Understanding OCD

Obsessive Compulsive Disorder is characterized by repetitive distressing, intrusive, and unwanted thoughts or doubts that cause anxiety, fear, shame, or disgust, known as obsessions. In order to neutralize the distress caused by obsessions, the individual will engage in behaviors (which can be mental or physical) to relieve these painful feelings. Over time, these actions become cyclical and repetitive and it feels as though there is no choice but to engage in these efforts to alleviate anxiety and fear. These behaviors are called compulsions. This pattern of obsession, anxiety, compulsion, and temporary relief characterizes the sequence known as OCD.

What OCD Is Not

OCD is often portrayed in our media and culture in one of two ways: people who are afraid of germs or dirt and check locks and stoves (which can be OCD, although many people with OCD experience very different kinds of obsessions and compulsions), or people who have quirks and preferences, such as liking their clothes or belongings arranged in a certain way or enjoying a clean and organized environment. It is common to hear people say “I’m so OCD” when talking about enjoyable or quirky preferences. To be clear: OCD does not cause happiness, satisfaction, or enjoyment, and is not a matter of personal preference. OCD causes incredible distress and pain, and OCD sufferers feel as though they have no choice but to engage in this sequence of doubt, fear, and compulsion. OCD is a serious mental health condition that often requires treatment and support from a qualified mental health professional. The good news? OCD is incredibly treatable and helping you reclaim your life and alleviate your suffering is our passion and highest goal.

Can OCD get better?

Many people with OCD live with these painful and debilitating symptoms for far too long, either because they are afraid to seek help, or because they have sought help and have either been given an incorrect diagnosis or have received treatment that is ineffective. One study found that people with OCD did not receive the correct diagnosis and effective treatment for 14-17 years, on average, after the onset of symptoms! These statistics are devastating, given that OCD is very treatable, and at high rates of success. You just need the right kind of help from a skilled and caring therapist who is trained to treat this condition in effective ways!

Subtypes of OCD:

Below is a list of common subtypes of OCD. While this list is by no means exhaustive, it does offer a glimpse into the extremely diverse ways that OCD can present. It can be incredibly helpful, validating, and freeing for people with OCD to realize that they are not alone, that their OCD is not weirder than everyone else’s, and that they, too, can respond to effective therapy and reclaim their lives. Please keep in mind while reading about OCD subtypes that particular obsessions and compulsions can vary significantly from one person to the next. Experiencing different obsessions or compulsions for particular OCD subtypes than what is listed does not mean that you do not have OCD, which is why seeking support from a qualified mental health professional for proper diagnosis and treatment is so essential.

Contamination OCD:

People with contamination OCD fear coming into contact with germs, dirt, bodily fluids, or other substances that cause them to feel gross, afraid, or in danger of becoming ill (or even dying). Fears of becoming contaminated can be focused on negative consequences for one’s self, or feared consequences for others (such as fear of making another person sick). Common compulsions can include handwashing, excessive cleaning, excessive bathing, avoidance of feared objects, people, or places, rumination, and reassurance-seeking.

Checking OCD:

People who experience Checking OCD doubt whether they have completed an important task, such as locking the door or turning off the stove, and will suffer or cause catastrophic consequences as a result of this lapse. These doubts will result in compulsive checking behaviors, mentally reviewing one’s actions, seeking reassurance, and even taking pictures of locks, stoves or other tasks and household items to ensure that no devastating mistake has been made.

Harm OCD:

Harm OCD sufferers experience intrusive images, fears, and doubts about whether they could harm themselves or another person. These obsessions are incredibly distressing, as the individual does not want to harm themselves or others, and finds these thoughts to be abhorrent and terrifying. Common compulsions include avoidance of feared items or situations (such as being in the kitchen using a knife to prepare food with a loved one in the room), rumination, reassurance seeking, and mental review of past actions for any sign of dangerousness.

Suicidal OCD:

Suicidal OCD presents as intense doubts and fears pertaining to whether one could harm oneself. Distressing images, thoughts, and urges to act on an unwanted impulse often characterize this form of OCD. Sufferers of Suicidal OCD are not truly suicidal, but fear that they could become so or might harm themselves despite the fact that they have no true desire to do so, only a fear that they could. Typical compulsions include seeking reassurance, online research about signs of suicidality, removing any items or objects from the environment that the individual worries could be used to act out their fears, seeking repeated assessment from mental health professionals (another form of reassurance-seeking), and rumination about whether there are any signs of suicidality presently or in the past.

