What is OCD? Common OCD Subtypes

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, active obsessions (fears) and compulsions (repetitive safety behavior). OCD is categorized as ongoing intrusive thoughts and urges that push individuals to repeat and perform specific behaviors to relieve anxiety. OCD regularly interferes with an individual’s ability to move through daily life and responsibilities.

OCD can develop as a result of a multitude of factors, including a combination of genetics, biology of brain function, and environment. Previous research has shown that people who have been diagnosed with OCD often display differences in their frontal cortex and subcortical brain structures, affecting their ability to manage behavior and emotional responses effectively.

OCD involves issues in the brain’s ability to regulate and receive appropriate amounts of serotonin and dopamine. OCD has been shown to suggest that genetic factors can be involved in developing the disorder, specifically in childhood. This can be primarily genetics or environmental factors, such as stressful life events or moderate to severe trauma, which can worsen symptoms.

Different Types of OCD

OCD is a complex disorder that includes various aspects that contribute to a diagnosis, including the differences in subtypes. An OCD subtype is a pattern of obsessions and compulsions focused on a specific fear and or theme. According to current research from NOCD, this disorder has numerous different subtypes, making it versatile.

Checking OCD

Checking OCD is a series of mental rituals by an individual designed to validate safety and prevent harmful catastrophes. With Checking OCD, common obsessions pertain, but are not limited to leaving the stove on, locking the door, or the concept of making a mistake that could potentially harm someone else.

Safety behaviors, known as compulsions, can look like taking photos of plugs, repeatedly checking locks, appliances, or messages/emails, and seeking reassurance to find temporary relief.

Contamination OCD

Contamination OCD is described as an individual’s fear of either harming others or themselves by chemicals, germs, bodily fluids, illness, dirt, or other forms of contamination; this can additionally include moral or emotional contamination. With contamination OCD, obsessions tend to look like rumination of various questions, such as “What if I become sick from touching that?” “What if I infect those around me?” “What if this room is unsanitary or unclean?”

Compulsions that follow tend to look like, but are not limited to, excessive cleaning, sanitizing, or washing, avoiding specific objects, people, or places, and throwing away, hiding, or replacing contaminated items.

Counting OCD

Counting OCD involves compulsive counting or fixation on certain numbers, which a person believes prevents harm. To ensure safety, an individual may feel the need to count in specific patterns or numerical order to feel “right.” Obsessions associated with this subtype can be categorized by avoiding odd numbers, needing to complete an activity a specific number of times, or needing to count numbers to prevent a catastrophe.

Compulsions that tend to follow can be demonstrated by repeating actions a certain number of times, mental counting during daily tasks, or trying to avoid numbers that don’t feel “correct” or “right.”

Existential OCD

Existential OCD is known to involve intrusive thoughts fixated on death, reality, or free will that trigger rumination and intense anxiety. Although existential OCD is a less familiar subtype, typical obsessions may involve intense focus on questions like, “What if my reality isn’t real?” or “Do I actually exist?” If so, why do I exist?” leading to more intense questioning of “what happens after death?”

Compulsions for existential OCD tend to surface in excessive online research to “seek the truth,” engagement in actions to confirm the individual’s existence, i.e., checking their reflection in the mirror. Or reassurance-seeking from others.

False Memory OCD

False memory OCD is an individual’s ability to become convinced they have done something “bad” or “wrong” without factual evidence of that event occurring. This subtype of OCD includes false memories that allow individuals to receive vivid images, triggering guilt, shame, or fear of consequences.

Common obsessions of false memory OCD can include intensive questions such as “what if I committed a crime years ago?” or “what if this memory is real and I have done something wrong?” Compulsions from these obsessions can further manifest by engaging in safety behaviors of mentally reviewing past events, actively seeking out reassurance, urgency to confess, or avoiding people or places that can trigger the false memory.

Harm OCD

Harm OCD necessitates fear of causing harm to others or oneself intentionally or by mistake. While harm OCD can sound alarming, these anxieties are deeply distressing to the individual struggling with this subtype and do not accurately reflect their values or desires.

Obsession with Harm OCD might include different questions like, “What if I stab someone with this knife?” “What if I drive my car off the road? Or “What if I lose control and hurt someone?” Common compulsions are demonstrated as avoiding sharp objects, staying away from people, assessing behavior for signs of danger, or seeking out reassurance.

