Types of OCD

Obsessive-compulsive disorder (OCD) is a mental illness that causes significant distress and impairment. It causes obsessive thoughts that won’t go away and that are negative and troubling, as well as compulsive behaviors that a person feels compelled to perform and struggles to control or minimize. OCD can take up a lot of time, causing significant impairment in one’s social, work, academic, and everyday life. It is not uncommon as a mental illness, with 1.2 percent of U.S. adults struggling with OCD any given year, and 2.3 percent being diagnosed at some point in their lives.

OCD, or obsessive-compulsive disorder, is a mental health condition characterized by two types of symptoms: obsessive thoughts and compulsive behaviors. To be diagnosed with the condition, a person must have one or both of these. Furthermore, the symptoms have to cause distress, significant impairment, and take up a lot of a person’s time.

Obsessive thoughts are persistent, unwanted, and troubling. They are nearly impossible to avoid or stop, and they cause significant distress, anxiety, or fear. The content of the obsessive thoughts can be anything, from a fear of being contaminated with germs to violent images that won’t go away or a persistent doubt that a task has been completed. These thoughts, whatever the specific content, are not reasonable and yet they are nearly impossible to control.

Compulsive behaviors are actions that a person takes to try to alleviate the distress of obsessive thoughts, to stop the thoughts, or to prevent something bad from happening. There is often no logical connection between the compulsions and the thoughts, but sometimes they are related, such as when someone afraid of germs washes his or her hands compulsively. Like obsessive thoughts, a person with OCD really struggles to control these behaviors, and even when they realize they are not logical, and feels compelled to engage in them.

There really aren’t any types of OCD, technically speaking. However, there are common symptom categories that can be described as “types.” These are based on similarities in the content of the obsessive thoughts and the actions a person takes to cope with them. Someone with OCD could potentially have any type of obsessive thoughts or any compulsive behavior, but these categories are seen most often:

• Aggressive or sexual thoughts. A common type of obsession is related to a fear of causing harm to others, of lashing out violently, or having violent, aggressive images that won’t go away. These kinds of thoughts may also be sexual, such as fearing behaving in a sexually inappropriate way or experiencing recurring, troubling sexual imagery. These types of obsessions are often coupled with seeking reassurance of one’s goodness, but there may be other accompanying compulsions.
• Harm to loved ones. For some people, the fear is not necessarily that they will harm someone but that some type of harm will come to their loved ones. For instance, someone may obsess over the thought that their child will get hurt in a car accident. Compulsive behaviors could be anything but are often used to prevent the harm from occurring.
• Germs and contamination. A fear of germs and a need to wash hands compulsively is often what people associate with OCD, and it is a common feature. Many people diagnosed with OCD are afraid of germs or other types of contamination and may avoid situations and activities because of this fear. Compulsive hand-washing and cleaning are also typical.
• Doubt and incompleteness. OCD can cause recurring thoughts that a person hasn’t done something correctly or completely. An example might be someone who doubts they have locked the door when leaving the house. This type of obsessive thought usually triggers compulsive checking behaviors, like going back to the door multiple times to be sure it is locked.
• Sin, religion, and morality. Some people worry obsessively about being immoral or sinning. They may use prayer compulsively or ask for forgiveness over and over again.
• Order and symmetry. Having objects ordered “just so” is a fairly common type of obsession with OCD. People with these thoughts spend an inordinate amount of time arranging and ordering objects or visualizing symmetry. They may also have specific superstitions about numbers, patterns, and symmetry.
• Self-control. A fear of losing control and doing something inappropriate characterizes many individual experiences with OCD. Some people may worry about shouting something in public, while others may be worried about harming someone, which ties into the aggressive or sexual type of obsessions. Any type of compulsive behavior may follow, but this kind of obsession can also lead to isolation, as a person may avoid being around others.

These types of OCD are really just groupings of some of the most common symptoms. Someone with OCD may have any type of obsessive thought. Some other examples include fears about specific relationships, beliefs in magic and magical thinking, or obsessions about one’s own body, such as breathing patterns or blinking.

OCD was once categorized as a type of anxiety disorder, but now it heads its own group of related conditions. These other conditions are not strictly types of OCD, but they are very similar and there can be some crossover in symptoms. For instance, hoarding disorder was once considered a type of OCD. It is characterized by an obsession with the need to keep items, even those that are not useful or needed, and a fear or distress associated with throwing anything away. As with OCD, this causes serious impairment, and in extreme cases people end up in homes that are unsanitary, unsafe, and unlivable. Other conditions listed in the OCD category are:

• Body dysmorphic disorder (BDD). BDD causes obsessive thoughts about one’s appearance, specifically perceived flaws. Often these flaws are non-existent, minor, or skewed and not perceived by others. A person with BDD spends a lot of time looking in the mirror, using makeup, and engaging in other activities related to appearance, in some cases even including plastic surgery.
• Trichotillomania. Also known as hair-pulling disorder, trichotillomania is characterized by a compulsive need or urge to pull one’s hair out. The urge is very difficult or impossible to control and can range from mild to severe, with serious hair loss and a major impact on social functioning.
• Excoriation disorder. This is also known as skin-picking disorder and is similar to trichotillomania. In the case of excoriation disorder, the urge is to pick at the skin. It can similarly cause serious damage to the skin and dysfunction socially. It can also lead to medical issues, such as skin infections.
• OCD caused by substances, medication, or medical conditions. A separate category of OCD is when it is triggered or determined to be caused by something specific, such as substance abuse, a medication used for another condition, or a medical condition itself.
• Other or unspecified OCD. These are diagnoses that may be made for a person who has some or many of the signs of OCD or a related condition, like hoarding disorder, but does not meet all of the criteria for a diagnosis.

Someone who has been diagnosed with OCD is likely struggling to manage the symptoms and to live a normal life. The challenge of stopping or coping with the obsessive thoughts and managing compulsive behaviors can be extreme, taking up a lot of time in a person’s life and causing severe impairment. There is hope, however, for anyone with this condition, regardless of what the thoughts and behaviors are or how serious the symptoms.

Many people with OCD, especially those with severe symptoms and impairment, can benefit from treatment in a dedicated residential setting. There, a patient can focus on learning how to manage symptoms, which is accomplished with the guidance of a trained therapist and behavioral therapies. With dedication to this treatment, a person can learn to successfully manage symptoms and restore function to their lives.

In addition to the specific type of behavioral therapy that a patient receives in residential treatment for OCD, this unique treatment setting includes additional care approaches. The use of medications where appropriate, exercise and nutrition, group support, creative therapies, and family education and therapy can all be used to supplement therapy and help a patient prepare to live successfully at home again.

OCD is a very serious mental illness, because it can cause significant dysfunction and emotional distress. Regardless of the types of thoughts or behaviors this condition causes, OCD can be treated and managed. The prognosis is good for patients who commit to dedicated treatment and to practicing healthy ways of coping with and managing obsessions and compulsions.

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