Here’s How Different Types of OCD Can Show Up in Real Life

If you’ve ever watched Sheldon Cooper have a very particular preference about the chair he sits in on The Big Bang Theory, you’ve seen how pop culture portrays people with different types of obsessive-compulsive disorder (OCD). Or, maybe you’ve heard some variation of the phrase “I’m so OCD”—perhaps from a friend explaining why their bathroom is always so clean or a blogger talking about why their closet just has to be color coded.

While it may seem harmless, these common tropes are extremely narrow characterizations of OCD and don’t even begin to scratch the surface of how debilitating the mental health condition can be.

Obsessive-compulsive disorder is a type of anxiety disorder that causes repetitive, intrusive thoughts, feelings, or urges—these are called obsessions—and repetitive behaviors or rituals—called compulsions. According to statistics from the Anxiety & Depression Association of America (ADAA), 2.2 million adults in the United States are affected by OCD. That’s roughly 1% of the country’s population.

“It’s important to recognize that OCD, conceptually, is not very different from any other anxiety disorder,” clinical psychologist and OCD expert Jenny C. Yip, Psy.D., ABBP, owner of the Renewed Freedom Center in Los Angeles, tells SELF. But with OCD, she says, there are two distinct parts to understand: your obsessions and your compulsions.

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People with OCD have anxiety, but it gets wrapped up in what experts call obsessions.

“Obsessions are any images, sensations, or thoughts that come into your mind that you cannot stop and that you do not want to have,” says Dr. Yip. With OCD, obsessions can be anything, but professionals find that there are certain types of obsessions—called subtypes or themes—that people with OCD tend to fixate on.

Just as for any other anxiety disorder, such as social anxiety or generalized anxiety disorder (GAD), these obsessions often cause feelings of distress, discomfort, excessive worry, and even panic. Naturally, a person who is dealing with these intense emotions would want to do something about it so they can feel better.

“With OCD, those are the compulsions,” says Dr. Yip. “The compulsions might be washing, checking, seeking reassurance, repeating, counting, and so on.” As she explains, these compulsions serve to relieve the person of their anxiety or distress. However, the relief they feel is only temporary and usually only lasts until the next intrusive obsession returns. Thus a compulsion becomes a ritual when it has to be done a certain way or in a certain order.

Depending on the severity of these obsessions and compulsions, OCD can become a life-altering condition, so it’s important to understand what it might look like and the common types or themes associated with obsessions.

OCD obsessions tend to revolve around common themes, or subtypes. For example, contamination OCD, which is what most people refer to when they think about “cleaning” OCD, causes obsessions related to being contaminated. And “just-right” OCD, which is also known as perfectionism OCD, can involve obsessions related to order or exactness.

But while there is an almost unlimited number of themes to which OCD can attach, the ultimate presentation of the disorder tends to be the same. “Someone is worried about specific unwanted or intrusive thoughts, and then they may engage in behaviors, many of which we don’t see, in order to tolerate or neutralize the discomfort or uncertainty,” Joanna Hardis, MSSA, a licensed clinical social worker and OCD specialist in Cleveland, tells SELF.

Despite the similar manner in which all OCD themes function, it can still be helpful to understand what the different subtypes might look like. According to the International OCD Foundation (IOCDF), here are some of the common obsessions that can appear in OCD:

Contamination OCD involves the fear of contamination, whether that’s becoming contaminated or contaminating someone else. Generally, contamination OCD is associated with things like dirt, bacteria, or viruses, but any substance can become the focus of contamination fears—including bodily fluids, chemicals, or other environmental contaminants. Some people also experience obsessions involving mental contamination from thoughts, feelings, words, images, or even superstitious beliefs. For example, if certain words trigger an obsession, such as the word accident, then the person might avoid saying or writing these words, and eventually stop reading the newspaper for fear that it could contain that word.

Practically, this is where those hand-washing stereotypes come into play. Yes, some people with OCD do wash their hands repeatedly, but again, it’s not a preference for being clean. They feel compelled to do it to allay the underlying anxiety they are feeling.