Hoarding OCD

Hoarding OCD entails the urgency to keep objects out of fear that discarding them will cause imminent danger, harm, or regret. While hoarding OCD holds similarity to Hoarding Disorder (HD), the difference is primarily in motivation. Hoarding OCD (HD) is driven by unwanted fear-based obsessions, whereas HD is focused on sentimental attachment and pride of possession.

Obsessions tied to hoarding OCD typically look like, “What if I need this later?” “If I throw this away, what if something bad will happen?” or statements such as, “Getting rid of this feels morally wrong.” Compulsions tied to hoarding OCD can be demonstrated as saving/stockpiling various items, storing objects in storage spaces such as a drawer or closet due to being “contaminated,” or excessively organizing possessions.

Pedophilia OCD (POCD)

Pedophilia OCD, also known as POCD, involves intrusive, unwanted sexualized thoughts about children. While POCD seems concerning, these thought patterns cause the individual a multitude of shame, distress, and fear that do not align with the person’s morals or values.

Obsessions tied to POCD fear-based questions, such as “what if I am attracted to children?” or “what if I looked at that child in the wrong way or inappropriately?” or distressing thoughts of “am I in danger?” POCD compulsions can be known as watching content about pedophiles and actively comparing yourself to them, mentally checking interactions with children/adolescents, checking physical reactions, or actively seeking out reassurance.

Perinatal OCD

Perinatal OCD can be defined as intrusive thoughts about harm coming to a baby during pregnancy, labor, or postpartum. Perinatal OCD is one of the less common OCD subtypes, making it underreported due to the mix-up between postpartum anxiety. Postpartum anxiety (PPA) involves excessive, but realistic concerns about an infant’s health and safety.

Whereas Perinatal OCD contains disturbing and irrational intrusive thoughts with safety behaviors to prevent harm.

For example, obsessions of this subtype of OCD include “what if something I do harms the baby?” “What if I purposefully fall down the stairs while pregnant?” or “what if I secretly want to harm my baby?” with compulsions involving excessive research about infant safety, confession, actively checking in, and reassurance seeking specifically from healthcare providers.

Postpartum OCD

Like perinatal OCD, postpartum OCD involves intrusive thoughts about an individual harming their baby, causing intense fear or guilt. Obsessions commonly associated with Postpartum OCD include fear-based questions such as “What if I snap my infant and hurt them?” “What if I accidentally cause the death of my baby?” or “Do these thoughts mean I am a bad parent?”

Compulsions heavily associated with Postpartum OCD manifest into avoidance of being alone with the baby, hiding dangerous objects, seeking out confession, asking for reassurance from healthcare providers, testing to see if you care about your infant, or repeating assertions/prayers about how much you care for your child. While this subtype may seem alarming, this thought pattern does not align with the individual’s morals or values.

Purely obsessional (Pure O) OCD

Purely obsessional OCD, also well known as “Pure O” OCD, can be categorized as compulsions that are primarily mental rather than physical. Individuals who struggle with “Pure O” tend to have “hidden” compulsions that are strictly thought neutralization.

Obsessions tied to “Pure O” can range anywhere from the fear of being immoral, dishonest, doubts about identity, memory, or the current reality, to intrusive sexual/blasphemous thoughts. Pure “O” is a mix of various subtypes mentioned, therefore earning its name as “Pure O.”

“Real Event” OCD

Although it shares similarities with False Memory OCD, Real Event OCD differs fundamentally from that subtype. Real event OCD is described as obsessive regret, guilt, or shame over a real memory that happened in the past. Real event OCD typically orbit minor events but are further exacerbated by intensive rumination.

Obsessions, an individual with Real Event OCD could be navigating thoughts such as, “What if I am a bad person for engaging in that?” “What if people find out what I did?” or “What if this memory concludes I am dangerous?” or “What if others find me harmful because I did this?”

Compulsions associated with these obsessions can be labeled as reassurance-seeking, confession, mental review of the memory, and avoidance of triggers or people, places, or objects that bring reminders of the event.

Relationship OCD (ROCD)

Relationship OCD, also commonly known as “ROCD,” focuses on excessive doubts and fear about a romantic relationship, even when the relationship is defined as healthy. ROCD is shared as one of the most frequently diagnosed subtypes due to its intensity of obsessions and compulsions, specifically around a romantic attachment.

While having thoughts of doubt in all relationships is normal, those diagnosed with ROCD have a thought process magnified in distress without natural questioning. ROCD obsessions involve questions like “What if I am not attracted to my partner?” “Do I really love my partner?” “What if I am in the right relationship?” “Is this person the one? What if they are not the one?”

