There are many different types of obsessions and compulsions.But most of them fall into four categories: control, order and symmetry, contamination, and taboo thoughts.
Read on to learn about the most common types ofObsessive Compulsive Disorder (OCD), risk factors, diagnosis and treatment.
What is OCD?
Obsessive Compulsive Disorder (OCD) is a common, long-lasting onemental health conditionthis includes disturbing, unwanted obsessions and compulsions.
Obsessions refer to thoughts, worries, urges, preoccupations, or mental images that are persistent, disturbing, and intrusive.Common examples are:
- Fear of infection, illness or germs
- Extreme concerns about organization, symmetry, or cleanliness
- Fear of losing or forgetting something
- Repetitive doubts or questions
- Violent or aggressive images or impulses
- Disturbing sexual images or thoughts
- Religious/blasphemous thoughts
Compulsions refer to behaviors or rituals that people feel compelled to repeat. Usually, people engage in compulsions to reduce distress over a recurring obsession.Examples can be:
- Excessive hand washing
- Repeated tidying up, ordering or organizing
- Check locks, devices (e.g. oven) or switches again and again
- Repeating certain phrases, words, or numbers
- ask for reassurance
- To count
How common is obsessive-compulsive disorder?
It is estimated that approximately 1.2% of US adults meet diagnostic criteria for OCD in any given year. OCD is more common in women than men.
symptoms of obsessive-compulsive disorder
SeaDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5), someone meets the diagnostic criteria for OCD if:
- They have at least one obsession or compulsion that is time-consuming, causes significant emotional distress, and interferes with their daily functioning.
- They feel powerless to suppress the urge to think about their obsessions or to exercise their compulsions.
- Your obsessions and/or compulsions are not primarily caused by another medical condition, such asgeneralized anxiety disorder(GAD) or aeating disorder.
Some people with OCD are unaware that their obsessions are excessive. Others know that their concerns or impulses are not based in reality, but still feel unable to control them.
Different types of obsessive-compulsive disorder
There is no single official way to divide OCD into subtypes. However, many researchers agree that there are certain common themes and clusters of symptoms in people with OCD.
One of the most common symptoms of OCD is compulsive checking.People with "Checking OCD" may over-check to make sure their devices are off, that their doors and windows are locked, or that they haven't lost, damaged, or misplaced anything important.
Control rituals can also be related to excessive doubt and anxiety and fear of losing control. There is often a fear of intentionally or unintentionally causing something bad.For example, someone with OCD may not be able to leave the house for more than an hour because they repeatedly check the stove.
order and symmetry
Many people with OCD experience obsessions and compulsions related to order, symmetry, arrangement, and counting.Symmetry-related coercion rituals can include repeatedly stringing things together, constantly rearranging furniture to make it look "just right," or counting items repeatedly to make sure they're put into equal groups.
Someone with an irrational love of order may also become overly concerned with their body proportions and/or grooming habits, which can lead to thisdisturbed eatingand poor self-image. Others feel compelled to plan excessively, plan, manage time, and organize rituals.
fear of contaminationis one of the most common obsessive-compulsive issues in people with OCD. People who are afraid of germs and/or contamination may clean surfaces or compulsively wash their hands, become overly concerned about ingredients in food or household products, and even avoid touching things that others have touched.
Some people with OCD also fear emotional contamination.Someone who fears emotional contagion will do whatever it takes to avoid people, places, or topics that they consider "immoral" or "dirty."
Brooding or intrusive thoughts
Rumination refers to obsessive, intrusive, and unwanted thoughts about a specific topic. ruminationoften concerns taboo or forbidden topics such as sexuality, violence or religion.
Intrusive thoughts can take many forms. Some people with OCD become obsessive about their sexual orientation or constantly question their religious identity.
They may constantly worry that they will cheat on their partner, hurt themselves or someone else, or be sexually predatory even when there is no evidence. Others experience intrusive, graphic sexual, or violent mental images that they find inappropriate or disturbing.
Rumination is often related to an underlying obsession with guilt and excessive responsibility for harm. People experiencing intrusive thoughts may engage in compulsion rituals to try to "neutralize" the perceived threat.