As the name suggests, this type of OCD surrounds the fear of losing control, usually in the context of doing things that a person doesn’t, or shouldn’t, want to do. Sometimes these obsessions can involve the fear of feeling (or acting) on a thought or impulse about hurting themselves or others. But loss-of-control obsessions can also involve other behaviors, such as worrying about saying something rude, doing something illegal, or simply losing control of one’s mind or body in some way.

To understand this obsession, it’s important to recognize that this fear is about losing your sense of identity and doing something on impulse that changes you from “good” to “bad,” or causes you to lose the comforts of your life. For example, if you lose control and yell obscenities at your boss, you might get fired and lose your paycheck. Therefore, people with loss-of-control OCD obsess over this idea and often look for constant reassurance that they will not act out in violence or lose control.

Harm OCD involves the fear of harming oneself or others, whether purposely or inadvertently. If you have harm OCD, you might experience violent thoughts, images, or impulses—things like hitting, stabbing, or otherwise injuring a loved one, a stranger, or even yourself, according to the IOCDF. Or you may fear doing something that can inadvertently hurt another person, such as something neglectful that could result in an accident, like leaving your flatiron on and causing your house to burn down.

The important thing to know about this obsession is that you don’t actually want to do any of these harmful things, but in life, it could mean that you avoid all activities that could trigger this fear, like not driving your kids to school because of you fear you might inadvertently get into a car accident and harm the people you love.

Perfectionism OCD, also known as just-right OCD, relates to the fear of things not being perfect, exact, or otherwise “just right.” With perfectionism OCD, the obsessions can involve physical things, such as the drive for certain items or objects to be even, exact, or look and feel just right. It can also involve mental obsessions, such as the need for thoughts, words, or behaviors to be perfect, whether those rules are self-made or are expectations (whether real or perceived) set by others.

This obsession can manifest in so many different ways, but one example is erasing and redoing written homework until your letters, words, or numbers are perfectly even. Another way it can show up is being unable to throw away or donate old possessions (because you fear something could be important at some later date).

Unwanted-sexual-thoughts OCD involves the fear of having or acting on forbidden, perverse, or taboo sexual thoughts. Someone who has these unwanted intrusive thoughts might experience obsessions related to sexual aggressiveness, violence, or even incest. (Just to be clear, this is not the same thing as compulsive sexual disorder, which involves acting on repetitive sexual urges and impulses, leading to sexual behavior that is harmful to you or others.)

What is included in this type of OCD is pedophilia OCD, which relates to unwanted, intrusive thoughts about pedophilia. The key here is unwanted thoughts, which means that having these thoughts does not make you a pedophile. In fact, people with this type of OCD are very distressed by these thoughts and typically engage in a lot of reassurance compulsions to make sure they aren’t actually a pedophile. Because these sexual thoughts are considered taboo, this adds to the stigma and shame surrounding this type of OCD.

It’s important to remember that if you have unwanted-sexual-thoughts OCD, you don’t actually want to do these things. Like people with loss-of-control OCD, you might spend a lot of time seeking reassurance that you are not a sexually violent person.

Pure obsessional OCD, also known as pure O, refers to an OCD subtype that is defined by obsessions and invisible compulsions. Previously, the distinction of pure O was created as a way to challenge the idea that people with OCD always perform compulsions that can be seen. However, experts in the field are now moving away from this distinction because, ultimately, almost all people with OCD engage in invisible compulsions. However, a person who has pure O likely only has mental compulsions, such as repeating words or phrases over and over again in their head to relieve anxiety.

“Mental compulsions are present in all forms and themes in OCD,” Hardis explains, noting that some people with OCD may not even be aware of their mental compulsions. “There may be people that just do mental but not physical compulsions, but again, I think the problem is that most people aren’t aware of the mental compulsions they’re engaging in.”

