Obsessive-Compulsive Disorder (OCD) is often misrepresented and when people think about OCD, they usually think about it in terms of contamination and symmetry. If you’re treating clients who present with subtypes that fall outside of the stereotypical box and aren’t sure what you’re looking for, you might be missing it. OCD can show up in sneaky and unexpected ways. The content can be limitless. In this blog, we’ll give a high-level overview of some common subtypes and what they all have in common. Keep in mind, this will not be exhaustive and is meant to give an overview of common symptoms and presentations.
1. Contamination OCD
Obsessions often sound like: Worries around getting sick, getting/being dirty, being responsible for spreading illness and causing harm, or intense feelings of disgust
Compulsions to look out for:
- Excessive handwashing, showering, or laundry
- Avoidance of public spaces or “unclean” objects (e.g., doorknobs, money)
- Mental rituals like repeating phrases to feel “clean”
2. Harm OCD
Obsessions often sound like: Fears around causing harm to others or oneself (intentionally or accidentally), fears of snapping, losing control and causing harm, fears around causing harm through negligence (worries of leaving the stove on, doors/windows unlocked, etc.), intrusive urges or images, or fears around hitting pedestrians or animals while driving
Compulsions to look out for:
- Avoidance of sharps, ligatures, driving or other items that could be used to cause harm
- Physically or mentally checking/reviewing to make sure harm wasn’t caused
- Excessive reassurance-seeking (“I’d never hurt anyone, right?”)
3. Sexual Orientation OCD (SO-OCD)
Obsessions often sound like: Being unsure/constant questioning of sexual orientation, questioning if they’re gay or queer enough, straight enough, how can I know for sure?
Compulsions to look out for:
- Excessive checking of physical reactions or attraction
- Mental comparisons (e.g., “Was I more aroused by him or her?”)
- Avoidance of LGBTQIA+ content or environments or compulsively seeking them out
4. Pedophilia OCD (POCD)
Obsessions often sound like: Intense fears around being a pedophile or having inappropriate desires toward children, groinal responses or intrusive images.
Compulsions to look out for:
- Avoidance of kids, babysitting, or changing diapers
- Researching, comparing and contrasting, mental review
- Checking arousal levels or bodily sensations around children
5. Relationship OCD (ROCD)
Obsessions often sound like: Fears around being in the “wrong” relationship or not loving one’s partner enough, concerns on perceived flaws in one’s partner, or questioning if their partner is the “right” one.
Compulsions to look out for:
- Constantly analyzing the “rightness” of the relationship or partner
- Comparing current partner to others
- Compulsive confessions or reassurance-seeking about feelings
6. Religious/Moral Scrupulosity
Obsessions often sound like: Fears around being sinful, blasphemous, a bad person or morally wrong.
Compulsions to look out for:
- Excessive praying, confession, or mental review of past actions
- Avoidance of media, swearing, or situations that feel “impure”
- Attempts to neutralize “bad” thoughts with “good” ones
7. Existential OCD
Obsessions often sound like: Fixating on unanswerable questions (e.g., “What’s the meaning of life?” or “What happens after you die?”), fears around reality not being real or living in a simulation
Compulsions to look out for:
- Mental rumination
- Researching philosophical models or using AI tools to try to get answers or certainty
- Seeking reassurance from self and others
8. “Just Right” / Perfectionism OCD
Obsessions often sound like/feel like: Things feeling “off,” incomplete, imperfect or uneven.
Compulsions to look out for:
- Repeating tasks or movements until they feel “right” or “perfect”
- Excessive time spent editing, fixing, aligning, arranging, re-reading, or re-writing
- Sensory discomfort or emotional unease without clear reasoning
9. Health OCD
Obsessions often sound like: Fears and worries about having or getting a serious illness, fears that benign physical sensations are indicators of more serious or life-threatening conditions
Compulsions to look out for:
- Excessive symptom-checking, doctor visits, or seeing multiple doctors to get “second opinions”
- Googling of symptoms and body scanning
- Reassurance-seeking from self and others
10. Sensorimotor OCD
Obsessions often sound like: Becoming hyperaware of bodily functions and fears of never being able to ignore them again, excessive concern that automatic bodily processes (like blinking, breathing, swallowing, heartbeat) are not working like they are supposed to.
Compulsions to look out for:
- Monitoring of swallowing, blinking, breathing, or heartbeat
- Googling or seeking out other forms of reassurance
- Attempts to “distract” or “get rid of” awareness
11. Postpartum / Perinatal OCD
Obsessions often sound like: Fears and worries around harming the baby or harm coming to the baby, being an unfit parent, or losing control or distressing images or urges.
Compulsions to look out for:
- Mental review or checking to make sure no harm was caused
- Avoidance of holding or being alone with the baby
- Reassurance-seeking or excessive checking of baby’s safety
12. Suicidal Obsessions
Obsessions often sound like: Fears that one might actually want to die, losing control or fears of acting on an urge or image
Compulsions to look out for:
- Trying to neutralize or push out the unwanted thoughts or images
- Avoidance of sharp objects, high places, ligatures or other places or things associated with the obsessions
- Reassurance-seeking that they “would never do it”, or searching online what suicidality actually looks like to compare and contrast
Quick reminder: OCD is ego-dystonic. To refresh, that means that the obsessions experienced are unwanted and go against how a person identifies in terms of their morals, character and values. They do NOT reflect desires, intent or motivations. Clients are often terrified by the content of their thoughts, not driven by them.
So what do all subtypes of OCD have in common? The obsessions are ego-dystonic, they all follow the OCD cycle, and they can all be treated with ERP.
Are You Missing OCD in Your Clients?
If you’ve been utilizing strategies like giving reassurance, encouraging avoidance of triggers, engaging in endless cognitive exploration and it seems like you’re spinning on a hamster wheel, it might be worth it to take another look. If any of these subtypes resonate, or if you can clearly identify the OCD cycle at play, its time to switch gears and move toward an evidence-based treatment like exposure and response prevention (ERP).