Updated: Jul 23
Obsessive-compulsive disorder (OCD) is probably one of the most misunderstood psychiatric disorders. You may hear people joking about being "so OCD" because they prefer to have their markers organized by color or because they are picky about keeping their room clean. But this is far from actual obsessive-compulsive disorder. Genuine OCD can be incredibly scary and debilitating.
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An OCD diagnosis requires the presence of obsessions, compulsions, or both, that are distressing, time-consuming, and interfere with your ability to live your life (DSM-5).
The DSM-5 defines obsessions as:
Recurrent and persistent thoughts, urges, or images that are experienced (at some point) as intrusive and unwanted and cause anxiety or distress.
The person having these thoughts, urges, or images attempts to ignore or suppress them, or neutralize them with another thought or action (for example, by performing a compulsion).
The DSM-5 defines compulsions as:
Repetitive behaviors (like handwashing, ordering, checking) or mental acts (like praying, counting, repeating words silently) that the person feels they must perform in response to an obsession, or according to a very rigid set of rules.
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Although obsessions and compulsions can take on any form, there are some common themes among OCD sufferers, called "subtypes." Similar triggers, thoughts, fears, and compulsions usually occur in people with the same subtype of OCD. While some people have predominantly one subtype or another, most people have a mix of several different subtypes. Common OCD themes include:
Because of the typical portrayal of OCD in the media, contamination (or cleanliness), OCD comes to mind for most people when they think of OCD. People with contamination or cleanliness OCD fear coming into contact with germs, bodily fluids, fecal matter, dirt, potentially toxic substances, or chemicals. They may also fear spreading germs or contaminants.
People with contamination OCD often have thoughts like:
"I think I touched my face before washing my hands- I might get sick and die from something that was on my hands."
"What if there was an STD on the toilet seat I sat on?"
"Was that bottle sealed properly? What if something poisonous got in there?"
To deal with these obsessions, people with contamination OCD tend to engage in the following compulsions and avoidance behaviors:
Handwashing (even to the point of causing skin rashes and injuries).
Having to shower in a particular order.
Avoiding touching other people or things that strangers may have touched.
Excessive cleaning or having to use particular cleaning rituals.
Avoiding situations that might expose them to germs or bodily fluids (for example, medical settings or public restrooms).
Mentally retracing their steps to think about whether they have come into contact with germs or contaminants.
Harm OCD is characterized by obsessive aggressive or violent thoughts, images, or urges. People with harm OCD typically fear losing control or obsess over whether they could have harmed someone without realizing it. People can develop these obsessions about anyone (including themselves). However, it is common for harm-related thoughts to center around vulnerable people (like children or elderly relatives) and loved ones (like family members and friends). People with harm OCD fear that their violent thoughts may mean that they are evil.
People with harm OCD often have obsessive thoughts like:
"I imagined stabbing my child with that knife. What if I did it?"
"I need to drive back to check because I might have hit someone with my car."
"What if I lost control and jumped in front of that bus?"
To deal with these obsessions, people with harm OCD tend to engage in the following compulsions and avoidance behaviors:
Retracing their route to check and see if they hurt someone.
Replaying scenarios in their head to analyze whether they may have injured someone.
Performing mental rituals or repeating prayers to try and get balance out aggressive thoughts.
Avoiding violent movies, books, news out of fear that they may increase violent thoughts or cause them to act on their violent thoughts.
Seeking reassurance that they won't become violent.
Hiding things that could be dangerous, like knives or matches.
Avoiding being alone with people they love, especially vulnerable people, out of concern that they may harm them.
Existential OCD involves obsessions about philosophical questions that are impossible to answer. For example, people with existential OCD may worry a lot about reality and the meaning of life, their purpose, or the nature of the universe. They may become concerned that reality is not as it seems or that they don't actually exist. While it is normal for anyone to think about these questions from time to time, people with existential OCD have much more anxiety and spend much more time and energy on existential thoughts.
People with existential OCD often have obsessive thoughts like:
"What if none of this is real, and I'm just in a coma right now?"
"The universe is so big; I must not matter at all."
"How do I know the person in the mirror is really me?"
To deal with these obsessions, people with existential OCD tend to engage in the following compulsions and avoidance behaviors:
Excessively researching different religious and philosophical views.
Pushing away the thoughts or trying to convince themselves they aren't true.
Seeking reassurance or answers from others about these questions.
Avoiding things that may cause them to think about philosophical questions.
Emotional/Mental Contamination OCD
People with emotional contamination OCD develop obsessive fears that they may absorb another person's disability, negative personality traits, or bad luck. They may fear losing their identity by unwillingly adopting another person's thoughts, preferences, or views. Emotional contamination OCD may also be related to places or objects that are associated with a traumatic event. For example, someone who witnesses a serious car accident may associate the location of the car accident with danger and avoid that location, things that remind them of that location, or things that could have come into contact with that location or things associated with it.
People with emotional/mental contamination OCD have obsessive thoughts like:
"I can't be around them too much, or I might start acting like them."
