Has a friend or family member told you, “Stop being so OCD?” There’s a common misconception that OCD is merely a problem with staying organized – but it’s so much more than that. Obsessive-compulsive disorder, OCD for short, is an often crippling disorder that causes severe obsessions and fear and is overlooked. Although it’s prevalent in our society, experts consider it the most misunderstood health condition. It’s portrayed in the media in one way, such as that only “neat freaks” have the condition or that it’s all about cleanliness. Others believe stress causes OCD or that it’s rooted in your childhood. These are not true, and there are various types and subtypes of the disorder out there today.
Obsessive-compulsive disorder is a long-lasting condition. The individual has uncontrollable, reoccurring thoughts and behaviors they feel the urge to repeat. According to the National Institute of Mental Health (NIMH), an estimated 1.2 percent of U.S. adults experienced the condition in the past year. Unfortunately, the past-year prevalence was higher for females at 1.8 percent than it was for males at 0.5 percent. The data also shows the lifetime prevalence of the disorder is 2.3 percent for adults 18 and older in the country.
Obsessive-compulsive disorder can be debilitating. Of adults with the disorder in the past year, their degree of impairment ranged from mild to severe. Of the adults surveyed, 50.6 percent of them had a severe impairment, followed by 34.8 percent with a moderate impairment, and 14.6 percent with a mild impairment. These figures show that you’re more likely to have a severe case when diagnosed.
Despite its complexity, obsessive-compulsive disorder is a highly treatable condition. However, you must determine the type and severity to find adequate treatment. Without care, OCD will limit your ability to function in daily activities and make it so many cannot work. The cycle of symptoms is constant and uncontrollable. Those with no choice but to live with the condition understand how much it disrupts daily living. A severe spike in symptoms will affect your ability to maintain social relationships, participate in life, and earn a living.
If you believe you have OCD and want to learn about the various types and subtypes of OCD, our guide will provide some clarity on what to look for and how to seek help.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is a widespread condition that affects 2 percent to three percent of the U.S. population. The mental illness causes unwanted and repeated thoughts or sensations, known as obsessions or the urge to repeat something continuously, known as compulsions. Unfortunately, it’s possible to have compulsions and obsessions.
According to WebMD, OCD isn’t a habit like biting your nails or having unfavorable thoughts. Obsessive thoughts might be about whether specific numbers or colors are good or bad, a far cry from the myth that individuals who are “neat freaks” might have the condition. Compulsive habits might consist of handwashing multiple times after touching something you consider contaminated. Whether or not you want to do these things, you have no control over your thoughts, leaving you feeling powerless to stop.
There are times when we have habits or thoughts that repeat. However, the following can be true of the actions or thoughts of someone with OCD:
- They are far from enjoyable.
- They are out of your control.
- They take up, at a minimum, an hour of your day.
- They interfere with your social life, work, and other parts of life.
Despite your best effort to stop or ignore these obsessions, you won’t succeed, and it can only increase the distress and anxiety you feel. You’ll be driven to perform one or more of these compulsive acts in an attempt to relieve the stress. While it may provide you with some temporary relief, they’ll return with a vengeance, leading to more ritualistic behavior. This is the vicious cycle of obsessive-compulsive disorder.
The disorder is often centered around specific themes. One example from the Mayo Clinic is a person with an excessive fear of being contaminated by germs. To relieve these fears, they’ll obsessively wash their hands until they’re sore, chapped, or even bleeding. Even worse, they’ll continue repeating the ritual, even if they’re in physical pain.
Another type of OCD, known as “harm OCD,” which is less common, is when someone has thoughts of harming their loved one. These can be as severe as dreaming about stabbing their sister with a steak knife or throwing their niece or nephew off of a balcony. OCD will make the individual believe that it’s a matter of time before they commit the crime, causing them to avoid anything that resembles a weapon or the person they’re having the thoughts about.
Below, we’ll discuss the most common OCD symptoms.
Common OCD Symptoms
The most common cases of OCD involve both obsessions and compulsions. However, it’s possible to have only compulsions or only obsessions. Unfortunately, you may not realize this until the obsessions or compulsions are so excessive that they interrupt your daily routine and school, social, or work functioning.
- Obsessions: These center around unwanted thoughts and ideas that cause a significant disruption in life and make it hard to focus on anything else.
- Compulsions: These center around things the individual feels possessed to do in a specific way to respond to their obsessions.
Obsessive-compulsive disorder presents itself in various ways. While one person may exhibit unique symptoms, others will exhibit something completely different. According to official OCD research published in Dialogues in Clinical Neuroscience, there are no “official” classifications or subtypes of OCD.