For example, someone who has forbidden thoughts about religion or blasphemy may pray excessively to protect themselves or others spiritually. Someone else may count, type, or repeat certain moves or phrases because they believe doing so will keep someone they love safe from harm.
What is Existential Obsessive Compulsive Disorder?
Other OCD subtypes
Researchers have identified several other possible OCD subtypes, including:
- Horten: Hoarding Disorder is now a standalone diagnosis in the DSM-5. Hoarding refers to the compulsive, excessive gathering of worthless or trivial items, often resulting in extreme clutter and disorganization.Some people with OCD hoard items related to an underlying obsession or fear.
- Somatic Obsessions: Somatic obsessions refer to preoccupation with body parts, bodily functions, and/or diseases.For example, someone with OCD experiencing somatic obsessions may hyperfocus on the way they breathe or swallow, or monitor themselves for signs of illness.
- Pure OCD: Some researchers refer to OCD that involves only thought-based obsessions with no behavioral or compulsive components as “pure OCD.”
- OCD with obsessive slowness: Some people with OCD are very prone toperfectionism. In some cases, their fear of failure can cause them to take an inordinate amount of time to complete a task to ensure it gets done "just right."
Causes and risk factors
Not a single one is knowncause of obsessive-compulsive disorder.Instead, researchers believe many factors contribute to the development of OCD, including:
- Genetic: According to twin and family studies, OCD is often inherited.Having a sibling, parent, or child with OCD increases your risk of developing the disorder.
- life events: Stressful and/or traumatic life events can trigger the onset of OCD, particularly in people who are already genetically predisposed to the disorder.
- brain structure: Studies suggest that certain differences in brain structure and function, such as B. Hyperactivity in theorbitofrontal Cortex(which helps manage emotions and decision-making) can influence the development of OCD symptoms.
- comorbid conditions: Many people with OCD have other mental illnesses, such asAttention Deficit Hyperactivity Disorder(ADHD), depression and anxiety.
Age and gender may also play a role in the onset and development of OCD. OCD is usually diagnosed before age 25, with many people showing their first symptoms in childhood or adolescence. It is rare (though not impossible) for someone to be diagnosed with the disorder after the age of 35.
Meanwhile, studies suggest that women are about 1.6 times more likely than men to develop OCD over their lifetime.
OCD and comorbidity
It's common for people with OCD to have more than one mental illness. A 2021 review and meta-analysis found that 69% of people with OCD have had at least one other mental illness at some point in their lives.
diagnosis and testing
If you suspect you have OCD, your doctor may refer you to aMental Health Therapist. They can diagnose you with OCD based on your medical history, an understanding of your symptoms, and the criteria in the DSM-5.
Your healthcare provider may also perform a physical exam and other tests to rule out the possibility of underlying physical illnesses or comorbid mental health disorders.
In the DSM-5, OCD appears under the OCD and related disorders category.OCD-related conditions within this supercategory include:
- hoarding disorder: While hoarding is sometimes a symptom of OCD, hoarding disorder can also be diagnosed and treated as a distinct mental health condition. People with hoarding disorder have extreme difficulty discarding items and controlling their impulses to collect items—even when they are collectingnegatively affect their relationships, safety, health and/or finance.
- Skin Picking Disorder: People with Skin Picking Disorder, also known asabrasiondisruption orDermatillomanie, persistently tugged at her skin. Harmful effects can include skin lesions, emotional distress, and social isolation.
- Trichotillomanie: people withTrichotillomanieHair loss, emotional distress, self-image issues and low self-esteem due to a persistent, uncontrollable impulse to pull or pluck hair.
- Body Dysmorphic Disorder: Body Dysmorphic Disorder(BDD) involves an overwhelming preoccupation with one's body and appearance. People with BDD often spend a lot of time, money, and energy trying to improve or "fix" their appearance.
Other conditions that are sometimes confused with or coexist with OCD include:
- obsessive-compulsive personality disorder: Obsessive-compulsive personality disorder (OCPD) is a mental illness that involves rigidity in thought and behavior, over-commitment to rules and perfectionism, and a preoccupation with maintaining control. OCD shares some symptoms with OCPD, but they are different conditions.
