Types Of Obsessive Compulsive Disorder
After 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 Disorder
Common 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
A fear of contamination can focus on how your own acts or omissions can contaminate you or how your acts can affect other people. They can also include how other’s acts or omissions can contaminate you.
The most common form of contamination is by direct physical contact. But contamination can also be spread through your senses e.g. how it looks, smells, sounds, tastes and feels. The memory trace of something contaminating can persist for some time after, demanding specific rituals to alleviate the distress of the obsession.
The list of objects that you fear as contaminants can be specific and quite extensive, more than what is commonly considered as a preoccupation with germs, dirt, illness and viruses. For example, contact with animals, bodily fluids and excretions, chemicals and spoiled food may also be feared as a potential source of contamination.
But the fear of contamination can also involve a type of mental contamination where there is no direct physical contact with harmful substances. The mind becomes infected by a certain thought, word, image or memory that connects you with something “contaminating” and this causes an internal feeling of dirtiness and can’t be cleansed with a physical compulsion. An example might be seeing a possession adored by a previous abuser. This mental contamination needs a specific thought-based compulsion to cleanse it and lift you out of the association, like an image of being free from your abuser.
Even more disconnected to physical contamination is a type of “magical contamination” in which the individual feels contaminated by an “unclean” word or unlucky number for example and has gradually become associated with contamination. Magical associations make very little sense to another person who does not share the same belief, but are “real” enough for the individual with magical OCD.
Connected compulsion: Decontamination
Common 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
People with an orderliness, symmetry, completeness or “just right” OCD have an obsession with the way that objects or the features of something are arranged and how they feel. Based on specific criteria, there is extreme discomfort and tension when there is a perceived misalignment and something “does not fit”. The perceived misalignment can be registered through any of your senses; how it looks, sounds, smells, tastes or feels when the object is being touched. Common situations can include attending to features of your own appearance such as how you dress, wear make-up or set your hair, the precise position of furniture, the alignment of personal items, the sound of a note being played on an instrument or the way that written content has been completed.
Arrangement obsessions can also combine with the other types of obsessive compulsive disorder where it necessary to structure the sequence of a cleaning ritual (with contamination OCD) or maintain the exact routine of checking securely (with checking OCD discussed below) for the distress to be alleviated.
Magical OCD associations can indirectly connect the perceived misalignment of an object with the fear of harm to someone or the fear of a catastrophic event.
Connected compulsion: Rearranging, reorganising and repeating
Doubting 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
With a fear of harm or damage OCD, you have an obsession that through your acts or omissions, you could accidentally, unknowingly, negligently or impulsively harm yourself, harm somebody else or cause damage. These thoughts and urges are repetitive, unwanted and often intrusive with no actual intention of harming anyone or causing damage to anything. When having these intrusive thoughts, you fear losing control over your acts or omissions and this loss of control could then result in subsequent physical harm or damage.
OCD harm fears can generate other shameful fears that there is something desperately wrong with you to be having these intrusive thoughts. You may fear being a secret sociopath and that people or the media will confirm your fears and expose you to the world. With this obsessive insecurity and distrust, you seek constant reassurance from other people or the media that these fears are not true. Ironically, if they give you reassurance, you then question their motives for being honest with you and wonder if there is a conspiracy against you.
Even though it is illogical, OCD harm and danger obsessions might connect the “power” of your thought or mental activity to the actual physical cause of harm or a disaster. When someone is harmed or damage has been done, you then feel an overwhelming sense of responsibility that you are the instigator through your thoughts.
Connected compulsion: Checking
Being 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
People who don’t have OCD are usually able to dismiss fleeting taboo thoughts that go against your individual nature or your cultural or religious values. Sufferers of OCD however are unable to separate the intensity, frequency and internal judgement of these thoughts or images. Having these forbidden thoughts convinces you that they must be part of your identity.
Forbidden or taboo OCD obsessions include thoughts or images that are physically violent, sexual and/or blasphemous towards people or subjects that are adored or valued.
Intrusive thoughts of violence can include strangling, stabbing and mutilating someone with any variety of dangerous objects. Examples of taboo sexual obsessions include intrusive thoughts about your (or your partner’s) infidelity, paedophilia, rape, incest, bestiality or thoughts against your sexual identity. Forbidden religious obsessions can include thoughts that might question the strength of your religious beliefs or thoughts that break religious laws (also known as scrupulosity). They can also include intrusive thoughts that involve shouting blasphemous words in a religious location or involve intrusive sinful or sexual thoughts about your deity.
As with other types of obsessive compulsive disorder, those with taboo or forbidden obsessions have no intention of acting upon these intrusive thoughts. This is what distinguishes you from more malicious psychological personality disorders. Instead, you worry that in the future you may lose control and then act on your taboo obsessions. You are convinced that by having these thoughts, there must be something wrong with you.
Another important point is that whereas sexual fantasies involve some form of potential pleasure, sexual obsessions are distressing and involve guilt, shame and self hatred. The responsibility you feel for having these thoughts causes you to over-control them, suppress them and seek reassurance from them.
Magical OCD forbidden or taboo obsessions might exaggerate the power of these thoughts being able to actually cause these events to happen. Magical connections may also be made with what you define as “unlucky” events e.g. by attending a funeral it will cause more death, or believing that something bad might happen on a certain day of the week.
