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Forms of OCD

Makayla Arcurgagi, LPC
Counselor, Insight Clinical Counseling and Wellness, LLC

If you read the last article I wrote about Obsessive-Compulsive Disorder (OCD), then you will already have a brief understanding of how OCD can show up and affect people. If you haven’t, consider reading “What is OCD and How Do We Treat It?” If you take away anything from this post, please let it be that OCD can look different for everyone. It would be impossible for me to cover every form of OCD and how it presents. Individuals may exhibit obsessions and compulsions from multiple categories, or only one. Their thoughts can be specific to their life or completely random. These are just some of the common themes we tend to see with examples provided for how they may present. Remember, OCD is just a fraud that gets people to do what it wants by convincing them that they are bad, or that they will continue to feel bad if they don’t do the compulsion, or that they will be responsible for something bad happening.

CONTAMINATION OCD

Alright, I know you’re ready for me to dive right in. I figured it would only be right to start off with the main obsession you all know and love…contamination! This obsession is rooted in the fear of contaminating self or others. It may also be a disgust response to contamination. A disgust response describes how you may feel when seeing vomit, feces, insects, or anything you find to be disgusting in some way. It is not a feeling that can be controlled, and it is not fear related.

Contamination Obsessions:

• “What if I didn’t wash my hands enough before eating lunch? Could I get sick?”
• “What if I didn’t cook the chicken all the way through? Will my whole family get food poisoning?”
• “That shower didn’t feel right. I should probably take another.”

Contamination Compulsions:

• Excessive handwashing
• Excessive or ritualized showering, bathing, toothbrushing, grooming, or toilet routine. Involves cleaning of household items or other inanimate objects
• Any measures taken to prevent contamination

AGGRESSION OCD

This form of OCD focuses on the fear of hurting self or others, doing something embarrassing, offending others, acting upon impulse, or having violent/horrific intrusive thoughts. It is important to remember these are distressing thoughts and not desires. Most people who have these thoughts do not share them because they do not understand why they occur and are horrified by the nature of the thoughts. They do not want to act upon them!

Aggressive Obsessions:

• “When I stand on a bridge, I sometimes picture myself jumping off. Does this mean I want to hurt myself? What if I impulsively jumped off?”
• “What if I leave my house and somebody follows me home and murders me?”
• “Sometimes when I see my cat, I imagine hurting her. Am I a bad pet owner? Should I give her away? What if I am a danger to her? Why would I have that thought? I bet nobody else thinks of this. Maybe I am a bad person.”
• “I don’t remember exactly what I said. What if I said something offensive? If I don’t remember it, there’s no way to tell.”
• “Did I shut my stove off? What if my house catches on fire and my entire family dies because I wasn’t careful enough?”

Aggressive Compulsions:

• Checking locks, stove, appliances etc.
• Checking that nothing terrible did/will happen
• Excessively checking in with loved ones to make sure they are okay/did not experience harm
• Avoidance strategies: not going near bridges, holding knives, or driving

SEXUALLY-RELATED OCD

This form of OCD focuses on whether one’s own sexual desires are immoral or wrong. It may also focus on sexual thoughts that somebody knows are immoral or wrong. This does not mean the person has such sexual desires, but that they are distressed at the thought of the possibility.

Sexual Obsessions:

• “Last night when my girlfriend and I had sex I didn’t ask for consent. What if I was being too forward and she was scared to tell me no? Am I sexually abusing my partner?”
• “My sister was wearing a dress and I looked at her breasts. Does this mean I am attracted to my sister? I do not want to be attracted to her. Does looking mean that deep down I am?”
• “I avoid looking at children at the public swimming pool. Am I doing this because I am secretly attracted to them? What if I am a pedophile? How does somebody know if they are attracted to kids? I am so ashamed for thinking about this.”
• “What if I was sexually abused and I don’t remember?”

Sexual Compulsions:

• Reassurance seeking, asking one’s partner if they feel sexual pressure, etc.
• Avoidance strategies: not being near kids, refusing to change a baby’s diaper, avoiding intimacy altogether in case one is being immoral and doesn’t know, etc.
• Googling what thoughts mean

RELIGION/SCRUPULOSITY OCD

This form of OCD centers around being a good person. They may be consumed with always doing “the right thing.” It can be focused on one’s religion or their desire to be a good human to others. This can be distressing when done in excess. You can imagine it as spending most of your day trying to prove to yourself that you are moral and good while your brain is always pointing out ways in which you aren’t.

Religion/Scrupulosity Obsessions:

• “Am I a bad person?”
• “Sometimes I question if God is real. I know I am not supposed to do that. God must know what I am thinking. I am sinning.”
• “Did I say the right thing? What if I made the situation worse? Are they mad at me?”

