD compulsions can include:

• Touching a door lock numerous times
• Flipping a light switch over and over
• Counting aloud or to oneself
• Stepping or walking a certain way
• Blinking or moving eyes compulsively

Pure-O OCD

While not all experts agree that it exists, purely obsessional OCD (also called Pure-O OCD) is a subtype that can present as obsessions without any outward compulsions. Research suggests most people with Pure-O have obsessions that are moral, sexual, aggressive, or otherwise “inappropriate” in nature.⁷ People with Pure-O OCD don’t engage in physical, compulsive rituals or behaviors to cope with their obsessive thoughts. Instead, they may engage in mental rituals like repeating mantras and prayers or rehashing memories (like in false memory OCD).³

Pure-O OCD may respond better to cognitive therapies or medication rather than exposure therapy.⁴

Pure-O OCD Obsessions

Pure-O OCD obsessions can include:

• Worrying about hurting or killing oneself or a loved one
• Worrying about abusing or molesting someone
• Worrying about driving off a bridge or into a wall
• Worrying about viewing pornography or their sexuality

Pure-O OCD Compulsions

Pure-O OCD compulsions can include:

• Saying “I’m okay” repeatedly
• Saying “I’m not like that”
• Saying “That will never happen”
• Replaying a painful memory excessively
• Saying “I’m wrong, bad, or broken” repeatedly

Sexual-Related OCD

OCD can impact sex in many ways. People with sexual subtypes of OCD experience a lot of doubt about their sexuality or sexual preferences, often have sexual intrusive thoughts, and may excessively question their gender identity or sexual orientation. Many engage in compulsive checking for sexual arousal, compulsive research into sexuality, or avoidance of triggers.

• SO-OCD: Marked by intrusive thoughts related to sexual orientation, people who struggle with SO-OCD (sometimes called HOCD) agonize over their sexuality and worry that others perceive them as having a different sexual orientation than they identify with.
• POCD: POCD involves intrusive thoughts related to fears about becoming a pedophile.
• TOCD: TOCD involves obsessions related to gender identity.¹²

The sexual subtype of OCD can be extremely distressing and difficult for people to discuss, which may cause some to avoid seeking treatment.

Sexual OCD Obsessions

Sexual OCD obsessions can include:

• Thinking about last sexual experiences
• Thinking about future sexual experiences
• Fantasizing about sex
• Thinking about their sexuality
• Thinking about how others view their sexuality

Sexual OCD Compulsions

Sexual OCD compulsions can include:

• Having sex
• Masturbating
• Viewing pornography
• Working out or dieting to change their appearance
• Asking people about their perceptions of their sexuality

Harm OCD

People with harm OCD have obsessive thoughts, worries, and mental images of hurting themselves or others. These violent obsessions are almost always fear-driven and not reflective of a true desire to harm anyone. Still, people with harm OCD become very anxious and distressed about their intrusive thoughts and many engage in compulsive avoidance, checking, research, or reassurance seeking to cope.

When harm OCD involves compulsions, it can often be treated with exposure and response prevention. When it mainly involves intrusive thoughts, cognitive therapies like CBT or ACT may be preferred, sometimes along with medication.^4,6

Harm OCD Obsessions

Harm OCD obsessions can include:

• Thinking about killing someone
• Thinking about hurting someone physically or mentally
• Believing that they hurt someone in the past
• Picturing horrific car crashes
• Believing that they will hurt someone in the future

Harm OCD Compulsions

Harm OCD compulsions can include:

• Reassuring oneself verbally or mentally
• Reassuring others verbally or mentally
• Doing research on harming behaviors
• Being overly timid or nurturing
• Avoiding people to keep them away from dangers

Relationship OCD

People with relationship OCD become obsessed with beliefs and fears about their partner or relationship. For example, they might become completely preoccupied with the fear that their partner is cheating on them or planning to break up with them. Others with relationship OCD might be obsessed with finding out if their partner is “the one.” Like other OCD subtypes, most of these obsessions are driven by anxiety, fear, and self-doubt instead of being reflective of realistic concerns about their partner or relationship.

Relationship OCD is a less common subtype of OCD, and there’s less research on specific treatments for this subtype.