- anorexia: Certain eating disorders, such asanorexia(AN), are often comorbid with OCD. Some research suggests that about 35% to 44% of patients with AN also meet diagnostic criteria for OCD. About 10% of female patients with OCD now also have AN.
- Tourette Syndrome:Tourette Syndrome(TS) is a nervous system disorder that causes involuntary tics (repeated movements, sounds, and/or jerks).OCD and TS are related and often comorbid, particularly in children and adolescents. About 60% of people with TS also meet diagnostic criteria for OCD, and up to half of children with OCD have experienced tics at some point.
OCD vs OCPD: What are the differences?
How OCD is treated
Many people with OCD experience improvements with treatment. Studies suggest that around 50% of people with OCD experience a complete remission of their symptoms after treatment. Many others can significantly improve their quality of life over time.
Psychotherapy is the typical first-line treatment for OCD.Many people with OCD benefit from a specific type of OCDcognitive behavioral therapy(CBT), known as Exposure and Response Prevention Therapy (EX/RP). In EX/RP therapy, patients gradually learn to face their compulsions (exposure) while resisting the urge to perform compulsions in response (response prevention).
In some cases, antidepressants can be used in combination with psychotherapy to relieve OCD symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs)—Antidepressantswho work to raise the levelSerotoninin the brain – have been shown to be particularly effective in treating people with OCD, especially at higher dosages.
What is serotonin?
Serotonin, or 5-hydroxytryptamine (5-HT), is a neurotransmitter — a chemical messenger — in the central nervous system that helps regulate mood, emotions, memory, pain tolerance, sleep, appetite, and sexual desire.
What is exposure therapy?
Obsessive Compulsive Disorder (OCD) is a chronic mental disorder that involves obsessions (intrusive, persistent, and unwanted thoughts or worries), compulsions (rituals or behaviors that one feels compelled to repeat), or both.
There is no single known cause of OCD. Several factors, including genetics, trauma, and differences in brain structure, can contribute to the development of the condition.
Researchers have identified several common subtypes of OCD. OCD symptoms often fall into one of four clusters: control, order/symmetry, germs/contamination, or rumination/intrusive thoughts. Other subtypes of OCD are hoarding and somatic obsessions.
OCD can be diagnosed by a mental health therapist using the criteria inDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5). It is typically treated with antidepressants,psychotherapy, or both.
A word from Verywell
Many people feel nervous when discussing their obsessions and compulsions with a healthcare provider. However, OCD is common, treatable, and manageable. If you think you have OCD, talk to your doctor about seeing a specialist to treat your symptoms and improve your quality of life.
frequently asked Questions
How many types of obsessive-compulsive disorder are there?
There is no single agreed list of OCD subtypes. However, many researchers agree that OCD and associated compulsions often fall into five main groups. These clusters of symptoms include contamination, order and symmetry, rumination (including over-responsibility for harm, fear of illness, and persistent doubt), taboo impulses and images (such as violent and/or sexual images), and hoarding.
Are there different degrees of OCD?
DieDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5) does not indicate different degrees of severity of obsessive-compulsive disorder. However, the DSM-5 categorizes OCD according to the patient's level of insight.
A person with OCD who has good or fair insight knows their obsessions are not based in reality, while someone with poor insight thinks their obsessive beliefs are probably true. Meanwhile, a person lacking in insight is fully convinced that their beliefs are true.
Is OCD an Anxiety Disorder?
OCD used to be categorized as an anxiety disorder. However, in 2013, theDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5) removed OCD from this category and placed it under the umbrella term OCD and related disorders. Other disorders associated with OCD include hoarding disorder, body dysmorphic disorder, trichotillomania, and skin pimple disorder.
Can perfectionism be considered a form of OCD?
The trait of perfectionism alone is not a form of OCD. However, research suggests that perfectionism is common among people with OCD.
A 2019 study found that children and adolescents who showed a tendency toward perfectionism were more likely to develop severe OCD symptoms and met diagnostic criteria for OCD.