In many people’s minds, obsessive-compulsive disorder (OCD) simply involves being obsessed about neatness and symmetry.
Some people may imagine that an OCD sufferer has to make sure all the pictures in his or her house are straight. But OCD is much more serious than this seemingly quirky behavior. And there are many types of OCD—obsessions and compulsions related to symmetry is just one. There are four other types of OCD that you should be aware of, each with a distinct set of signs and symptoms.
The 5 Types of OCD
Clinicians suggest that there are five different subtypes of OCD. If you suffer from OCD, you may generally experience symptoms of one type, while struggling with symptoms of another at the same time.
1. Harm Obsessions with Checking Compulsions
When you experience this type of OCD, you will have distressing thoughts related to causing harm to yourself or to those you care about. To relieve yourself of your anxiety about such harm, you will engage in checking rituals. For instance, you may worry that your house is burning down and then constantly go back to your house to make sure you turned the stove and electrical appliances off.
If you have this subtype of OCD, you will carry out checking compulsions multiple times, perhaps even hundreds of times. Your checking rituals may last for hours. This can disrupt your normal functioning and everyday activities. Because of your checking rituals, you may be late for school, work, and important occasions or appointments. This type of OCD can affect your ability to hold down a job or maintain a relationship.
2. Contamination Obsessions with Washing/Cleaning Compulsions
One of the other common types of OCD involves obsessions about contamination. If this subtype of OCD applies to you, then you will often use washing or cleaning rituals to relieve yourself of anxiety. People who suffer from this type of OCD have a constant fear of being dirty or contaminated. You worry that this contamination (e.g. from bacteria) could cause you or a loved one harm, such as contracting a disease. Common triggers of anxiety include:
- Public toilets
- Shaking hands
- Chemicals
- Sex
- Staircase banisters
- Crowds
- Money
- Hospitals
- Door handles
- Public telephones
- Clothes
- Outside air
- Eating in public
Since so many things in life can act as triggers, living with this type of OCD can make it difficult to feel comfortable during day-to-day activities. Fears of contamination can be overwhelming at times, which may cause you to avoid triggering situations. This can, in turn, interfere with one’s work and relationships.
Repetitive hand, face, or body washing takes place until the OCD sufferer feels that they are clean. In contrast, someone without OCD would just clean himself or herself until they can see that they are clean. It’s possible to engage in cleaning rituals so often that you cause harm to yourself. Excessive hand scrubbing, for example, can sometimes result in bleeding.
3. Symmetry Obsessions with Ordering and Arranging Compulsions
If you experience this subtype of OCD, things seeming to lack order and symmetry can be a major cause of distress. Everything has to be “just right” in order to relieve you of your anxiety. For example, you may be obsessed with keeping your possessions pristine. Alternatively, you may feel compelled to arrange your shirts by color. Sometimes, these compulsions can act as a way to ward off danger. For example, you might try to arrange your desk perfectly so that a loved one doesn’t get into a terrible accident. This is known as “magical thinking.”
People living with this type of OCD may spend a lot of time trying to achieve perfect symmetry. This can result in them turning up extremely late for work, appointments, or social occasions. And like with other types of OCD, those involving symmetry obsessions can impact relationships, too. A person with this subtype of OCD may avoid socializing at home, out of fear that others will disrupt the symmetry they have created. This can have a negative impact on social interaction and important relationships.
4. Collecting Obsessions with Hoarding Compulsions
Hoarding is another type of OCD, but it’s also listed as a distinct mental disorder in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
When you suffer from this subtype of OCD, you will feel extreme anxiety related to thoughts of throwing stuff away. To get rid of these uncomfortable thoughts, you will collect useless or worn out possessions. This is known as hoarding. If you hoard due to specific fears and worries, you have this particular type of OCD, rather than the separate condition called Hoarding Disorder (HD).
Patients with this OCD subtype will collect items considered to have little to no value by others. Such items may include old magazines, clothes, junk mail, notes, containers, and receipts. OCD sufferers may hoard so much stuff that their living space becomes inhabitable.
Hoarders tend to have intense fears about losing items they think they will need some day. Some of these OCD sufferers will also have an excessive emotional attachment to their possessions. People with hoarding obsessions tend to experience worse symptoms of depression and anxiety compared to patients with other types of OCD. If a mood disorder (e.g. major depressive disorder or bipolar disorder) accompanies your OCD, this is known as a co-occurring disorder.
5. Obsessions Without Visible Compulsions
This type of OCD is also known as “Pure O” (i.e. purely obsessional). This is because it’s the only subtype of OCD that doesn’t involve visible compulsions. Instead, the compulsions are purely mental in nature. OCD sufferers who have this type of OCD generally have repetitive, intrusive thoughts that are disturbing or repugnant in nature. The obsessions usually include sexual, religious, or violent themes. For example, OCD sufferers with this type may have unwanted thoughts about causing violence to loved ones. They may also have distressing thoughts about being a rapist or being sexually attracted to family members.
People who struggle with this type of OCD don’t have accompanying compulsions to act on such thoughts. In fact, they tend to be horrified they are thinking these things in the first place. An OCD patient will use mental rituals to lessen the anxiety associated with these intrusive and disturbing feelings. Such mental rituals may include counting in one’s head or repeating particular words and phrases. OCD sufferers will tend to avoid situations that may trigger involuntary thoughts.
Managing Your OCD
For all these types of OCD, treatment can be quite similar. SSRI antidepressants, such as Prozac and Paxil, are commonly used to treat the different types of OCD. Treatment also usually consists of a specific type of behavior therapy, such as cognitive behavioral therapy (CBT) or exposure and response prevention (ERP), which itself is based on the CBT model. These types of therapy encourage OCD sufferers to gain control over their obsessions and resist engaging in compulsions.
For those who don’t respond well to medication or might be looking for an alternative treatment, there is also transcranial magnetic stimulation (TMS). This is a relatively new, non-invasive and drug-free therapy that incites lowered activity in the prefrontal cortex, which can help regulate your mood and overall mental health.
If you are trying to recover from a particular type of OCD, it’s important to work with a therapist who is knowledgeable about your OCD subtype. This will give you the best chances of tackling your OCD in a productive way and leading a life that isn’t controlled by obsessions and compulsions.