Even though some subtypes of OCD are more common than others, OCD can be rooted in any idea that causes you to experience repetitive, unwanted, and intrusive thoughts. Other examples of OCD themes may include:

• Sexual orientation OCD: This relates to obsessions surrounding your sexual orientation and leads to distressing thoughts about being attracted to people who you’re not actually attracted to.
• Relationship OCD: This involves fears around uncertainties or doubts that you might feel in a relationship and can show up as constantly asking your partner for reassurance that they are not cheating on you, for example.
• Real-event OCD: These are obsessive thoughts about past events that have already happened. It often involves ruminating on past conversations and actions during an event, looking for answers that you can’t find. You may obsess over the event for hours a day, and the OCD warps normal regrets into all-or-nothing thinking, according to telemedicine site NOCD. For example, you may regret having made fun of a kid when you were in middle school, and your OCD tells you that it was inexcusable and makes you a “bad” person.
• Health OCD: Just as it sounds, this involves intense fear around catching an illness and therefore makes you chronically anxious about your mental and physical health. It could be a general fear about illness or anxiety centered around a specific one.
• Somatic OCD: This relates to obsessions surrounding automatic bodily functions and sensations, such as breathing, blinking, and your heart beating. You may start to worry whether you are blinking enough or taking in enough air when you breathe.
• Religious and existential OCD: This involves obsessions surrounding existential, philosophical, or spiritual questions. If you have religious OCD¹, for example, you might obsessively repeat a prayer to appease the fear that you will end up in hell.

Compulsive hoarding also used to be considered a subtype of OCD. However, the ADAA explains that although hoarding may become an OCD compulsion, it is now categorized as an entirely separate mental health disorder.

A compulsion, the second part of the OCD equation, is an act you do or a thought you have to try to reduce the anxiety caused by the obsessions—even if it doesn’t actually reduce it or does so temporarily. According to IOCDF, these are some of the more common compulsions that people with OCD experience:

Cleaning and washing are commonly found in contamination OCD. It can include activities such as excessive cleaning of certain rooms, specific objects, or anything else that may be considered a potential contaminant. It may also include excessive washing of the hands, hair, or other body parts in order to “decontaminate” them.

Checking can be found in many different forms of OCD. In harm OCD, it can involve things such as checking that someone wasn’t harmed by something that was done. In perfectionism or just-right OCD, it might look like checking to make sure that something feels right or was done properly. In health OCD, it can present as checking body parts for signs or symptoms of an illness, symptoms.

Repeating is commonly found in perfectionism OCD, among other types. It often appears as repeating certain activities, like rereading a line in a book or rewriting an email. Sometimes people may repeat physical activities, such as tapping something or blinking. Sometimes you may feel compelled to repeat an activity a certain number of times until it feels “right.”

Arranging is also common in just-right OCD, although it may appear in other subtypes too. It can include excessive arranging of objects, perhaps according to size, color, material, or other physical characteristics. It may also include arranging or adjusting things until they look or feel perfect.

Reassurance seeking is often found across various subtypes of OCD. It involves seeking excessive reassurance from yourself or others about intrusive thoughts and obsessions. In health OCD, someone might frequently ask their doctor whether they are at risk for a certain disease. In someone with harm OCD, it might look like constantly asking a loved one if they’ve hurt them.

Avoidance is a compulsion that many people with OCD engage in as a natural response to their anxiety. As Dr. Yip explains, “Whenever we experience fear, our natural inclination is to go into avoidance mode.” Avoidance can be physical, such as avoiding people, places, or things—or it can be mental, such as trying to avoid intrusive thoughts, words, urges, or even feelings.

Rumination is defined as an attempt to problem-solve intrusive thoughts or obsessions through worrying, analyzing, or replaying conversations or events in the mind. Although rumination is not a visible compulsion, people with OCD can spend hours ruminating. It can look different from person to person, and generally relates to their specific OCD subtypes.

According to the American Academy of Child & Adolescent Psychiatry (AACAP), OCD affects roughly 1 in 200 children and adolescents. But despite OCD’s being one of the most common anxiety disorders, it’s still surprisingly misdiagnosed—especially in children.

