For adults
Types of OCD
OCD gets named after its content, which is why people talk about having contamination OCD or harm OCD. These are the same condition with different content, and this page describes the common themes and what they share.
The theme is not the disorder
Underneath every version of OCD is the same pattern. An unwanted thought, image, urge or doubt arrives and feels urgent and meaningful. You do something to settle it, such as washing, checking, asking or going over it in your head, and that works for a short time. The relief teaches your brain that the thought was a real threat and the ritual kept you safe, so the next one arrives with more force. Treatment works on this pattern rather than on the theme.
- Trigger: Something sets it off
- Obsession: An unwanted thought or doubt that feels urgent
- Feeling: Anxiety, disgust, guilt or a sense that something is wrong
- Compulsion: Washing, checking, asking, or going over it in your head
- Relief, for now: Settled for a while, then it comes back stronger
- Then back to the first step, and the loop runs again.
- Other situations that now set it off too: A new situation, A news story, being tired or stressed, A stray thought.
Where treatment steps in. Whatever the theme, you face the trigger in planned steps without the ritual and learn that you can carry the anxiety and the doubt without it.
New triggers. Over time, more situations become linked to the trigger and start the loop off too.
The common themes
Choose one to read more. Five of the themes have their own page, and the others are described further down this one.
- Contamination Germs, dirt, illness or chemicals, and the washing, cleaning and avoiding that follow.
- Checking Checking doors, hobs, emails or the road behind you, to make sure nothing bad happens because of you.
- Just right and symmetry Things have to look, feel or be done a certain way, and be redone until they feel right.
- Harm Unwanted thoughts or images of hurting someone, very often the person you love most.
- Sexual intrusive thoughts, including about children Sometimes called POCD. Unwanted and horrifying to the person having them. They are obsessions, not desires, and not a sign you would act on them.
- Sexual orientation Repeated doubt about your own orientation, with checking your reactions and reviewing your past.
- Relationship (ROCD) Constant doubt about whether you love your partner, or whether they are the right person.
- Religious and moral Fear of having sinned or of being a bad person, with praying, confessing or going over what you did.
- Pure O Compulsions that happen in your head, such as reviewing, arguing with a thought or checking for a feeling.
- Existential Whether anything is real, whether you are conscious, what happens after death.
Contamination, checking and symmetry
Contamination and illness
Germs, dirt, chemicals, or a sense of having been contaminated by a person, place or memory, followed by washing, cleaning and avoiding. It is often driven by disgust, or by fear of being responsible if someone else becomes ill. Where the fear is specifically of vomiting, the page on emetophobia is likely to fit better.
Checking and responsibility
Doors, hobs, emails, and the road behind you after a bump you are not sure happened. The fear is usually of being the person whose carelessness caused harm. Repeated checking makes your memory of the check less vivid (van den Hout and Kindt, 2003), so the tenth check leaves you less certain than the first.
Symmetry, order and things feeling just right
Often there is no feared outcome at all, which is why this one can be missed. Something is uneven or incomplete, or was done while the wrong thought was in your head, and it has to be arranged, evened up, tapped or rewritten until it feels right.
Harm, sexual intrusions, orientation and relationship doubt
Harm obsessions
Unwanted images or urges to hurt someone, very often the person you love most, or a doubt that you might already have hurt someone. The thoughts horrify the person having them, and the compulsions include hiding knives, avoiding being alone with someone and confessing in order to be told you are not dangerous.
Sexual intrusions, including thoughts about children (POCD)
Unwanted sexual thoughts or images, sometimes about children, that horrify the person having them. They are obsessions, not desires, and not a sign that the person would act on them, and this is often the theme people wait longest to mention. Intrusive thoughts of this kind, in someone who is horrified by them, are a common symptom of OCD and are not in themselves a safeguarding concern.
Sexual orientation obsessions
Repeated doubt about your own sexual orientation, with checking for arousal and going back over your past. This differs from questioning your orientation, which is exploratory. In the obsessional version any answer would do, as long as it felt certain.
Relationship OCD
Doubts about whether you love your partner or whether they are the right person, with checking how you feel about them and comparing them with other people. It can be mistaken for a relationship problem for years.
Scrupulosity, Pure O and existential doubt
Religious and moral scrupulosity
Fear of having sinned or blasphemed, with compulsive praying or confessing. In the secular version the fear is of being a bad person, with going over what you did and apologising at length. What separates both from ordinary faith or conscience is the demand for certainty.
Pure O
Shorthand for OCD where the compulsions happen in your head, such as reviewing memories, arguing with a thought or checking internally for a feeling. It is not a separate disorder and it is not free of compulsions.
Existential and philosophical obsessions
Whether anything is real, whether you are conscious, what happens after death, with reading and arguing the question out internally. These questions cannot be answered with certainty, so the search for an answer never reaches a natural end.
What is not well understood
Why one person’s OCD attaches to contamination and another’s to harm is not settled, and the theme does not reveal something hidden about the person. What is better established is the treatment, exposure and response prevention, in which you practise facing the thought or situation without doing the compulsion. The page on OCD in adults describes how it is done.
When OCD starts suddenly in a child
If your child’s OCD or restricted eating appeared over a few days rather than months, the first step is your GP and a paediatrician. The section on sudden-onset OCD, PANS and PANDAS explains why.
What to do with this page
Recognising your theme here is useful once, because it tells you that what you have been carrying alone has a name and a treatment. Reading it repeatedly to check whether you still match the description becomes another form of checking.
Sources
- Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., et al. (2014). Part 1: You can run but you can’t hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269-279. doi.org/10.1016/j.jocrd.2013.09.002 (opens in a new tab)
- van den Hout, M., & Kindt, M. (2003). Repeated checking causes memory distrust. Behaviour Research and Therapy, 41(3), 301-316. doi.org/10.1016/S0005-7967(02)00012-8 (opens in a new tab)
Common questions
Does having a violent or sexual intrusive thought mean something about me?
No. In a study of 777 university students, about 94 per cent (93.6 per cent) of people across 13 countries reported at least one unwanted intrusive thought in the previous three months (Radomsky and colleagues, 2014), and aggressive and sexual thoughts were among the types reported. What separates OCD from ordinary mental life is the meaning attached to the thought and the effort spent getting rid of it.
My theme changed. Does that mean the treatment failed?
No. Themes often shift over time in OCD, with or without treatment, so the doubt can move from contamination to harm or to your relationship. The earlier work was not wasted, and the same approach applies to the new theme.
Do I need to know my type before starting treatment?
No. What matters at assessment is what the OCD demands of you, what you avoid, and what you do to make the feeling go away. I will ask about the content, because it tells us what the practice needs to include, but nobody needs to arrive with a label, and many people have several themes at once.
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