OCD Subtypes: Understanding the Different Types of OCD

Obsessive-Compulsive Disorder (OCD) can present with several distinct and different subtypes, each characterized by specific themes of obsessions (intrusive thoughts) and compulsions (repetitive behaviours or mental acts). Below are the main OCD types to help you better understand how OCD can appear, with examples of what someone with this OCD type might experience. Those with OCD can sometimes struggles with a variety of OCD types, so the boundaries between each category are not necessarily firm or certain.

Contamination Obsessions with Washing and Cleaning Compulsions

This OCD type involves fears of germs, dirt, or contamination, leading to excessive washing or cleaning rituals and compulsion to reduce anxiety. This is perhaps what many people think of when they think of OCD, although there are several different types of OCD.

• Fear of contracting diseases: Worrying about getting sick from touching door handles or shaking hands. This could include fear of contracting a cold, flu, COVID, virus, or more serious illness (Hepatitis, HIV, sexually transmitted disease,etc.)
• Fear of chemical contamination: Avoiding household cleaners, certain foods, or chemicals that we come across in daily life (e.g. car fumes) due to perceived toxicity or the harm they may cause.
• Fear of spreading illness: Avoiding contact with others to prevent "contaminating" them with germs. OCD sufferers can worry not only for their own safety, but for that of their loved ones, and even strangers.

Aggressive, Sexual, or Religious Obsessions with Checking Compulsions 

Sometimes called "forbidden thoughts," this type of OCD involves intrusive thoughts about harm, morality, or taboo topics, often followed by checking or mental rituals to neutralize distress, and avoidance of reminders of the fears or triggers to the anxiety.

• Thoughts of harming others: Fearing you might act on unwanted impulses to hurt loved ones, or strangers, leading to checking behaviours (e.g., ensuring knives are locked away, not using sharp objects) and avoidance (e.g. not being near others, avoiding gatherings, or catch-ups with friends).
• Obsessions around homosexuality (often called HOCD): Intrusive thoughts about being or becoming homosexual or gay, despite not aligning with one’s identity, prompting mental reassurance or checking behaviours. Those suffering with this type of OCD may check their responses (including any physiological changes) to same-sex others, and avoid topics of homosexuality (e.g. interviews or gay celebrities on television).
• Unwanted sexual thoughts: Experiencing distressing, intrusive thoughts about inappropriate sexual scenarios, or with inappropriate others, prompting reassurance seeking, checking behaviours, or avoidance behaviours. People with this form of OCD can feel morality corrupt, as if they’re a terrible person, just for ‘thinking’ certain things (or more specifically, for having intrusive thoughts). They may also avoid contact with others, or avoid contact with children, which typically makes the anxiety worse.
• Relationship doubts (ROCD): Obsessive doubts about whether or not one loves their partner, whether they are truly compatible. They may hold fears of infidelity, leading to mental checking or reassurance-seeking, looking for ‘feelings’ that prove their love. Such searching tends to only make the anxiety worse.
• Blasphemous thoughts: For those with religious beliefs, fearing the occurrence of sinful thoughts or of experiencing offensive religious ideas, leading to compulsive praying or confession. They may seek reassurance from others, or confess to religious leaders in their faith to ‘cleanse’ their feared blasphemy.

Symmetry Obsessions with Ordering/Repeating/Counting Compulsions

This subtype involves a need for order, symmetry, or exactness, often accompanied by rituals like arranging, repeating actions, or counting to achieve a "just right" feeling.

• Need for objects to be aligned: Rearranging items until they feel perfectly balanced, in-line, or symmetrical.
• Repeating actions: Tapping a surface a specific number of times to prevent a vague sense of unease.
• Counting rituals: Counting steps or objects to achieve a "correct" number. Certain numbers may seem safer or appropriate than others, with no particular reason why.

Hoarding Obsessions and Compulsions

This involves difficulty discarding items due to fears of needing them later or emotional attachment, often leading to cluttered living spaces. Hoarding is sometimes classified as a separate disorder, and in the most recent diagnostic reference book that psychologists use (Diagnostic and Statistical Manual of Mental Disorders: DSM 5) it has been moved out of the OCD section specifically.

• Fear of losing important items: Keeping old receipts or broken objects "just in case."
• Emotional attachment to objects: Refusing to throw away items due to sentimental value and an emotional connection to them.
• Fear of making wrong decisions: Avoiding discarding items due to anxiety about regretting it.

Notable Mention: Pure Obsessional OCD (Pure-O)

Although not considered its own category per say, Pure-O is another form of OCD characterized by intrusive thoughts seemingly without any visible compulsions, though mental rituals (e.g., thought suppression, mental reviewing, checking things off in one’s head) are often present. Pure-O is generally rare, and when clients come to see a psychologist for ERP therapy, it often becomes apparent that there are indeed compulsions and behavioural changes in those with this form of OCD. Those who do struggle with Pure-O type OCD, most often have intrusive thoughts around themes of aggression, sexually taboos, or blasphemy.

• Intrusive violent thoughts: Repeated unwanted images of harming others without acting on them.
• Mental rumination: Endlessly analysing past conversations to ensure no harm was caused.
• Existential obsessions: Obsessing over unanswerable questions, like the meaning of life.

We hope this has been helpful as you better try to understand your particular type of OCD, of the symptoms of your loved ones.

Note: OCD types often overlap across subtypes, and individuals may experience multiple types of OCD at the same time, or at different points in their life. For more information, consult resources like the International OCD Foundation (IOCDF) or seek professional help.

OCD treatment is available by our Clinical Psychologist at our Coomera clinic, MHM Psychology. Cognitive Behaviour Therapy, or CBT, is a highly effective treatment approach in the management of OCD (see ERP Therapy). 

Click here to read more about Dr Mark Bartholomew, our services, or take a look at our blog page for more OCD information. 

References

• Abramowitz, J. S. (2006). Understanding and treating obsessive-compulsive disorder: A cognitive behavioral approach.
• Bloch, M. H., Landeros-Weisenberger, A., Rosario, M. C., Pittenger, C., & Leckman, J. F. (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry, 165(12), 1532-1542.
• Calamari, J. E., Wiegartz, P. S., & Janzen, M. R. (1999). Obsessive-compulsive disorder subgroups: A symptom-based clustering approach. Behaviour Research and Therapy, 37(3), 251-258.
• Mataix-Cols, D., Rosario-Campos, M. C., & Leckman, J. F. (2005). A multidimensional model of obsessive-compulsive disorder. American Journal of Psychiatry, 162(2), 228-238.
• McKay, D., Abramowitz, J. S., Calamari, J. E., et al. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24(3), 283-313.