However, people experience it in four primary categories, including the following:
- Ordering and symmetry
- Contamination and the urge to clean
- Harmful, forbidden, or even taboo thoughts and impulses
- Hoarding, the need to collect and keep specific items related to obsessions or compulsions
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) also describes these groups of symptoms. However, mental health professionals often refer to them as “symptom dimensions” as opposed to OCD subtypes.
No two people will experience OCD the same. Specific symptoms might be similar among some, but they will also vary widely. You could experience symptoms from more than one dimension.
These symptoms include the following:
- If you or someone else throws something away, you believe it could bring harm to you or them.
- You feel an overwhelming urge to collect a specific number of items to protect yourself from harm.
- You fear accidentally throwing away what you consider an essential item.
- You feel the need to buy multiples of one item even if you don’t need them.
- It’s impossible to throw things away because you believe touching them might contaminate you.
- You feel compelled to constantly check or review your possessions.
- You feel incomplete if you can’t find something.
When it comes to OCD and hoarding, it’s much different from a hoarding disorder, which is considered a different mental health condition. The primary difference between these two conditions is the stress the individual experiences with hoarding-related OCD. If you’re diagnosed with the disorder and don’t want the items you’ve collected, you’ll still feel compelled to save them due to your intrusive thoughts.
Cleaning and Contamination
These symptoms include the following:
- A prolonged worry about getting sick or germs
- Constant thoughts that consist of feeling unclean or dirty, whether it’s physically or mentally
- Constant fear about exposure to blood, viruses, toxic substances, or any source of contamination
- Avoiding any potential source they deem “contaminated”
- Overwhelming compulsions to get rid of items that are considered dirty, even if they aren’t
- Constant compulsion to clean or wash your hands or scrub surfaces over and over again
Symmetry and Ordering
These symptoms include the following:
- An overwhelming urge to have your items or belongings aligned in a specific way.
- An overwhelming need for symmetry and organization for all of your items.
- An overwhelming need for symmetry in your actions. For example, if you crack the right side of your neck, you must crack the left side as well.
- You feel you must arrange your belongings until it feels “just right.” However, it may never feel right.
- If items aren’t exact, you’ll feel a sense of not being complete.
- You’ll go through counting rituals and need to count to a certain number.
- Believing something bad might happen if you don’t organize or arrange things the right way.
- You have rituals to align objects in a specific way.
These symptoms include the following:
- Intrusive thoughts that happen regularly about violence or sex
- Shame, guilt, and significant distress about these disturbing thoughts
- Constant wonder about your sexual desires, orientation, or interests
- Constant sense of worry about whether or not you’ll act upon these intrusive thoughts
- Constant sense of worry that you’ll harm something against your will
- Obsession with religious ideas that feel wrong
- You feel compelled to hide things you consider a weapon
- You conduct mental rituals to hide these disturbing thoughts
- You always ask others if they consider you a bad person
- You review daily activity to ensure you haven’t harmed anyone
This form of OCD is sometimes referred to as “pure O.” It’s described as obsessions and intrusive thoughts of a sexual nature. However, no outward compulsions are visible.
Another subtype of OCD consists of behavioral tics, which include the following:
Tics often relieve unwanted obsessions and other feelings of incompleteness or distress that are common with OCD. Both adults and children can develop tic-related OCD. However, it’s more common when it starts in childhood. Children won’t experience the same symptoms of OCD as adults. Their compulsions are less apparent and include avoidance of contact or social interaction. These are far less noticeable.
Obsessions are less apparent in children as seeking reassurance, magical thinking, and checking behaviors are no different than their typical developmental stages. Children will experience a broader range of symptoms than adults.
Subtypes of OCD
If you’re concerned you have OCD or were recently diagnosed, you’ve likely noticed that your obsessions and compulsions are centered around a theme. Knowing the various subtypes of OCD will help immensely in understanding the type of treatment to seek. However, please note that people report experiencing many subtypes.
Checking OCD is considered one of the most common OCD subtypes and is the more stereotypical version of the disorder in TV and movies. It’s categorized by checking-based compulsive behavior, including returning to the house to ensure you’ve locked the door or the inability to fall asleep at night because you constantly go downstairs to confirm the stove is off. Individuals with this form of OCD fear they’ll be responsible for something bad if they don’t perform their checking rituals. If you have checking OCD, obsessions will vary from safety concerns about behaving inappropriately or making mistakes. For someone without OCD, it’ll appear irrational.