Sexual OCD:

This form of OCD results in intrusive thoughts, images, or fears of acting on an unwanted impulse that are sexual in nature. Sexual OCD typically results in intense feelings of shame and horror, as these thoughts are unwanted, upsetting, and are not aligned with the individual’s true feelings of sexual attraction or desire. Compulsions performed by people with this subtype of OCD often include reassurance seeking, avoidance of certain places or situations where these thoughts seem more likely to occur, and mental review of past actions and thoughts for any sign of sexual wrongdoing.

Pedophilia OCD:

Pedophilia OCD is similar to Sexual OCD, although its obsessions are focused on the fear of sexual attraction to children. It is essential to understand that these doubts, images, and thoughts are unwanted, extremely disturbing to the individual and are not aligned with their true desire or attraction. Common compulsions include reassurance seeking and confession of doubts and fears, avoidance of activities or places in which children are likely to be present, mentally reviewing past actions, and ruminating on feelings and thoughts for any sign that these doubts could be true. This form of OCD, although common, often results in deep feelings of shame and reluctance to seek treatment due to fears related to how mental health professionals will respond.

Scrupulosity OCD:

Scrupulosity obsessions can be religious or moral in nature, and may include distressing or blasphemous images or intrusive thoughts, and reflect doubts related to whether one has sinned, engaged in dishonest or immoral behavior, offended God, or could go to Hell. Sufferers of this type of OCD can be religiously affiliated or not identify as religious at all, and feel debilitating fear and doubt about their obsessions. Frequent compulsions associated with this type of OCD include confession of blasphemous thoughts or behavior the individual feels anxious about, ritualized and repetitive prayer, avoidance of religious objects, places, or scriptures, reassurance seeking from family members or religious figures, and mental examination of past or current thoughts and conduct for signs of sinfulness or morally deficient behavior.

Existential OCD:

Existential OCD is characterized by disabling doubts and fears about philosophical questions, their purpose, whether God exists, and the meaning of life. These doubts and fears intensify to a degree that functioning is impaired and the individual cannot tolerate the “not knowing” that is built into many of life’s deep questions. Compulsions are time-consuming and interfere with quality of life, and often include constant researching, rumination, and reassurance seeking from others.

Sexual Orientation OCD:

Sexual Orientation OCD results in intense doubts and questions related to one’s sexual orientation. As in other forms of OCD with a sexual theme, these unwanted thoughts, images, and questions are not congruent with the individual’s real sexual desire and attraction, yet they feel unable to trust their true sexual identity and feelings. Compulsions may include monitoring and evaluating feelings and thoughts about others for any sign of the feared attraction, rumination, reassurance seeking from other people or information online, and watching pornography of various types to assess for any feelings of attraction.

Transgender OCD:

This form of OCD is characterized by fears and doubts that a person may be living life as the incorrect gender. These doubts and questions are intrusive, unwanted, cause intense distress, and again, are not aligned with their true identity and self-concept. Common compulsions may include avoidance of items associated with the feared gender such as clothing or accessories, rumination, reassurance seeking, and mental review in an effort to identify any sign that they could be living as the incorrect gender.

Relationship OCD:

Disabling obsessions related to one’s partner or relationship characterize this subtype of OCD, and include fears that one is not in the right relationship, intense focus on feared flaws within the partner, and compulsive comparison to the other peoples’ relationships. Reassurance seeking, compulsive comparison to other relationships, online research about signs of toxic relationships, and possibly ending relationships due to these fears are all compulsions commonly experienced within this type of OCD.

Just right OCD:

This form of OCD often presents as an intense fear of feeling bad, wrong, incomplete, or simply “not right.” Individuals suffering from this form of OCD may be unable to identify a specific feared outcome, other than simply the way it feels. Repeating and redoing tasks until they feel right, ordering activities or items in a particular way, mentally replacing “bad” or “wrong” words with “right or “good” words, and avoidance of certain activities, items, or tasks can all be compulsive elements for this form of OCD.