Connected compulsion: Cleansing, reassuring, purifying and undoing
Compulsions related to having forbidden or taboo obsessions aim to alleviate the emotional distress of your intrusive thoughts. Your compulsive acts can include many of the other types of obsessive compulsive disorder behaviours. Objects that could be used to inflict harm on someone may be ritually hidden and then repeatedly checked that the object has stayed in its safe place. Avoidance of the associated situations, people or objects is another common short-term strategy.
Reassurance that you are not the bad character that you define yourself to be will be sought from various sources. Those people that you trust, or consider an authority, and are likely to maintain confidentiality over your sensitive issues will be constantly approached like close family members, doctors or clergy members.
Due to the sensitivity of the obsessions, you rarely feel confident enough to talk to other people about your taboo thoughts in case they misunderstand your condition and label you as malicious or as a potential criminal. This suppression maintains the internal suffering of these disturbing thoughts and your desperate need to alleviate your distress. Reassurance may also be repeatedly sought from online sources by checking the content of relevant topics.
Intrusive thoughts can feel internally contaminating and may be comforted by indirect compulsions. For example, washing compulsions may be used to “cleanse and purify” your intrusive thoughts from your body into your mind. Other arranging compulsions may also be used to help you feel “clean” by maintaining order and alignment in your personal life. Internal mental and magical compulsions may be used like repeating “good” words or excessively praying to undo and cancel out the intrusive negativity of your religious intrusive obsessions. Counting may also be used as a strategy to block intrusive thoughts from entering your mind.
Some compulsions can also serve as an outlet to release the potential urges in your intrusive obsessions. Excessive use of porn may be used with intrusive sexual obsessions to manage the build up of your sexual arousal. Drugs that have a sedating effect may also be over-used to reduce the potential urge to be aggressive.
Other Types Of Obsessive Compulsive Disorder
Compulsive hoarding has been previously listed as one of the types of obsessive compulsive disorder. It has been re-classified as a condition in its own right because many hoarders refuse to accept that they have a problem. In some cases however, the individual’s hoarding issues can be related to OCD.
Hoarding disorder is the excessive retention and collection of objects. Your (and other people’s) living space is swamped by these objects causing potential burdens on your day-to-day functioning, your health, finances, work spaces and social ability. Common living and mobility around the home is obstructed and becomes hazardous or potentially hazardous.
Compulsive hoarding is connected to many issues including the exaggerated importance and emotional attachment of material possessions. Hoarders feel guilty and wasteful about throwing items away and so will retain it in case it has a future use. You continue to make excessive purchases of these treasured items in an attempt to increase the collection, often sacrificing other functional spaces like shower cubicles or ovens.
These collectable items can have connections with one’s history and identity and thus you would feel grief if these items were interfered with or thrown away. Items can also develop personalities and can act as replacements for anticipated memory loss; “I’ll keep hold of this just in case I forget…” is the common response.
Hoarders may have lived in poverty during childhood, experienced trauma following a major lifestyle change like a bereavement or house move. There may be other mental health issues too. Hoarders are also known to suffer with perfectionism and behavioural avoidance. You can have problems with decision-making, organisational skills and procrastination.
Rumination is the repetitive and excessive thinking about the same event. It can involve reflecting on issues which is more analytical in nature. Another type of rumination is brooding which is more negative, repetitive and continual. Hours can be spent being self absorbed in deep thought on topics of morality that may not have satisfactory conclusions or on depressive issues in which the individual is unable to create closure.
Trichotillomania (hair pulling)
Sufferers of Trichotillomania have strong urges to pull hair from any part of the body. It is considered an impulse-control problem often in response to certain (often unconscious) emotional cues such as stress, anxiety, boredom, loneliness and worthlessness.
Body dysmorphic disorder is the excessive preoccupation with a perceived defect in one’s appearance. The sufferer is usually convinced about the defect’s negative qualities. The condition can relate to issues of low self esteem, anxiety and perfectionism. It can involve numerous repetitive behaviours like, checking in mirrors, skin picking and reassurance seeking.
Other specific obsessions
Other obsessions may not fit precisely into the above types of obsessive compulsive disorder but can still be classified as OCD. Obsessions can include specific superstitious fears like not walking on the cracks on pavement, luck or bad luck related obsessions, inquisitive obsessions (needing to know all the details of something), speech-related obsessions (speaking perfectly) and fears of losing things. Some obsessions can focus on the hyperawareness of bodily functions like blinking or swallowing.
Other specific compulsions
Other compulsions can be specific to each individual and may not fit the common types of obsessive compulsive disorder listed above. They can include list-making in which the sufferer believes that they will forget something important and this will then lead to a catastrophe. People who fear making mistakes can have the compulsive urge to tell people absolutely everything but in doing so can make a minor issue into a bigger problem e.g. telling your partner every time you notice someone else who is attractive, or feeling the need to elaborate on or confess every detail of a specific issue. Other compulsions can include, skin picking (excoriation), nail-biting, ritualised eating patterns, superstitious behaviours, blinking or staring rituals, and specific touch-related compulsions.
Summary of types of obsessive compulsive disorder
OCD is a serious medical condition that can cause significant dysfunction and emotional distress. With any type of therapy treatment, the therapist will initially explore the make-up of your obsessions and compulsions. They can then devise a treatment plan to help to address the specific features of your condition.