Counting OCD is a subtype where someone feels they must count in a specific pattern or otherwise it won’t feel “right.” It’s characterized by obsessive thoughts that something bad will occur if you don’t give in to the counting-based compulsion. Although someone who isn’t diagnosed with the disorder can clearly see it doesn’t make sense, you will continue to count for their safety.
When exposed to a triggering event, you might mentally count a specific number repeatedly. If your obsessions become more intense, your counting could evolve into other things, such as performing a ritual a set number of times before leaving your house, brushing your teeth for the same amount of time each day, or only taking the same number of steps each day. The counting could eventually become automatic. If you become aware of the counting, obsessive thoughts could be triggered.
While OCD is challenging enough, harm OCD is a genuinely frightening subtype of the disorder. It focuses on intrusive thoughts of hurting others. Similar to other subtypes of OCD, those with harm OCD will act on compulsions to relieve their stress stemming from the thoughts. If you’re dealing with harm OCD, you genuinely fear that you might hurt someone around you. You might feel the only way to overcome this is to avoid objects that can harm, such as a knife, or avoid the person altogether. Constant reassurance from others that you won’t hurt someone could be another part of your mental ritual.
As mentioned earlier, hoarding OCD differs from a hoarding disorder, which is marked by excessive collecting of items and feeling unable to get rid of them. Individuals with hoarding OCD cannot discard items because they believe something bad will happen to them if they do. It could also be attributed to obsessive feelings about being incomplete without the item. You could develop this subtype of OCD from distress caused by other obsessions. For example, if you have contamination OCD, a fear of germs will stop you from throwing it away.
‘Just Right’ OCD
“Just right” OCD is characterized by a feeling that something is off or something “isn’t right.” Like other subtypes, this form of the disorder can lead you to get stuck in a cycle of compulsions and obsessions. The obsessions may appear that something isn’t right and that you need to start over. The compulsions include redoing activities or rearranging things until they feel right. However, they may never feel right, and this is something that could persist for hours.
This is more than a fear of germs. Individuals with this subtype are often paralyzed by germs, leading to obsessions with severe anxiety and distress. If you’re diagnosed with contamination OCD, you likely explained to the doctor that you have an overwhelming fear of getting sick or spreading germs. You often relieve your anxiety by engaging in compulsive behavior, such as handwashing until your hands are raw. Contamination OCD can manifest itself in various ways. You might avoid public restrooms or become obsessed with an illness you believe you contracted by going out.
It’s challenging to live a life with OCD. If you’re reading this and relate to anything we’ve said so far, perhaps it’s time to consider seeing a doctor.
How Is OCD Diagnosed?
If you’ve been battling symptoms similar to what we’ve written above, help is available. By reaching out to a mental health care provider, they can discuss your symptoms and rule out any other conditions. Once they’ve made a diagnosis, they will find the most effective treatment.
During an appointment, they’ll ask you about your symptoms, if they cause stress, and how much of your time they take up each day. An OCD diagnosis consists of symptoms that affect daily function and consume an hour or more of your day. The mental health expert will go in-depth about your symptoms as different subtypes require different treatments.
From there, the doctor will find out whether you have tics or other behavioral symptoms and learn about your beliefs about your obsessions and compulsions. They want to better understand whether you feel your OCD beliefs will happen, might happen, or won’t happen. They’ll ask how long you’ve had symptoms. A 2009 study found that OCD symptoms that start in childhood are far more severe.
What Causes OCD?
Unfortunately, despite the intensive research, the cause of OCD has yet to be determined. However, there are some theories:
- Biological causes: Research released by Stanford Medicine suggests an impaired function in specific parts of the brain or issues with transmission of neurotransmitters like norepinephrine and serotonin contribute to the development of OCD.
- Environment: Some experts believe that abuse, trauma, or other highly stressful events might play a role in developing mental health conditions. There is little evidence that one factor might contribute to OCD, but one study of young people found that tic-related OCD runs in families.
- Family history: You’re more likely to develop the disorder if a family member has it. Specific genes potentially play a role in development. However, not all people with OCD have a family member with the condition.
How Is OCD Treated?
Fortunately, OCD is a treatable disorder. Mental health experts will use either medication, therapy, or a combination of the two to treat it. Exposure and response prevention (ERP), a form of cognitive behavioral therapy (CBT), is the recommended approach. It gradually exposes people to examples of obsessions or something that causes compulsions. During that time, you can learn how to deal with discomfort without giving into compulsions. You’ll spend most of your time practicing these at home or in the environments you frequent the most.
If your symptoms are severe and don’t respond to therapy, the mental health expert will suggest medication. Medication may only be prescribed for a short period. The drugs with the best benefits are antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or antipsychotics.