“In general, sufferers of OCD are often misdiagnosed because the presentation is so complex and it’s not always visible,” says Dr. Yip. “And it takes an average of 14 to 17 years to receive proper treatment of OCD.” In children, diagnosing this condition can be even more complex, she explains.

“Often times, in little kids, we begin to see just-right traits or compulsions, and these are more common in kids who have sensory issues,” Hardis says. “Toys lined up a certain way, shoes lined up, they can’t have the picture frame off.” And these are just a few of the behaviors that a parent or caregiver might notice.

According to the IOCDF, other common obsessions and compulsions in children may include:

• worrying about germs or getting sick
• worrying about doing the wrong thing
• worrying about bad things happening
• experiencing unwanted or disturbing thoughts or images
• excessively checking different things
• excessively cleaning or washing
• repeating things or starting things over
• excessively organizing, ordering, or arranging things
• excessively confessing, apologizing, or seeking reassurance

In her professional experience, Hardis shares, most parents will see these behaviors and write it off as the child just being a little quirky, “when in fact it just doesn’t feel right, and the kid may not be able to articulate because there’s no fear associated with it.” And while some of the behaviors don’t necessarily look like compulsions, they are ultimately done to help the child avoid feeling off, uncomfortable, or tense.

Unfortunately, the misconceptions and lack of awareness around OCD symptoms in children often lead to a misdiagnosis or late diagnosis.² “Children are often misdiagnosed with stuff like ADHD, GAD, or even bipolar disorder because people believe that OCD isn’t very common,” explains Dr. Yip. “But it’s actually very common, and it’s underrepresented.”

When it comes to finding the right therapist, one thing to remember is that OCD treatment is highly specialized. You’ll want to find someone who does exposure and response prevention (ERP), according to the American Psychological Association. “ERP is a type of cognitive behavioral therapy,” Dr. Yip explains. “We’re going to help you recognize the faulty thinking patterns that you have, and then we’re going to teach you ways to engage with your environment so that it is healthier.”

Here’s how it works: “E is for exposure, so you are approaching whatever it is that you have been fearful of, or avoiding, or doing with compulsions,” Hardis explains. “RP stands for ritual/response prevention, which means that you do the exposure and you prevent yourself from doing rituals.”

The purpose is to practice being in an anxiety-provoking situation and responding differently, she says. So instead of entering the situation with the idea that you can’t tolerate the uncertainty or the intense sensations, it offers the opportunity to be in that situation and learn that you can tolerate these things.

Ultimately, she says, “What ERP does is it puts in new learning that the ‘threat’ is not dangerous—it’s just uncomfortable.”

An OCD diagnosis can feel overwhelming, but there are resources available to help you work through your obsessions and compulsions. Whether you’re taking that first step toward finding treatment (which can include therapy and medication) or just looking for more information about the condition, the following websites are a great place to start:

• IOCDF is a global organization that serves to support people all over the world who are living with OCD. You can find more information on its community events and programs.
• Peace of Mind is an IOCDF foundation that works to promote the education, research, and advocacy of OCD. It has a comprehensive list of resources, programs, and support groups.
• AACAP is an organization that also supports the education, research, and advocacy of mental health conditions in children and adolescents. It has a list of family-focused OCD resources.
• NOCD is a virtual OCD resource that focuses on providing specialized therapy, group sessions, and education for people living with OCD.
• Anxiety & Depression Association of America is an international nonprofit organization that helps people with mental health conditions find treatment and support and provides educational materials.

When you’re in the thick of your OCD thoughts and behaviors, you might not realize how much it’s taken over your life. Listen to your family and friends if they bring up concerns, and take note of how you are feeling. If you realize your anxiety is at a 10—driven by intrusive thoughts and behaviors that just don’t feel right—reach out to a mental health professional if you can. With help, you can work toward feeling better.

Sources:

1. International OCD Foundation, Scrupulosity
2. American Family Physician, Obsessive-Compulsive Disorder: Diagnosis and Management

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