"I have to avoid people whose names start with the letter C because the street where I witnessed the car accident started with the letter C."
"I can't sit where that blind person was sitting, or I might lose my vision too."
To deal with these obsessions, people with emotional/mental contamination OCD tend to engage in the following compulsions and avoidance behaviors:
Reassure themselves that they will not become like the person they fear.
Avoid people, places, or things that may have come into contact with what they fear.
Engage in elaborate rituals (like counting, praying, or repeating specific phrases) to avoid absorbing someone's negative energy.
Holding their breath or shielding themselves when near the feared contamination source.
People with hyperawareness OCD become very aware of their bodily sensations, for example, their blinking, breathing, walking, or heartbeat. In addition to internal stimuli, people with hyperawareness OCD may also become very bothered by external stimuli, such as repetitive noises, flashing lights, or clothing textures. People with this form of OCD worry because they are aware of sensations and stimuli that are typically involuntary, automatic, or not even noticeable to most people. They start to wonder if they will ever be able to focus on anything else. They may worry that their awareness of their movements may cause them to move strangely or embarrassingly. They may even feel like they will lose their mind, pass out, or become depressed because they can't stop thinking about a particular bodily sensation, automatic function, noise, or feeling.
People with hyperawareness OCD often have obsessive thoughts like:
"If I keep noticing my breathing like this, my anxiety will get worse, and I may faint."
"I can't stop seeing these floaters. What if they start to bother me so much that I can't work anymore?"
"This fan is so irritating. Why am I noticing it? I'll never be able to focus on this test if I don't stop noticing the sound."
"My walking feels strange. I'm afraid other people can tell that my walking isn't normal."
To deal with these obsessions, people with hyperawareness OCD tend to engage in the following compulsions and avoidance behaviors:
Mentally checking to see if they still notice the sensation.
Seeking reassurance that their movements appear normal to others.
Avoiding social interactions because others may notice their movement.
Seeking reassurance from medical professionals that the sensations are normal or will go away.
ROCD involves obsessive fears and doubts about an important (usually romantic) relationship. People with ROCD may worry about whether their partner is the right person for them, whether they truly love their partner or whether their partner loves them (or even whether their partner knows them well enough to love them). They may constantly wonder whether their relationship is successful and whether they would be better off in another relationship. The truly frustrating part is that people with ROCD do love their partners and are very bothered by their doubts.
People with ROCD often have obsessive thoughts like:
"Is it possible that my girlfriend isn't the one for me?"
"Do I like my fiance enough to marry them?"
"How do I know that this relationship will be successful?"
"What if my husband doesn't know me well enough? If he did, maybe he would leave me."
To deal with these obsessions, people with ROCD tend to engage in the following compulsions and avoidance behaviors:
Seeking reassurance about their relationship from their partner, friends, and family.
Researching the qualities of successful or happy relationships.
Mentally checking whether they feel attracted to their partner.
Avoiding people or situations that may trigger them to doubt their relationship satisfaction.
Comparing their relationship to other relationships to see if it measures up.
Confessing all of their relationship doubts to their partner to relieve guilt or anxiety.
People with POCD have obsessive fears that they may be attracted to children, may have sexually assaulted a child, or may develop pedophilia. People with POCD may fear touching or being around children out of concern that they may touch them inappropriately or be aroused by them. POCD can be an incredibly isolating form of OCD because sufferers fear that if others knew about their obsessions, they would be considered a pedophile. However, it is very different from a pedophilic disorder as the person with POCD is not actually attracted to children. Instead, they are afraid of the possibility of being attracted to children and repulsed by the thoughts when they arise.
People with POCD often have obsessive thoughts like:
"I felt a sensation in my groin. Does that mean I'm attracted to that child?"
"I can't allow myself to dwell on the image of a child- it might make me become a pedophile."
"I can't be alone with the kids. These thoughts mean I might do something terrible."
To deal with these obsessions, people with POCD tend to engage in the following compulsions and avoidance behaviors:
Avoiding being around children.
Asking others to supervise them when they are around children.
Checking for groin sensations when around children.
Excessive mental review of any times when they have been around children.
Asking for reassurance from others about their character as proof that they would never do something to harm a child.
Responsibility OCD (also sometimes erroneously called "Checking OCD" after the most common compulsion in this form of OCD) involves fears that they have done something irresponsible that could cause a future catastrophe if not corrected. People with responsibility OCD have excessive worries that they have improperly locked or closed something, left something undone, or accidentally sent an inappropriate email/text to someone. They may be afraid that they've left an appliance on, failed to properly use safety devices (such as parking brakes or a child's car seat), or have taken medication inappropriately.
People with responsibility OCD often have obsessive thoughts like:
"What if I didn't lock the door properly?"
"I should go recheck the stove; otherwise, the house could catch fire."
"I think I remember taking my medicine this morning, but what if I'm wrong and I didn't? If I take it, will I take too much?"
To deal with these obsessions, people with responsibility OCD tend to engage in the following compulsions and avoidance behaviors:
Repeatedly checking that doors are locked.