Symmetry, Neatness, and Exactitude OCD:

While many people enjoy neatness, order, and beauty in their environment, this form of OCD results in an overwhelming preoccupation with these ideals that becomes disabling. These obsessions and compulsions interfere with functioning, may cause frustration for self and others, and result in tasks being repeated in such an exacting manner that the point of the task is lost. People who experience this form of OCD often realize that their compulsive urges are unreasonable and cause great distress, yet feel unable to stop. Reordering, unnecessarily straightening, performing tasks to an unreasonable degree of perfection, and becoming “stuck” in this state of hyperfocus are common compulsions for this subtype of OCD.

Somatic OCD:

Somatic OCD refers to an intense and all-consuming focus on particular functions or sensations within body, such as breathing, blinking, or swallowing. This preoccupation can interfere with the ability to function in normal ways and is extremely anxiety-provoking, and subjective inability to stop focusing on it constitutes the obsession. Compulsions often associated with Somatic OCD include rumination, checking behaviors, testing to make sure that sensations feel right, and avoidance of activities or items that seem to make the hyperfocus more intense.

False Memory or Real Event OCD:

Intense doubts and anxious emotions about real or feared events from one’s past form the basis for this type of OCD. Feeling overwhelming shame, guilt, and distress about past actions that are not fully remembered, questioning motivations for behavior, and feeling terrified by the normal incompleteness and imperfection of memory that we all experience become debilitating and consuming. This inability to remember events with perfect clarity results in assuming the worst, and the more questioning and trying to remember that occurs, the less clear one feels about what happened. As in all forms of OCD, rumination, seeking reassurance from others, mentally checking emotions and past behaviors for signs of wrongdoing are common compulsion associated with this subtype.

Magical Thinking OCD:

This form of OCD involves an intense and disabling experience of what is commonly referred to as “magical thinking,” which refers to the belief that thoughts alone can cause real events or impact reality (i.e., thinking about a disaster such as a plane crash may actually cause a plane crash to happen). While magical thinking is not uncommon, for OCD sufferers it can be overwhelming and consuming and results in fear that thoughts, words, or images may cause calamities or disasters to unfold for which they will then feel responsible. Reassurance seeking, replacing “bad” thoughts or images with “good” thoughts or images, avoidance, and other mental compulsions are commonly observed within this type of OCD.

Perinatal OCD:

OCD symptoms that occur during pregnancy or around the arrival of a new baby (within the first year of birth) are referred to as Perinatal OCD. While all new parents experience anxiety related to the safety and wellbeing of their baby, for sufferers of Perinatal OCD these feelings are magnified tremendously and infused with intense fear about harm coming to their child, doubt about harming their child despite having no desire to do so, and at times intrusive and unwanted images related to something awful happening to their baby. Avoidance of being alone with the baby, reassurance seeking from others, excessive checking on the child’s safety and wellbeing, time-consuming research about possible danger may all be elements of compulsion for this type of OCD.

“Pure O”:

Some sufferers of OCD experience their condition only in terms of its apparent obsessional elements, which is commonly referred to as “Pure O.” People who experience OCD in this manner may not engage in overt behavioral compulsions that are observable by others, but instead engage in mental compulsions, also known as rumination, that serve the same function as behavioral compulsions (temporary relief from anxiety). These compulsions are characterized by the same loss of agency that defines behavioral compulsions and often include mental reassurance of one’s self, mental checking and review, monitoring for the presence of obsessions, and seeking “evidence” that doubts and fears are true or untrue.

Why get treatment?

Many sufferers of OCD experience a worsening of their symptoms over time and feel increasingly less able to control their compulsive urges and behaviors.  Although compulsions may bring temporary relief, overall, these behaviors serve to strengthen and reinforce the fears and doubts that plague OCD sufferers. Symptoms of OCD often intensify over time and impact aspects of life, relationships, self-concept, and ability to function in more debilitating ways. Finding and receiving the right help now can allow you to put a stop to your suffering, learn the tools and strategies you need to enjoy life and trust yourself once again, and reclaim your freedom! We are here to help you untangle OCD and build the tools you need to live your best life.