Compulsions commonly associated with ROCD can include excessive relationship comparison, active reassurance seeking, testing feelings, and avoiding intimacy.

Scrupulosity (Religious OCD)

Scrupulosity (Religious OCD) entails the fear of religious sin, punishment, or moral failure. A common symptom of those with Religious OCD often fear they have committed the “unforgivable” sin, blasphemy, or have broken religious rules unintentionally.

Those navigating Scrupulosity tend to have obsessions associated with “what if I offended God?”, “What if I am going to hell for committing the unforgivable sin?”, “What if I am not praying correctly? What if I am not praying enough?”

Individuals with religious OCD tend to have compulsions such as excessive prayer, confession, and religious rituals, avoiding religious content, or actively practicing and repeating spiritual practices until they have been “forgiven” or things feel “right.”

Sensorimotor OCD (Somatic OCD)

Sensorimotor OCD (Somatic OCD) is defined by the inability to dissipate intrusive awareness of automatic bodily functions. This can involve, but is not limited to, breathing, blinking, swallowing, etc. Somatic OCD can cause intense distress when the individual becomes hyper-focused on automatic functions.

Obsessions in Somatic OCD resemble questions such as, but not limited to, “What if my heartbeat isn’t normal?” “What if I can never stop thinking about my breathing?”, or “what if something is wrong with my body?” Compulsions often overlap with obsessions, as individuals struggle to ignore bodily sensations, try to suppress them, or avoid quiet environments where these feelings intensify.

Sexual Orientation OCD (SO-OCD)

Sexual Orientation OCD (SO-OCD) intensifies obsessive doubts about an individual’s sexual orientation, specifically any contradictions to their perceived gender identity. Those experiencing SO-OCD have unwanted, distressing fear around the natural exploration of sexuality.

Obsessions associated with SO-OCD include distressing concerns such as, “What if I am secretly gay/straight/bi/lesbian?” “What if I have been lying to myself and others about my sexuality?” or “What if I am enjoying the intrusive images in my mind? Did I enjoy those?”

Compulsions can be displayed as a mental review of past romantic relationships or attractions, avoiding specific people, media, or locations of past events regarding sexuality, testing reactions, or actively seeking reassurance.

Suicidal OCD

NOTICE: ALL THOUGHTS OF SUICIDE NEED TO BE TAKEN SERIOUSLY. IF YOU OR SOMEONE YOU KNOW IS EXPERIENCING ACTIVE SUICIDAL THOUGHTS, PLEASE CALL 911 OR CONTACT THE NATIONAL SUICIDE AND CRISIS LIFELINE 988 OR TEXT THE CRISIS TEXT LINE “HOME” TO 741741.

Suicidal Obsessive-Compulsive Disorder is characterized by persistent, distressing, and intrusive thoughts concerning self-harm or suicidal ideation. While this subtype may display as alarming, individuals experiencing Suicidal OCD thoughts go against the morals and values of that person.

Obsessions commonly linked to suicidal OCD can be similar to Harm OCD, but primarily hyper-fixating on the death of oneself rather than general harm. Obsessions include questions such as, “What if I jump off this bridge?” or “What if I want to die?” or “What if I drive off this cliff?” Compulsions tied to these obsessions can include seeking reassurance, mental checking, or avoiding specific triggers.

Treatment Options

All types of obsessive-compulsive disorder (OCD) subtypes are treatable. According to evidence-based research, Exposure and Response Prevention (ERP) is the gold standard for OCD treatment. ERP is considered a modified version of Cognitive Behavioral Therapy (CBT) for those with OCD, anxiety disorders, phobias, etc. ERP is designed to help reduce distress, sit in discomfort, and manage uncertainty.

ERP is highly effective, with 65%-80% of clients noticing substantial symptom reduction and effectiveness in treating their OCD. ERP can be anywhere from 12-20 sessions with an 8–16-week turnaround for success. Other options for treatment include SSRI medication, ACT, and CBT conformed to OCD treatment as these can be mixed in with ERP.

Next Steps

Navigating OCD can be debilitating or watching someone you love struggle with OCD can be devastating. OCD treatment can bring freedom from obsessions and compulsions. There is hope in Jesus Christ and by His grace, allowing ERP therapy to be an effective treatment modality for OCD.

Some individual counselors specialize in OCD treatment, specifically utilizing ERP to help. If you would like to contact someone who is professionally qualified to treat OCD, we can help. Reach out to us, and we can connect you with a counselor who specializes in OCD treatment. You are not alone or beyond help. Call or email today.