Relationship OCD Obsessions

Relationship OCD obsessions can include:

• Worrying about cheating
• Thinking the partner is lying
• Thinking the partner could do better
• Imaging the partner having sex with someone else
• Worrying that the other person isn’t “the one”

Relationship OCD Compulsions

Relationship OCD compulsions can include:

• Calling and texting the person often
• Checking their phone
• Questioning them
• Spying on them
• Checking their social media

Scrupulosity or Religious OCD

Some OCD obsessions have a moral, ethical, or religious focus, which is sometimes labeled as scrupulosity OCD. For example, people with religious OCD might become obsessed with the belief that they’re going to hell or have offended God. Other types of moral OCD may be less religious in nature and more focused on general fears about being a “bad person.” These moral obsessions can cause extreme self-doubt and questioning, leading to compulsive checking, reassurance seeking, or prayer.

Exposure therapy, CBT, or medication may be recommended depending on a person’s symptoms.⁴

Scrupulosity OCD Obsessions

Scrupulosity OCD obsessions can include:

• Thinking there is no God
• Thinking there is a God, but that God is angry at them
• Thinking about heaven and hell
• Thinking that you are not good enough
• Thinking that you’re constantly sinning

Scrupulosity OCD Compulsions

Scrupulosity OCD compulsions can include excessive amounts of:

• Praying
• Going to church
• Asking for forgiveness
• Talking to religious leaders
• Doing “good deeds”

Somatic OCD

People with somatic OCD have obsessions that focus on their body or their physical health. For example, people with health OCD develop obsessive thoughts and concerns that they have a serious chronic illness or disease. This can lead to excessive research or expensive medical tests and procedures that become compulsive. Similar to body dysmorphia, some people with somatic OCD become convinced their bodies are deformed or flawed and develop disordered eating and exercise habits.¹

Somatic forms of OCD are closely associated with checking OCD, and may be treated similarly with exposure and response prevention, sometimes in addition to medications.⁴

Somatic OCD Obsessions

Somatic OCD obsessions can include:

• Worrying about having cancer
• Worrying about getting COVID
• Worrying about contracting AIDS/ HIV
• Worrying that skin or hair are unhealthy
• Worrying that some body part is becoming deformed

Somatic OCD Compulsions

Somatic OCD compulsions can include excessive amounts of:

• Researching online
• Making doctor’s appointments
• Going to the ER
• Checking in the mirror
• Asking loved one’s for reassurance

Real Event OCD

While many OCD obsessions involve ideas or beliefs that are untrue or unlikely, real event OCD obsessions involve an event that someone actually experienced. People with real event OCD might obsessively replay their memory of the event in order to figure out if it actually happened. For example, they might question or doubt what they said or did in a situation and feel the need to compulsively replay it in order to find out.

Excessive self-doubt and mental compulsions are common features of real event OCD, and may be best targeted with cognitive therapies, and sometimes medication.⁴

Real Event OCD Obsessions

Real event OCD obsessions can include:

• Thinking about a car wreck
• Thinking about an injury
• Thinking about a scary news report
• Thinking about a time where there was “almost” a tragedy
• Worrying about a past break up

Real Event OCD Compulsions

Real event OCD compulsions can include:

• Researching and seeking out more information
• Seeking reassurance from loved ones
• Re-reading the news
• Reviewing medical records
• Re-reading emails, texts, and direct messages

Hoarding

Hoarding disorder is not technically an OCD subtype, but it’s often classified as one. This OCD-related disorder is not diagnosed as obsessive-compulsive disorder, unlike the other subtypes. Someone with hoarding disorder becomes obsessively attached to their belongings and refuses to get rid of things that are cluttering up their space. Because of the strong emotional attachment to their belongings, people with hoarding disorder will not usually get rid of things that are broken or that they no longer use.¹

After checking OCD, hoarding is the second most common subtype and can also be one of the hardest to treat.^3,4

Other OCD Subtypes

The list of OCD subtypes continues. Though rarer, people with OCD could also experience:

• Hit and run OCD: Hit and run OCD is characterized by worrying about hitting a person or animal while driving or believing they already had hit someone.
• Magical thinking OCD: Magical thinking OCD is characterized by a person believing that their actions or inactions profoundly impact a situation or person.
• Existential OCD: When overtaken by questions that can’t possibly be answered, that are philosophical or even frightening, a person might be suffering from existential OCD.
• Mental contamination OCD: Mental or emotional contamination OCD involves obsessions related to feeling mentally or emotionally unclean, or internally “dirty,” which are dealt with through physical cleaning rituals.
• Racism OCD: Individuals with racism OCD have obsessive thoughts surrounding the possibility of being racist. These obsessions result in compulsions to ensure that one is not racist, such as reading books about racism for hours a day or obsessively seeking reassurance from loved ones that they are not racist.
• Sensorimotor OCD: Individuals with sensorimotor OCD are fixated on involuntary bodily processes like blinking, breathing, or swallowing.
• Staring OCD:  Individuals with staring OCD are fixated on their inability to control their staring.

