Types Of Obsessive Compulsive DisorderAfter defining obsessive compulsive disorder, this article will explore the various types of obsessive compulsive disorder. Obsessive compulsive disorder (OCD) is a type of anxiety disorder. The condition can be firstly characterised by having an obsession in which you have repetitive, unwanted, uncontrollable or intrusive thoughts, images or urges that cause emotional distress. The obsession may then drive the need to perform certain compulsions which form the second part of the condition. Compulsions are repetitive behaviours, rituals or acts that you perform in order to alleviate the emotional distress caused by the obsession. The benefit is usually temporary however. Sometimes the compulsion remains as a “pure obsession”, where the individual uses an additional internal thought-based ritual to alleviate the emotional distress of the primary obsession e.g. you silently repeat a word ten times to “close” the cycle of anxiety. The additional connected “safety” thought is not usually observable by another person.
Common Types Of Obsessive Compulsive DisorderCommon obsessions include (1) fear of contamination; (2) arranging; (3) fear of harm; and (4) forbidden thoughts. Common compulsions include (1) decontamination; (2) rearranging and repeating; (3) checking; and (4) cleansing and reassuring. Whilst there is a common connected compulsion that alleviates the distress of a specific obsession, an individual suffering with OCD may incorporate several different compulsions to alleviate the emotional distress depending on your specific history. Obsessive thoughts can originate from (or be reinforced by) strong emotional experiences or traumas. Common emotions can include disgust, guilt, fear, blame and shame learned from authority figures in childhood or generated by the individual. These emotions can be connected to the following types of Obsessive Compulsive Disorder:
Obsession: Fear of contamination
Connected compulsion: DecontaminationCommon compulsive strategies to alleviate contamination fear distress can include avoidance of the object, person or situation. Avoidance can be constructive in the short term but will cause high anxiety when there is an obligation to interact with the object. If avoidance is not an option, then other strategies will be used to limit contamination including using protection. Gloves, masks and other protective equipment suitable for the situation or task may ease the level of anxiety of direct contact. Confidence in the protective equipment may be complemented by excessive washing, cleaning and hygiene rituals. These rituals can be time-consuming and can adopt a specific ordering of the routine to feel decontaminated. If doubt is triggered by any part of the ritual then the ritual will need revising and until it feels cleansed. Sometimes the confidence in the ritual is not enough and someone believes that the contamination has developed a new medical condition. This then needs external verification by a doctor or a medical test to reassure the contamination fears. Someone who uses internal thought-based compulsions and magical thinking may try to cleanse the contamination by repeating “clean” words or counting to a “clean” number to alleviate the distress of contamination.
Obsession: Arranging, organising and sequencing
Connected compulsion: Rearranging, reorganising and repeatingDoubting that the arrangement is “just right” drives the compulsion to rearrange and repeat the ritual as many times as it is needed to achieve a deeper feeling of comfort. The process can be time-consuming, often with nocturnal hours being spent on the ritual. The result is usually mental and physical exhaustion. It is not uncommon to arrive late or miss deadlines for appointments as doubts creep in with “just not right”-thoughts. Without getting it right, it would disturb the next situation like being able to concentrate on an important meeting. Or it can cause high anxiety with fear of failure if say an academic assignment has been submitted with errors. This type of OCD, like the other types of obsessive compulsive disorder, can impact on relationships with time-consuming rituals being prioritised over quality time with family and friends. Social interaction at the individual’s house may be avoided in case another person disturbs the symmetry of objects. Even outside the home, meeting new people can involve a degree of social anxiety when you fear judgement from others. Will they notice your personal appearance imperfections? When you feel that something is not right, magical OCD compulsions might be used to break the misalignment anxiety. Irrelevant objects might need to be touched in a certain way or over a certain number of times to feel comforted again.
Obsession: Fear of harm or damage
Connected compulsion: CheckingBeing in fear of harm or damage by losing control pushes your compulsion to ritually check and recheck that all is safe. You may also seek constant reassurance from other people by continuously asking them, texting them or by thoroughly researching if your danger fears are true. Other reassuring compulsions including hiding objects that could harm people or avoiding situations in which you consider you could lose control and then act on your obsessions. Checking compulsions aim to ease the distress associated with the uncertainty or doubt that a situation is safe. For example, that you really have locked the doors to prevent an intruder from entering your house or turned off the appliances in case there is an electrical problem that starts a fire. When going through your checking ritual, doubts can creep into the process and you wonder if you missed something that could then result in harm. As with the other types of obsessive compulsive disorder, these checking rituals develop a sense of being “just right”, but the feeling can be misplaced with general feelings of anxiety. On generally anxious days, the checking ritual can be confusing and exhausting, wondering if your senses are failing you. Other compulsions can include returning to the location several times to check that nothing harmful has happened. For example, as a driver, you may retrace your last journey to ensure that the road hump you drove over was not a pedestrian. You may want to take numerous photographs or videos of a situation to be confident that no harm was caused. With bigger disasters, you might ritualistically check the newspapers or research on Google that a catastrophe has not happened. If you fear self harming you may constantly check yourself in case you have inadvertently hurt yourself. These self harming fears can cause psychosomatic sensations in various parts of your body like tingling or tension, as prompting you to believe that you may have harmed that part of your body and not realised it. These false alarms then cause you to feel constantly on edge, disconnected from your body wondering if a sensation is real or not, checking constantly for reassurance that you have not self harmed. With an obsessive fear of sexual harm, you could fear that your arousal may trigger an impulsive sexual attack on someone. To alleviate this distress you may be concerned about sensations of sexual arousal. But your sexual thoughts could inadvertently influence you to feel sexually aroused when seeing someone that you don’t want to be attracted to. By triggering sexual arousal, you may then fear that your arousal is out of control and must be connected to real sexual desires towards that person. If you cannot control these desires, you may then impulsively act on them and sexually attack them. With magical OCD checking compulsions, you might use a specific number of times that you need to check for the situation to feel “just right”. Or you may have “unlucky” checking numbers that you avoid because they have been connected to previous disasters. If the unlucky number is presented in any way, internal mental rituals might then need to be used again to neutralise the fear of harm.
Obsession: Forbidden or taboo thoughts