What Are the 4 Types of OCD?

Within the disorder known as obsessive-compulsive disorder, or OCD, are many different types of obsessions and compulsions. However, most of them can be grouped into four categories: checking, order and symmetry, contamination, and taboo thoughts.

Read on to learn more about the four most common types of obsessive-compulsive disorder (OCD), diagnosis, and treatment.

Signs of Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a common, long-lasting mental health condition that involves disruptive, unwanted obsessions and compulsions.

Obsessions refer to thoughts, worries, urges, preoccupations, or mental images that are persistent, disruptive, and intrusive.

Compulsions refer to behaviors or rituals that people feel driven to repeat over and over. Usually, people participate in compulsive acts to reduce their anxiety or distress.

Symptoms of OCD

According to the "Diagnostic 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 perform their compulsion.
• Their obsessions and/or compulsions are not primarily caused by another condition, such as generalized anxiety disorder (GAD) or an eating disorder.

Some people with OCD are not aware that their obsessions are excessive. Others know that their worries or impulses are not based on reality, but they still feel unable to control them.

4 Types of OCD

There is no single official way to divide OCD into subtypes. However, many researchers agree that there are certain common themes and symptom clusters among people with OCD.

Checking

One of the most common symptoms of OCD is compulsive checking. People with “checking OCD” may excessively check the following types of things:

• Their appliances are turned off.
• Their doors and windows are locked.
• They haven’t lost, damaged, or misplaced something important. 

Checking rituals can also be related to excessive doubts, anxiety, and a fear of losing control. There is often the fear of intentionally or unintentionally causing something bad to happen. For example, someone with OCD may not be able to leave the house for over an hour due to repeatedly checking that the stove is off in order to prevent a fire.

Order and Symmetry

Many people with OCD experience obsessions and compulsions related to order, symmetry, arranging, and counting. Symmetry-related compulsive rituals may involve:

• Lining things up over and over
• Constantly rearranging furniture to make it look “just right”
• Repeatedly counting items to ensure they’re divided into equal groups 

Someone with an irrational preference for order may also become overly preoccupied with their body proportions and/or grooming habits, which can lead to disordered eating and poor self-image. Others feel compelled to perform excessive scheduling, planning, time management, and organizing rituals.

Contamination

Fear of contamination is one of the most common obsessive themes among people with OCD. People who fear germs and/or contamination may:

• Clean surfaces over and over
• Wash their hands compulsively
• Worry excessively about ingredients in food or household products
• Avoid touching things others have touched

Some people with OCD also experience a fear of emotional contamination. Someone who fears emotional contamination may go out of their way to avoid people, places, or topics they see as “immoral” or “dirty.”

Ruminations or Intrusive Thoughts

Rumination refers to obsessive, intrusive, and unwanted thoughts around a certain theme. Rumination frequently involves taboo or forbidden topics, such as sexuality, violence, or religion. 

Intrusive thoughts can take on many forms. Some include:

• Ruminating about their sexual orientation
• Constantly question their religious identity
• Constantly worry that they will cheat on their partner
• Worry they will hurt themselves or someone else
• Worry they may become sexually predatory, even in the absence of any evidence
  

Others experience intrusive, graphic sexual or violent mental imagery that they consider inappropriate or disturbing.

Often, rumination is related to an underlying obsession with guilt and excessive responsibility for harm. People who experience intrusive thoughts may perform compulsive rituals in an attempt to “neutralize” the perceived threat. 

For example, someone who has forbidden thoughts around religion or blasphemy may pray excessively to protect themselves or others spiritually. Someone else may count, tap, or repeat certain movements or phrases because they believe it will save someone they love from harm.

Other OCD Subtypes

Researchers have identified several other possible OCD subtypes, including:

• Somatic obsessions: Somatic obsessions refer to preoccupation with body parts, body functions, and/or illness. For example, someone with OCD who experiences 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 component, as “pure OCD.”
• OCD with obsessive slowness: Some people with OCD are highly prone to perfectionism. In some instances, their fear of failure may lead them to take excessive time to complete a task to ensure it’s done “just right.”
  

Diagnosing OCD

If you suspect you may have OCD, your healthcare provider can refer you to a mental health therapist. They can diagnose you with OCD using 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 any underlying physical conditions or comorbid mental health disorders.

Related Conditions

In the DSM-5, OCD appears under the category of “obsessive compulsive and related disorders.” OCD-related conditions within this umbrella category 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 difficulties in discarding items and controlling their impulses to collect items—even when their collections negatively affect their relationships, safety, health, and/or finances.
• Skin picking disorder: People with skin picking disorder, also known as excoriation disorder or dermatillomania, pick at their skin persistently. Harmful effects may include skin lesions, emotional distress, and social isolation.
• Trichotillomania: People with trichotillomania experience hair loss, emotional distress, difficulties with self-image, and poor self-esteem due to a persistent, uncontrollable impulse to pull or pluck out their hair. They may pull hair from eyebrows, eyelashes, the scalp, or other body hair.
• Body dysmorphic disorder: Body dysmorphic disorder (BDD) involves an overwhelming preoccupation with one’s body and looks. People with BDD often spend a great deal of time, money, and energy to improve or “fix” their appearance.

Other conditions that are sometimes mistaken for OCD or may appear alongside it include:

• Obsessive-compulsive personality disorder: Obsessive-compulsive personality disorder (OCPD) is a mental condition that involves rigidity in thinking and behavior, excessive devotion to rules and perfectionism, and a preoccupation with maintaining control. OCD shares some symptoms with OCPD, but they are different conditions. 
• Anorexia nervosa (AN): Certain eating disorders, such as anorexia nervosa, are often comorbid with OCD. Some research suggests that about 35% to 44% of patients with AN also meet the diagnostic criteria for OCD. Meanwhile, about 10% of female patients with OCD also have AN.
• Tourette syndrome (TS): Tourette syndrome is a nervous system disorder that causes involuntary tics (repeated movements, sounds, and/or twitches). OCD and TS are related and often co-exist, especially in children and adolescents. About 60% of people with TS also meet the diagnostic criteria for OCD, and up to half of the children with OCD have experienced tics at some point.

How OCD Is Treated

Many people with OCD experience improvements with treatment. Studies suggest that about 50% of people with OCD will experience full remission of their symptoms after treatment. Many others are able to significantly improve their quality of life over time.

Psychotherapy is the typical first-line treatment for OCD. Many people with OCD benefit from a particular type of cognitive behavioral therapy (CBT) known as exposure and response prevention (EX/RP) therapy. In EX/RP therapy, patients gradually learn to confront their obsessions (exposure) while resisting the urge to perform compulsions in response (response prevention).

In some cases, antidepressants may be used in combination with psychotherapy to ease OCD symptoms. Selective serotonin reuptake inhibitors (SSRIs)—antidepressants that work to increase the level of serotonin in the brain—have been found to be especially effective in treating people with OCD, particularly at higher dosages.

Summary

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 driven to repeat), or both.

Researchers have identified several common subtypes of OCD. OCD symptoms often fall into one of four clusters: checking, order/symmetry, germs/contamination, or rumination/intrusive thoughts. Other subtypes of OCD include hoarding and somatic obsessions.

OCD can be diagnosed by a mental health therapist using the criteria in the DSM-5. It is typically treated with antidepressants, psychotherapy, or both.