Religion/Scrupulosity Compulsions:

• Need to ask, tell, or confess
• Excessively praying, reading the bible, attending church services, etc.
• Reassurance-seeking from others

“JUST RIGHT”, ORDER, SYMMETRY, OR EXACTNESS OCD

This category can be very broad. It focuses on the need for order, symmetry, or exactness, and may be accompanied by “magical thinking.” Magical thinking is the belief that performing a specific action can prevent an unrelated outcome. An example of this would be flipping the light switch four times so that one’s family does not die. This individual may understand that their pattern of flipping the light switch does not decide if their family is alive or dead. However, the fear of being responsible for something so big feels far worse than accepting the compulsion. An individual experiencing “just right” OCD may or may not have magical thinking about their behavior. If it is not accompanied by magical thinking, the behavior is usually aimed to release a certain anxiety or discomfort.

“Just Right”, Order, Symmetry, or Exactness Obsessions:

• “If I don’t count every step that I take on my way to work I will have a bad day” (magical thinking)
• “When I stood up, it didn’t feel right. I should sit down and stand up again. That one also didn’t feel right. Let me do it again until I feel satisfied” (no magical thinking, just a feeling they have)
• “Before I leave work, I must make sure all of my files are organized and everything on my desk is exactly the way I like it to be” (no magical thinking, just a feeling they have)

“Just Right”, Order, Symmetry, or Exactness Compulsions:

• Rereading or rewriting
• Need to repeat routine activities (in/out of door, up/down from chair)
• Counting, repeating words/phrases, ordering, and arranging
• Need to touch, tap, or rub

HEALTH-FOCUSED OCD

This is the one we all have probably fallen victim to. Ever been on WebMD convincing yourself that you have an undetected tumor and only three days to live? This form of OCD is kind of like that…. but all the time.

Health-Focused Obsessions:

• “What if I have a heart attack? How does one know? Would I be able to get to the hospital in time?”
• “What if I develop cancer and it’s untreatable?”
• “I’m worried that my doctor is going to tell me some really bad news. What if I can’t handle it?”
• “I feel a bump on my neck. Am I imagining this? How long has it been there? Should I call my doctor?”

Health-Focused Compulsions:

• Checking pulse, heart rate, or specific body parts to ensure nothing is wrong
• Googling symptoms
• Excessive visits to the ER, doctor’s office, or getting tests/scans done that are not ordered by the doctor

RELATIONSHIP OCD

This category focuses on one’s relationship with others (usually a significant other). The obsession can be about their own wrongdoing and uncertainty, or about their partner’s wrongdoing and uncertainty. Individuals experiencing this usually overanalyze their own thoughts and feelings within the relationship. They may also overanalyze their partner’s words and actions to find deeper meaning.

Relationship-Focused Obsessions:

• “When me and my partner got into a fight, I couldn’t stop thinking about what he said. Is he mean to me? Do other couples get into fights like we do?”
• “Sometimes my partner annoys me. What if I don’t like her? How do I know if she is the one?”
• “What if my partner is cheating on me? What if they cheat on me one day?”

Relationship-Focused Compulsions:

• Taking online quizzes to assess if they are in a good relationship
• Reassurance seeking from their partner
• Googling why they feel this way
• Taking mental notes of what their partner does or says that they perceive as wrong

As you read through these categories, did anything stand out to you? Any thoughts or compulsions that you have had at some point? Now before you self-diagnose and begin googling, this does not necessarily mean that you have OCD. Intrusive thoughts are normal. Obsessions are normal. Most people probably perform a few compulsions as well.

Individuals living with OCD are excessively experiencing these thoughts that some of us have periodically. The more that they have distressing thoughts, the more compulsions they engage in to alleviate the anxiety. However, over time these compulsions make their OCD worse, and their day is spent focusing on obsessions and engaging in rituals. If anything in this article was disturbing to you, just know that these thoughts affect people with OCD the same way. Imagine what that must be like. Not only would you be afraid of why they are occurring and what it may mean, but you may also be afraid of how others would perceive you if they could hear your intrusive thoughts.

Individuals living with OCD should not be ashamed of these thoughts. Afterall, their brain has become an expert at convincing them they should be ashamed, afraid, and must always avoid situations or engage in behaviors to evade these thoughts and feelings. But as I said in the beginning, OCD is a fraud with nothing more than false promises based on fear tactics. When the world begins to understand what OCD is and how it can be treated, more people suffering can come forward without fear of sharing their own thoughts and obsessions.

If you read this article and felt that the information applied to you, it is never too late to reach out and ask for help. Discuss what you’re experiencing with a mental health professional that is educated in diagnosing and treating OCD. You do not have to suffer alone. Your thoughts do not define who you are. Effectively managing OCD will give you your life back. I’ve seen it happen!