Disorders Related to OCD

In the latest version of the DSM, hoarding disorder, trichotillomania, skin picking, Tourette’s syndrome, and body dysmorphia are all classified as “OCD-related disorders.” OCD-related disorders have some obsessive and/or compulsive features but are separate disorders that are diagnosed using a different set of symptoms than OCD.

• Body dysmorphia: Body dysmorphia involves obsessive thoughts about a perceived flaw in one’s physical appearance.
• Trichotillomania: Trichotillomania is marked by a compulsion to pull hairs out of one’s body.
• Excoriation: Excoriation is a compulsive disorder in which a person cannot resist constantly picking at their own skin.
• Other or unspecified OCD: This diagnosis might be used to describe obsessive jealousy, or other body-focused compulsive behavior patterns, like excessive lip chewing or nail biting.
• Olfactory reference syndrome: People with olfactory reference syndrome have an intense fear of omitting a bad odor, like bad breath or body odor.

With the exception of hoarding disorder, none of these conditions are specifically listed as subtypes of OCD. However, because of their similarities, having one of these disorders can increase the risk of developing OCD. Additionally, it’s common to have one or more co-occurring disorders with OCD.^1,10

How Are OCD Subtypes Treated?

OCD is typically treated with therapy, or therapy in conjunction with medication.^4,6,11 According to some studies, specific OCD treatments are more effective in treating certain subtypes. For example, people with cleaning and checking compulsions often respond well to exposure and response prevention, while people with more obsessive symptoms may benefit from cognitive therapies.

Other research suggests that hoarding disorder and Pure-O OCD subtypes are harder to treat and may not respond as well to ERP or medications.^3,4

Therapy for OCD

Therapy is a frontline treatment for OCD, and can often help people manage their symptoms. Certain kinds of therapy have more research to suggest they’re effective in helping people with OCD symptoms.

Here are some of the types of psychotherapy that have the most empirical support for OCD:^4,6,11

• Exposure and Response Prevention (ERP): ERP for OCD is a specialized type of exposure therapy that helps people face their fears, learn healthy coping skills, and break the OCD cycle of compulsive behaviors.
• Cognitive Behavioral Therapy (CBT): CBT for OCD can help people identify, track, and change unhelpful obsessive thoughts that contribute to their symptoms. This methodology also uses behaviorism and habit-reversal training to break compulsive habits.
• Acceptance and Commitment Therapy (ACT): Acceptance and commitment therapy for OCD can help people learn how to use mindfulness and emotional acceptance skills to cope with OCD in healthier ways. This treatment also encourages people to identify and align their actions with their core values.

Medication for OCD

Sometimes, people with OCD benefit from psychiatric medication in addition to therapy. A number of psychiatric medications are used to treat OCD, including antidepressants and antipsychotic medications. Medications can help people manage some of the symptoms of OCD, including anxiety, impulsivity, and intrusive thoughts.^4,6

Here are the most commonly prescribed OCD medications:^4,6

• SSRI medications: SSRI medications work on serotonin receptors in the brain, and are commonly prescribed to people with OCD, especially when they have a co-occurring mood or anxiety disorder.
• Antipsychotic medications: Antipsychotic medications block dopamine receptors in the brain, which can help reduce intrusive thoughts related to OCD.

How To Get Treatment for OCD

Therapy, specifically exposure and response prevention, is the gold standard for OCD treatment, which may be combined with psychiatric medication. Because OCD is a specialized area of psychology, finding a therapist with training and experience in OCD treatments like ERP is recommended.^6,11

Many people begin their search online by using a free online therapist directory that allows them to filter their search by location, insurance type, and specialty. There are also several online OCD resources that could help someone find appropriate treatment options, like NOCD, which offers online therapy options for people with OCD. During the first appointment, most therapists conduct a clinical assessment to confirm a diagnosis and provide recommendations and options for treatment.