Taking a photo of something in a specific position that they can use to reassure themselves later.
Mentally reviewing actions from earlier in the day to ensure safety procedures were followed.
Asking for reassurance from others that things are safe or asking others to check for potential safety issues behind them.
Just Right/Symmetry OCD
Just Right/Symmetry OCD involves obsessive concerns that things are out of order, uneven, or somehow off, causing extreme discomfort and anxiety. People with this kind of OCD often have to fix the way things are arranged to look perfectly balanced and symmetrical, or so they feel "just right." Similarly, they may have to take a specific action or complete a sequence of steps in a particular manner until they feel right. For example, walking through a doorway in a certain way, touching each side of their body symmetrically, or repeating behaviors on each side of their body.
People with just right/symmetry OCD often have obsessive thoughts like:
"That didn't feel normal. I better do it again, or something bad might happen."
"That pillow is not in the perfect position. I need to adjust it."
"I'm so anxious because my morning routine was out of order. I can't focus on my work."
To deal with these obsessions, people with just right/symmetry OCD engage in the following compulsions and avoidance behaviors:
Repeating behaviors or evoking the same sensations over and over until they "feel right."
Adjusting or moving things around until they seem like they are in the perfect place.
Having to do their routines in the exact same way every time.
Scrupulosity (Religious/Moral) OCD
People with scrupulosity (also called religious or moral) OCD develop excessive fears that they have done something blasphemous, sinful, immoral, or evil. They might become excessively anxious about whether they could have unintentionally lied to someone or behaved unethically. They may be afraid of doing something selfish or offensive and will often go to great lengths to ensure they behave morally. If they are religious, they may have fears that they are not correctly interpreting or following their sacred texts or laws or not feeling the right amount of love, faith, or connection to their deity. When sinful thoughts or images pop into their head, they take this as a sign that they aren't correctly following their religion. They may fear certain signs or symbols and become highly rigid in performing religious rituals or reciting prayers.
People with scrupulosity OCD frequently have obsessive thoughts like:
"I imagined having sex with [a deity]. A real follower would never do that. I must be evil."
"I told my mom the wrong time when she asked when practice was today. Did I do that on purpose? Am I trying to hurt her?"
"If I come across [a certain number or word], I have to recite my prayer four times, or I may go to hell."
To deal with these obsessions, people with scrupulosity OCD engage in the following compulsions or avoidance behaviors:
Avoiding symbols, words, or numbers associated with evil.
Seeking reassurance from faith leaders or others that they person considers morally upright.
Attempting to cancel out negative or sinful thoughts by repeating prayers or reciting religious scriptures.
Mentally reviewing mistakes to see if they could have been done intentionally.
Punishing or criticizing themselves for behavior they deem to be immoral.
Sexual Orientation OCD (SO-OCD)
People with SO-OCD fear having a sexual orientation different from the orientation with which they have historically identified. Most research has looked at heterosexual people who develop obsessions centered around whether they might be gay. As a result, this form of OCD used to be called "Homosexuality OCD" (HOCD) or "Gay OCD." However, a recent change in the name of this disorder reflects that this subtype of OCD can affect people of any sexual orientation in any direction. It is important to note that this subtype of OCD does not mean a person is homophobic or in denial of their true sexual orientation. Instead, obsessions center around fears that they will never figure out their true selves or are living inauthentically. They may worry that their sexuality will change, and they may lose their connection with significant others as a result.
People with SO-OCD often have obsessive thoughts like:
"I don't find that person disgusting. What if that means I am attracted to them?"
"I keep thinking about kissing my friend. Does that mean I'm gay?"
"I felt something in my groin when I looked at that person. So that must mean I'm attracted to them."
"What if I become straight and lose my connection with my partner?"
To deal with these obsessions, people with SO-OCD engage in the following compulsions and avoidance behaviors:
Forcing themselves to watch porn or think about scenarios reflecting the feared sexual orientation to check for signs of physical attraction.
Looking at people they "should" find attractive to check for signs of physical attraction.
Avoiding things traditionally associated with the feared sexual orientation.
Asking others to reassure them about their sexual orientation.
Mentally replaying previous sexual encounters to see if there is any sign that they may relate to the feared sexual orientation.
Compulsively masturbating to images (including mental images) of their identified sexual orientation to check for signs that they are still attracted to these images.
A note on Pure-O/Obsession Only OCD:
Some people refer to a type of OCD that they call "Pure-O" or Obsession Only OCD. While some people describe this as OCD without the compulsions, that is not entirely accurate. People with "Pure-O" OCD still have compulsions, but their compulsions are not visible to the outside observer. Instead, they use mental compulsions such as counting, repeating certain words or phrases, praying, reassuring themselves, or otherwise neutralizing the thoughts, images, or urges that cause them anxiety. Pure-O OCD is not a separate subtype of OCD, as mental compulsions may be predominant in any of the subtypes listed above.
Resources and Further Reading
Books and workbooks to help people with OCD:
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Some organizations that provide more information and resources for people with OCD: