Common Types of Obsessive Compulsive Disorder (OCD)

What Is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder, or OCD, is a psychiatric condition that involves repeated distressing 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. 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}

Co-morbid anxiety and OCD frequently occur together, and it’s estimated that over 90% of people with OCD have another co-occurring mental health condition.⁸ OCD is one of the most debilitating mental illnesses, often worsening if it’s not treated. Those with OCD who do pursue treatments like therapy and medication are often able to manage their symptoms and improve their quality of life.^{6, 7}

Are There Different Types of OCD?

There has been an ongoing debate within the field of psychology for decades about whether or not subtypes of OCD exist. 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, 4, 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, 10}

Common Subtypes of OCD

Most of the research includes the following OCD subtypes: contamination, checking, symmetry, intrusive thoughts, hoarding, sex, harming, relationships, and morality.^{2, 4, 5} 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 harder to treat.^{3, 4, 5, 8}

Common subtypes of OCD are:^{2, 4, 5}

Contamination OCD

People with contamination OCD often have a phobia of germs, bacteria, and/or viruses. Contamination types of OCD can lead to compulsive handwashing, 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 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}

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 also highly treatable and often responds well to exposure therapies like exposure and response prevention (ERP).⁴

Symmetry 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 is also called “Just Right OCD.” Symmetry OCD is the third most common subtype and can often be treated with exposure therapy or ERP.^{4, 8}

Inappropriate Thoughts OCD

While not all experts agree that it exists, inappropriate thoughts or purely obsessional OCD (aka Pure-O OCD) is a subtype that can present as obsessions without any 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 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

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}

Sexual OCD

OCD impacts sex in many ways. Some people with OCD become obsessed with the idea that they’re gay (homosexual OCD), transgender (transgender OCD), or have other sexual obsessions, like pedophilia OCD. These thoughts are usually driven by fear and anxiety and not by real sexual desire or attraction.

People with sexual subtypes of OCD experience a lot of doubt about their sexuality or sexual preferences 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. The sexual subtype of OCD can be extremely distressing and difficult for people to discuss, which may cause some to avoid seeking treatment.

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 therapy. When it mainly involves intrusive thoughts, cognitive therapies like CBT or ACT may be preferred, sometimes along with medication.^{4, 6}

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.

Morality 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

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 or muscle 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 therapy, sometimes in addition to medications.⁴

Real Event OCD

While many OCD obsessions involve ideas or beliefs that are untrue or unlikely, real event OCD obsessions involve an experience or 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

OCD Related Disorders

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.

With the exception of hoarding disorder, none of these conditions are 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 also common to have one or more co-occurring disorders with OCD.^{1, 10}

How Is OCD Treated?

In many instances, OCD is treatable 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 therapy, 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 SRI 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. Below are some of the types of psychotherapy that have the most empirical support for OCD:^{4, 6, 11}

• Exposure and Response Prevention (ERP): Exposure and Response Prevention (or ERP) is a specialized type of exposure therapy that helps people with OCD face their fears, learn healthy coping skills, and break the 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 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}

• SRI or SSRI medications: SRI and SSRI antidepressant 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

Most people with OCD are recommended for therapy, 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 therapist directory that allows them to filter their search by location, insurance type, and specialty. During the first appointment, most therapists conduct a clinical assessment to confirm a diagnosis and provide recommendations and options for treatment.