When we use the term “OCD” or “Obsessive Compulsive”, many people picture someone endlessly washing their hands or repeatedly checking the stove before leaving the house. In actuality, Obsessive Compulsive Disorder can manifest itself in a number of ways and is often broken down into four subtypes.
Contamination OCD: People with this type of OCD fear that they are going to be contaminated by germs. As a result, they may develop a fear of shaking hands, touching doorknobs, eating in restaurants, or being exposed to germs in kitchens or bathrooms. In response, they meticulously wash/clean themselves when they come into contact with these things, or attempt to avoid them altogether. This temporarily relieves the distress they feel about being exposed to germs but it causes their OCD to get worse in the long run. Eventually, the phobias and rituals may take up hours of time each day and cause them to miss out on the kinds of things that can make life worthwhile (e.g., meeting a friend for lunch in a café, attending social gatherings).
Harm/Checking OCD: People with Harm OCD worry that they are going to inadvertently hurt themselves or someone else. To relieve their distress about this, they check things repeatedly. People with a fear of burning down their house may have to repeatedly check the stove, coffee pot, and other electrical appliances before leaving in the morning. Some people chronically worry that they’ve run over somebody while driving and repeatedly return to the location where they think this happened. This can result in circling the same block 15 or 20 times, pulling over to the side of the road to check for victims, or avoiding driving altogether.
“Just Right” OCD: People with this type of OCD tend to be uncomfortable or ill-at-ease if things are not “just right”. Some may fixate on order and symmetry (e.g., the person who has to have everything on their desk perfectly aligned). Others may be triggered by touch or feel (e.g., the person who has to find a shirt or pair of socks that fit perfectly and feel “just right” before they can leave the house). Others may obsess about the way they express themselves (e.g., checking and rewriting emails over and over again). Counting rituals may be associated with “Just Right” OCD (e.g., having to count from 1 to 100 by multiples of 4 every time you’re in a certain place or situation). Perfectionism and a need for order, control, and predictability are hallmarks of this type of OCD. Many people realize the absurdity of their rituals and high standards but have difficulty stopping them because of the anxiety they feel when they don’t perform the ritual.
Intrusive Thoughts/“Pure OCD”: Sometimes referred to as “Pure O”, people with this type of OCD suffer from obsessions that may not have any visible compulsions associated with them. These typically include unwanted, intrusive thoughts or mental images associated with sex, violence, or religion. Some people worry that they may be gay (or straight), when in reality they aren’t. Others worry that they’re going to molest a child or kill their father, when in reality they would never do such a thing. Some have exaggerated fears about having committed a sin or done something to offend God and ruminate on it endlessly (“scrupulosity”). These intrusive thoughts or images can be very troubling and lead to depression, anxiety, and self-doubt (e.g., “How could I think of doing such a thing?” “What is wrong with me?” “Why am I having these horrifying thoughts over and over again?”)
The treatment of choice for all these types of OCD is Exposure and Response Prevention (link to blog on ERP). Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness have all been shown to be helpful in treating OCD as well.
Other Disorders related to OCD:
Hoarding: People who “hoard” have difficulty throwing away possessions that most other people would perceive as useless. Hoarders fear they may someday need these items and can end up accumulating so much stuff that parts of their home become unlivable.
Excoriation: This is a condition in which people repetitively pick at their skin until they develop skin lesions.
Trichotillomania: This a condition in which people repeatedly pull out their hair, resulting in hair loss.
John “Andy” Bradshaw, Associate Marriage & Family Therapist #101517 (supervised by Dino Di Donato, MFT #39831) focuses on the treatment of OCD and anxiety at Market Street Center for Psychotherapy. You can contact him at (510) 599-9845 or firstname.lastname@example.org.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing.