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How many types of ocd are there


The 4 Types of OCD

About Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety-related condition that causes much suffering and even disability. Researchers have determined that the symptoms of OCD tend to fall into four different categories, called OCD symptom dimensions. Each dimension includes both obsessions and compulsions.

How many types of OCD are there?

OCD can come in dozens of forms - with wildly varying obsessions - but there are four major categories these groupings fall under. Some websites have taken to listing 7 types of OCD, but ultimately they all fit in the 4 types of OCD groupings.

What are the four different types of OCD?

  1. Contamination & Washing
  2. Doubt About Accidental Harm & Checking
  3. Just Right OCD — Symmetry, Arranging, & Counting
  4. Unacceptable Taboo Thoughts & Mental Rituals

Keep reading to learn about each kind of OCD.

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This figure illustrates the four major types of OCD. Some of these types also have subtypes under them.

OCD Type 1:


Contamination & Washing

Fear of contamination typically involves excessive concern regarding the threat of illness or disease, the feeling of being physically unclean, or even feelings of being mentally polluted. Feared contaminants are not simply limited to dirt, germs, and viruses, but may include such things as blood, household chemicals, sticky substances or residues, people who appear unclean or unkempt, and various types of insects or animals.

People with this type of OCD may go to great lengths to avoid places and situations associated with feared contaminants (e.g., public bathrooms, etc.) and may involve themselves in many protective rituals, such as disinfecting and sterilizing, throwing "contaminated" objects away, changing clothes frequently, and designating "clean" areas within their home that are off limits to others. If contaminants cannot be avoided, however, individuals will often resort to excessive washing or housecleaning to decontaminate themselves and their possessions. Contact with a feared contaminant often results in feelings of fear, disgust, and general discomfort, and in some cases may result in feelings of responsibility for spreading contamination to others

OCD Type 2:


Doubt About Accidental Harm & Checking

Individuals whose primary obsessions fall within this category typically experience intrusive images, impulses, and fears related to the possibility of unintentionally harming themselves or someone else by means of carelessness or negligence. For example, some of the more common harming fears include the fear of hitting a pedestrian while driving, or the fear of forgetting to turn off the stove before going to bed, thereby leading to the death of a loved one in a house fire. Accompanying the fear of harm is often an excessive feeling of doubt, dread, or uncertainty, as well as a heightened feeling of responsibility. Repetitive checking behaviors are used as a means to neutralize these feelings of dread and uncertainty by ultimately trying to prevent or avert the perceived dangerous consequence; thus, people demonstrating such behaviors have often been referred to as "checkers. "

OCD Type 3:


Just Right OCD — Symmetry, Arranging, & Counting

Perfectionism is a typical symptom of OCD patients who tend to be primarily preoccupied with order, symmetry, and exactness. These individuals tend to engage in compulsive behaviors that include repetitive arranging, organizing, or lining up of objects until certain conditions are met. For example, patients may experience intense discomfort if the objects on their desk are not symmetrically aligned or a certain distance apart from one another. It has been proposed that a common theme in the symmetry and ordering category is a feeling of "incompleteness" which is also associated with compulsive slowness. Individuals with this type of OCD may engage in rituals, such as mental arranging and counting, as well as tapping and touching behaviors. These behaviors are sometimes accompanied by magical thinking &mdasp; i.e., the belief that a thought can cause an event to happen or not (e.g., "If I don't align the dinner plates, my husband will have a car accident and die on his way home from work"), although studies have shown that there is also a large group of individuals who do not report beliefs of this sort.

OCD Type 4:


Unacceptable Taboo Thoughts & Mental Rituals

The "taboo," or "unacceptable thoughts," symptom dimension describes people with unwanted obsessions that are often of a religious, violent, or sexual nature. This group is often referred to as "pure obsessional" due to their lack of overt rituals. However, it is these individuals tend to engage in covert rituals, such as mental compulsions and excessive reassurance-seeking. This symptom dimension captures individuals who have intrusive thoughts that severely violate their morals or values. Examples include thoughts of sexually molesting children, blasphemous thoughts about religious figures, and impulses to do violent things, such as to push pedestrians into oncoming traffic. People with these thoughts typically are not violent, nor do they act on their urges or impulses; however, because people with OCD often believe their thoughts are dangerous and overly important, they devote a large amount of their mental effort in attempts to suppress them.

Other attempts to control intrusive thoughts include mental ritualization (e.g., arguing with oneself over the morality of one's character), neutralizing (e.g., mentally "cancelling out" bad thoughts by replacing them with good thoughts, engaging in excessive prayer or confession), and performing some form of checking (e.g., reviewing one's behaviors, seeking reassurance from others, etc.) Avoidance of known triggers is also especially common in this group. For example, sufferers may make excuses to avoid childcare responsibilities or religious ceremonies that might trigger unwanted thoughts. People with unacceptable thoughts may suffer with more severe obsessions than those with other forms of OCD.

Scientific References

Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., Timpano, K. R., McGrath, P. B., Riemann, B. C., Adams, T., Björgvinsson, T., Storch, E. A., & Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22(1), 180–198. doi: 10.1037/a0018260

Williams, M. T., Farris, S. G., Turkheimer, E., Franklin, M. E., Simpson, H. B., Liebowitz, M., & Foa, E. B. (2014). The Impact of Symptom Dimensions on Outcomes for Exposure and Ritual Prevention Therapy for Obsessive-Compulsive Disorder. Journal of Anxiety Disorders, 28 (6), 553-558. doi: 10.1016/j.janxdis.2014.06.001

Types of OCD | OCD-UK

Checking

The need to check is the compulsion, but the obsessive fear might be to prevent damage, fire, leaks or harm. Common checking obsessive worries and compulsions include:

Reassurance

The sufferer will often seek reassurance about their OCD fears, usually from a loved one or via sources such as Google or local news outlets. Frequently the obsessional worry is that something bad may have happened to a loved one, so they will repeatedly check they're OK. Another obsessional fear leading to reassurance seeking compulsions is worries that their partner may no longer have feelings for them or love them or they may have upset their loved one.

Past memories

The person with OCD will often check their own memory to try and recall past events  for reassurance they they did not cause harm to a loved one or child or even a stranger. The more they try and recall the more  OCD doubts set in, further worsening the need to be certain and therefore to check more.

Door locks and/or windows

Door locks and/or windows will be checked and the handle pulled multiple times until there is a ‘feeling’ of certainty that they’re secure. The obsessions go far beyond that someone might break in and steal treasured possessions and spill over into feeling responsible for preventing the consequences of not checking and the guilt that would follow if there was a theft.

House/office alarm

It’s common for someone with OCD to spend considerable time checking that their home or office alarm is set, sometimes through staring at it, sometimes constantly resetting until such time it ‘feels’ set. The primary obsessional worry is that if it’s not set correctly somebody will break in and valuables will be stolen, the secondary obsession is that the person has an heightened sense of responsibility to check, otherwise theft will be their fault, and it will make them feel guilty and like a bad person for not checking enough.

Gas or electric stove knobs

The person with OCD may physically keep checking the knob is securely in the zero/off position or spend time fixated and staring at the knobs until there is a ‘feeling’ of certainty that it is safely off. The primary obsession is that the property may catch fire and burn down killing loved ones or neighbours or that treasured possessions will be destroyed. The  primary obsessive fear will spill over into  feeling responsible  for the consequences of not checking and the guilt that would follow for allowing the loss of life and property destruction.

Water taps

The person with OCD may physically keep checking the tap is in the off position or spend time fixated and staring at the tap until there is a ‘feeling’ of certainty that it is off and no water is dripping. The primary obsession is about leaving a tap running and causing  a flood  in either their property and/or a neighbouring property.  This may result in treasured possessions  being destroyed or  an electrical fire occurring and the property catching fire causing further damage and/or deaths. The  primary obsessive fear will spill over into feeling responsible for preventing the consequences of not checking  and the guilt that would follow for allowing the loss of life and expensive property destruction.

Car

Each time the car is parked, the person with OCD may physically keep checking the car is secure and/or lights are off by pulling at door handles, physically staring at lights and pulling at the light switch to ensure it is in the off position and/or pulling on the handbrake. The primary obsessive worry is that the car may be stolen, or the handbrake is left off and it will roll back causing a serious accident or that the lights may be left on causing a dead battery. The primary obsessive fear will spill over into feeling responsible  for the consequences of not checking and the feelings of guilt that would follow for allowing the consequences to happen.

Electrical appliances e.g. hair straighteners

The person with OCD may physically keep checking electrical devices like computers or hair straighteners are off, this will usually happen at night before bed and can take a significant amount of time. The primary obsession is that the property may catch fire and burn down killing loved ones or neighbours or that treasured possessions will be destroyed. The  primary obsessive fear will spill over into feeling  responsible  for the consequences of not checking  and the feelings of guilt that would follow for allowing the loss of life and property destruction.

House lights and candles

For similar obsessional fears to the above checking, the person with OCD may physically keep checking lights, lamps and candles to ensure they are off, this will usually happen each and every time the person leaves the house and in the evening before bed which can take a significant amount of time. The primary obsession is that the property may catch fire and burn down killing loved ones or neighbours or that treasured possessions will be destroyed. That primary obsessive fear will spill over into the responsibility and consequences of not checking would lead to guilt for allowing the loss of life and property destruction.

Emails or letters

Before sending/posting an email/letter someone with OCD may spend considerable time checking the text, re-reading every line over and over again out of fear of saying something inappropriate or offensive or until it 'feels' right. The primary obsessive fear will be that saying something inappropriate may lead to guilt and feelings of disapproval from the recipient.

Driving route and checking car

The person with OCD may repeatedly drive their journey, retracing their route to check for signs of accidents ( the obsessional fear), the person may also spend time checking the exterior of the car for signs of impact. The fear may also lead to feelings of guilt and worries about consequences of causing a fatal accident which may lead to prison,  loss of employment or  their family disowning them.

Checking with a camera

The person with OCD will routinely check a room or other location before leaving  by taking photos with a phone or digital camera  so they can check later that they have not left anything behind, from seemingly worthless bits of paper to more valuable items. The primary obsessional fear is that they may leave and lose something they may later need, but the fear may also lead to feelings of guilt and worries about being irresponsible for not checking, perhaps meaning that they are a careless and/or a bad person and having a sense of ‘incompleteness’.

Illness and conditions

The person with OCD will have the obsessional worry that seeing mild symptoms means they are going to develop an illness and will repeatedly check their body for more signs, google various medical websites for symptoms and even visit the GP for diagnosis and checks. The secondary obsessional fear and worry is that the illness is present and they will become seriously ill and/or die, or  that they would be to blame for spreading viruses if they are ill themselves.

Re-reading text

Re-reading text, usually in a book but also can be in a letter or on an email over and over again is a common checking problem. They will keep reading until they 'feel' confident they have taken the text in correctly. The primary obsessional fear is not quite taking in the information or missing something important from the text.

Pregnancy

For some women suffering with OCD, they can become convinced that they have picked up semen from toilet seats and will become accidentally pregnant, equally through protected and unprotected sexual encounters, even if not full sexual penetration. The person suffering with OCD will be convinced, that they have become pregnant and will engage in checking for signs, pregnancy tests at home and through their GP. Sometimes such obsessional worries will lead to avoidance's of public toilets and sexual encounters.

Schizophrenia

Two checks this is a very specific and common OCD problem where the person with OCD will have the obsessional worry that their OCD will lead to them developing schizophrenia.  They will repeatedly check and google various medical websites for symptoms and even visit their GP for diagnosis and checks. The secondary obsessional fear and worry is that the illness is present and they will become seriously ill and it will lead to them losing control and carrying out dangerous behaviours that go against their morals.

HIV and AIDS

We will categorise this separately because of it being a very specific and a very common OCD problem. The person suffering with OCD will be convinced, perhaps through unprotected and protected sex or sexual activity that they have become infected with HIV or AIDS. The person suffering may worry that they weren't careful enough during a past sexual encounter and  in addition  avoids new sexual encounters. They will Google symptoms, and go for HIV tests, sometimes more than once until they ‘feel’ they’re not at risk.  Further sexual encounters can sometimes trigger the return of the obsession. The secondary obsessional fear and worry is that the illness is present and they will be guilty for spreading the virus to someone they care about through sexual encounters or passing of blood or saliva accidentally.

Sexual arousal

For some people suffering with OCD their obsessional thoughts lead them to believe they may be attracted to people they don't want to be, perhaps the obsessional fear of being a paedophile or a straight person being attracted to a member of the same sex or someone who is gay being attracted to someone of the opposite sex. Frequently the person will check their body for arousal, however because they are focused on not wanting a sexual response, the body will automatically generate feelings of arousal, and like checking in all forms of OCD, the solution becomes the problem.

Valuable items (wallet, purse, phone)

The person with OCD will be repeatedly checking their pocket and bags for valuable items like their wallet/purse or bank cards, mobile phone, or important documents they keep on them each time they leave somewhere . Even when they can see the documents, sometimes the checks will continue until the person ‘feels’ the check is complete which can  impact to such a degree that they are unable to proceed with their day or journey until the checks are complete. The primary obsessional fear is that they may leave and lose the valuable item, but the fear may also lead to feelings of guilt and worries about being irresponsible for not checking, making them a careless and a bad person.

Checking is often carried out multiple times, sometimes hundreds of times  and might last for an hour or even longer causing significant impact on the person’s life, being late for school, work, social occasions and other appointments. This can impact on a person’s ability to hold down jobs and relationships , which is why the phrase ‘a little bit OCD’ is so inaccurate and offensive. Another consequence of  checking compulsions is that they can often damage  objects that are constantly being pulled and prodded or over tightened.

Contamination

The fear of being dirty and contamination is the obsessional worry, often fear is that contamination might cause harm to ones self or a loved one. The common compulsions might be to wash or clean or avoid. Common contamination obsessive worries and compulsions include:

Public toilets

Fear of and avoidance Using public toilets (fear of contracting germs from other people).

Chemicals

Coming into contact with chemicals (fear of contamination).

Shaking hands

Shaking hands (fear of contracting germs from other people).

Door Handles

Touching door knobs/handles (fear of contracting germs from other people).

Public Telephones

Perhaps less so nowdays Using public telephones (fear of contracting germs from other people).

GP Surgery / Hospital

Waiting in a GP’s surgery/hospitals (fear of contracting germs from other people).

Eating in public locations

Eating in a cafe/restaurant (fear of contracting germs from other people).

Staircase banisters

Touching banisters on staircases (fear of contracting germs from other people).

Sex

For some the enjoyable act of sex or masturbation causes fear of sexual bodily fluids, leading to avoidance of intimacy and sexual acts. Or causing hours of cleaning own body, or the bed sheets and washing everything which may have been touched after sexual interaction, such as door knobs through a fear of contamination from semen. The actual obsessive worry can sometimes be traced back to mental contamination and a fear of disgust around the act rather than from the fluids themselves.

Crowds

Being in a crowd (fear of contracting germs from other people)..

Money

Fear of coming into contact with germs from coins and notes, leading to avoidance of cash. It's not unknown for someone with a fear of germs to drop notes or coins and have to leave them, or if the note had something red which might be blood to dispose of those note.

Clothes and Dead Skin

Clothes (having to shake clothes to remove dead skin cells, fear of contamination).

Bathroom

Touching items in the Bathroom at home and out (fear of germs being spread or picked up).

Teeth Brushing

Excessive Tooth Brushing (fear of leaving minute remains of mouth disease).

Outside Air

Some people believe that they will become contaminated just by being outside in the air, so either avoid going out or after returning home will shower. They might keep indoor and outdoor clothes separate and even force family to strip naked at the door before coming inside the house.

Places

Some people fear places so will not only avoid going to those plaves, avoid all contact with such places including accepting mail from those locations, avoid ordering items from companies in that area. More recently we have seen people have a fear of the entire town of Salisbury because of the recent poisenening with nerve agent of the former Russian spy.

The cleaning or washing is often carried out multiple times often accompanied by rituals of repetitive hand or body washing until the person ‘feels’ it is clean, rather than someone without OCD who will wash or clean once until they ‘see’ they are clean. The time this takes can have a serious impact on a person’s ability to hold down jobs and relationships and there is also a secondary physical health impact of the constant scrubbing and cleaning on the skin, especially the hands where people will scrub until the hands are bleeding. Some people have also gone to the extremes of bathing in bleach. A person may also avoid entire places, people or objects if they experienced contamination fears previously. There is also a cost implication of the constant use and purchase of cleaning products, and also of items, especially electrical items like mobile phones, that are damaged through excessive liquid damage.

Mental Contamination

In addition to the more familiar type of contamination OCD involving someone that washes their hands repeatedly after coming into contact with potentially dirty objects or environments, there is also a less obvious form called 'mental contamination'. Mental contamination is a more recent area that researchers have only just started to get an understanding of. The feelings of mental contamination share some qualities with contact contamination but have some distinctive features. Feelings of mental contamination can be evoked by times when a person perhaps felt badly treated, physically or mentally, through critical or verbally abusive remarks. It is almost as if they are made to feel like dirt, which creates a feeling of internal uncleanliness — even in the absence of any physical contact with a dangerous/dirty object. A distinctive feature of mental contamination is that the source is almost always human, unlike the contact contamination that is caused by physical contact with inanimate objects. The person will engage in repetitive and compulsive attempts to wash the dirt away by showering and washing which is where the similarities with traditional contamination OCD return, the key difference is the contaminated feeling does not need to come from a physical contact, often it is from feeling alone with mental contamination.

Hoarding

Another obsession long considered to be part of ‘OCD’ is the inability to discard useless or worn out possessions, commonly referred to as ‘hoarding’. Long considered to be a form of Obsessive-Compulsive Disorder, hoarding disorder was probably correctly reclassified in the 2013 publication of DSM-5 as a condition in its own right, however it does become somewhat complicated because some people with Obsessive-Compulsive Disorder will hoard for very specific obsessive worries/fears, and should still be diagnosed as having OCD rather than hoarding disorder. More information about hoarding can be found here.

Ruminations

Rumination is a term often used to describe all obsessional intrusive thoughts, and the definition of rumination perhaps helps encourage that belief "a deep or considered thought about something", but this is slightly misleading from an OCD context. In the context of OCD a rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive. Unlike obsessional thoughts, ruminations are not objectionable and are indulged rather than resisted. Many ruminations dwell on religious, philosophical, or metaphysical topics, such as the origins of the universe, life after death, the nature of morality, and so on. One such example might be where a person dwells on the time-consuming question: 'Is everyone basically good?'. They would ruminate on this for a long period of time, going over in their mind various considerations and arguments, and contemplating what superficially appeared to them to be compelling evidence. Another example might be someone that ruminates about what would happen to them after death. They would weigh up the various theoretical possibilities, visualise scenes of heaven, hell, and other worlds and try to remember what philosophers and scientists have said about death. With most ruminations it inevitably never leads to a solution or satisfactory conclusion and the person appears to be deeply pre-occupied, very thoughtful, and detached.

Intrusive Thoughts

In the context of OCD, are where a person generally suffers with obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature, for example, thoughts of causing violent or sexual harm to loved ones which don't involve specific immediate compulsions these are called Intrusive Thoughts, and sometimes mistakenly referred to as 'Pure O'. However, the term is a little misleading like rumination above because everybody alive will have intrusive thoughts, of course it could be argued that everybody with OCD will have 'intrusive thoughts' i.e. their 'obsessions'. But in reality even people without OCD will and do have intrusive thoughts, which can be both negative or positive, the thought of winning the lottery is technically an intrusive thought, just a pleasant one. But from an OCD perspective it is generally assumed that the thoughts are both unpleasant and repetitive (constant) and it is generally accepted that when talking about OCD 'Intrusive Thoughts' it of the types listed below that can cover absolutely any subject, but the more common areas of OCD related concerns covers the following sub- categories:

Relationship Intrusive Thoughts

Relationship Intrusive Thoughts - Obsessive doubts over the suitability of a relationship, one’s partner or one's own sexuality are the main focus for the obsessional thoughts. Obsessional thoughts include:

  • Constantly analysing the depth of feelings for one's partner, placing the partner and the relationship under a microscope and finding fault.
  • Constantly needing to seek reassurance and approval from one's partner.
  • Doubts that one's partner is being faithful.
  • Doubts that one may cheat on their partner.
  • Questioning one’s own sexuality, and having feelings, thoughts and impulses about being attracted to members of the same/opposite sex.

The constant analysing and questioning of the relationship and partner often places immense strain on the relationship, often causing a person with OCD to end the relationship to rid themselves of the doubt and anxiety. Unfortunately, this cycle is often repeated with any subsequent relationship.

Sexual Intrusive Thoughts

Sexual Intrusive Thoughts - Obsessive thoughts of unintentionally causing inappropriate sexual harm (i.e. to children), or the constant questioning of one’s own sexuality are the main focuses for these obsessional doubts. Obsessional thoughts can include:

  • Fearing being a paedophile and being sexually attracted to children.
  • Fearing being sexually attracted to members of one's own family.
  • Fearing being attracted to members of the same sex (homosexual OCD) or for those who are gay fear of being attracted to members of the opposite sex.
  • Thoughts about touching a child inappropriately.
  • Intrusive sexual thoughts about God, saints or, religious figures.

The constant analysing and questioning of one’s own sexual preferences, or the thought of being attracted to a child, are perhaps two of the most mentally disturbing aspects of OCD and, because of the nature of the thoughts, many sufferers are reluctant to seek help from health professionals, fearing they may be labelled. A person that experiences these types of intrusive thoughts will avoid public places, like shopping centres, in an attempt to avoid coming into close contact with children. They may also avoid spending time with younger members of the family. A parent with this type of OCD may avoid bathing and hugging their own children which can lead to emotional distress for both children and parent.

Magical Thinking Intrusive Thoughts

Magical Thinking Intrusive Thoughts - is the fear is that even thinking about something bad will make it more likely to happen - sometimes also called ‘thought-action fusion’. Sufferers are beset by intrusive bad thoughts. They try to dispel them by performing rituals - magic rituals, in effect - that are often bizarre and time-consuming and involve linking actions or events that could not possibly be related to each other. For example having the thought 'I may strangle someone' is regarded as being as reprehensible as actually strangling a person. Another example is believing that simply imagining a horrific car crash will increase the likelihood of such a crash taking place, or a person may feel that if they don’t count to ten ‘just right’ harm will come to a family member. Other examples of magical thinking, or thought-action fusion intrusive thoughts include:

  • A certain colour or number has good or bad luck associated with it.
  • Certain days have good or bad luck associated with them.
  • A loved one’s death can be predicted.
  • One’s thoughts can cause disasters to occur.
  • Stepping on cracks in the pavement can make bad things happen.
  • Whatever comes to mind can come true.
  • Breaking chain letters will actually bring bad luck.
  • Attending a funeral will bring death.
  • One can inadvertently cause harm to others with thoughts or carelessness.
  • Hearing the word ‘death’ will mean repeating the word ‘life’ to prevent death.

In each example listed above, the thoughts and events happening could not possibly ever be linked, but the person with OCD will believe that this possibility does exist, and as a result, this will cause them immense stress and anxiety. As a result, their silent internal compulsive behaviours will take hours, and often prevent them interacting with anyone else during this time.

Religious Intrusive Thoughts

Religious Intrusive Thoughts - OCD often fixates on areas of great importance and sensitivity and religion and matters of religious practice are prime candidates for OCD obsessions. Sometimes referred to as scrupulosity, religious intrusive thoughts include:

  • Sins committed will never be forgiven by God and one will go to hell.
  • One will have bad thoughts in a religious building.
  • One will scream blasphemous words loudly in a religious location.
  • Prayers have been omitted or recited incorrectly.
  • Certain prayers must be said over and over again.
  • Religious objects need to be touched or kissed repeatedly.
  • One is always doing something sinful.
  • Repetitive blasphemous thoughts.
  • That the person has lost touch with God or their beliefs in some way.
  • Intrusive sexual thoughts about God, saints or, religious figures.
  • That the person has broken religious laws concerning speech, or dress or modesty.
  • Intrusive bad thoughts that occur during prayer will contaminate and ruin or cancel out the value of these activities.
  • The constant analysing and questioning of a person’s faith places immense strain on their beliefs and prevents the person deriving peace from their religion. As a result they will often avoid church and all religious practice out of fear of their thoughts.

Violent Intrusive Thoughts

Violent Intrusive Thoughts – obsessive fears of carrying out violent acts against loved ones or other people. Intrusive thoughts include:

  • Violently harming children or loved ones.
  • Killing innocent people.
  • Using kitchen knives and other sharp objects (compulsion will include locking away knives and sharp objects).
  • Jumping in front of a train or fast moving bus.
  • Poisoning the food of loved ones (compulsion will include avoiding cooking for family).
  • Acting on unwanted impulses, e.g. running someone over, stabbing someone.
  • Thoughts about accidentally touching someone inappropriately, with the aim of hurting them.

Most sufferers with these types of fears often end up labelling themselves as a bad person, simply for having the thoughts. They falsely believe that having the thoughts means they are capable of acting upon them. The constant analysing and questioning of these disturbing aspects of OCD becomes incredibly upsetting and because of the nature of the thoughts many sufferers are reluctant to open up to health professionals to seek help, fearing they may be labelled. A person with these types of intrusive thoughts will avoid public places like shopping centres and other places, where social interaction may be required, to avoid coming into close contact with people that may trigger the obsessive thoughts.

Body focussed obsessions (Sensorimotor OCD)

An hyperawareness of particular bodily sensations, also sometimes called sensorimotor obsessions. Symptoms might include:

  • breathing, obsession over whether breathing is shallow or deep, or the focus is on some other sensation of breathing.
  • blinking, an obsessive fixation on blinking.
  • Eye floaters/visual distractions, an obsessive fixation on eye floaters.
  • swallowing/salivation, focussing on how frequently one swallows, the amount of salivation produced, or the sensation of swallowing itself.
  • awareness of specific body parts, for example perception of the side of one’s nose while trying to read.

This form of OCD should not be confused with BDD where the obsession is more about perceived defects with body parts.

The intrusive thoughts are repetitive and not voluntarily produced, they cause the sufferer extreme distress - the very idea that they are capable of having such thoughts in the first place can be horrifying. However, what we do know is that people with Obsessive-Compulsive Disorder are the least likely people to actually act on the thoughts, partly because they find them so repugnant and go to great lengths to avoid them and prevent them happening. To sufferers and non-sufferers alike, the thoughts and fears related to OCD can often seem profoundly shocking . It must be stressed, however, that they are just thoughts, and they are not voluntarily produced. Neither are they fantasies or impulses which will be acted upon. We have chosen not to list anything about Pure O on this page because it's an unhelpful and not an officially recognised medical term. But more information about 'Pure O' can be found here. But all of the above will include both mental and physical compulsions, which is why the term 'Pure O' remains unhelpful.

Symmetry and Orderliness

The need to have everything lined up symmetrically just ‘right’ is the compulsion, the obsessive fear might be to ensure everything feels ‘just right’ to prevent discomfort or sometimes to prevent harm occurring (see Magical Thinking). Examples include:

Neatness

Having everything neat and in its place at all times.

Pictures

Having pictures hanging aligned and straight.

Tinned Cans

Having canned food items all facing the same way, usually forward.

Clothes

Having clothes on the rail all hanging perfectly and facing the same way..

Books and CD's

Having books and CDs lined up perfectly in a row on a bookshelf.

Spotless without blemish

Having everything spotless, with no marks or smudges on windows and surfaces. Less about cleaning and contamination, more about just right and neatness

Those affected will spend a lot of time trying to get the symmetry ‘just right’ and this time consuming checking can result in them being extremely late for work and appointments. They may also become mentally and physically drained if the compulsions take a considerable amount of time. The sufferer may also avoid social contact at home to prevent the symmetry and order being disrupted which can have a negative impact on social interaction and relationships.

The above list categorises the more common forms of Obsessive-Compulsive Disorder and some of the fears associated with them. But this is by no means an exhaustive list and there will always be other OCD types not listed here. So if you’re experiencing distressing and unwanted obsessions or compulsions not listed here, this does not mean it is definitely not OCD,  if these impact significantly on your everyday functioning this could still represent a principal component in the clinical diagnosis of Obsessive-Compulsive Disorder and you should consult a doctor for a formal diagnosis. Regardless of the type of OCD a person may be suffering with, the following three components are generally present, triggers, avoidance and reassurance, but what do they all mean?

Trigger

A trigger is the original source of the obsessional worry, that could be a place, person or object that sets off the obsession, a feeling of discomfort, or indeed a compulsive urge. A trigger may be a physical object or an internal mental thought. For example, a person had the obsessional thought about stabbing someone every time they saw a knife or any other sharp object, so seeing the knife was the trigger that provoked the obsessions and compulsions. In order to avoid hours of anguish this person would avoid knifes at all costs. An example of an internal mental trigger is where a person experienced distressing obsessions about death every time they thought about their deceased father. The memory of their father was the internal trigger for the obsessional thoughts. What generally happens is a person with OCD will find their obsessions and compulsions so frightening, scary and mentally and physically draining, that they will go to great lengths to avoid triggers that instigate hours of obsessions and compulsions.

Avoidance

Avoidance is a common compulsive behaviour, and  is where a person with OCD avoids the objects, places or person/people  that they feel trigger their OCD. This will be their way of preventing the distress and anguish, and the hours of rituals they will be compelled to perform.

  • Examples include those with checking compulsions that may avoid tasks or situations that will increase their sense of responsibility and/or feel unsafe.
  • A person who had the obsessional thought that they might stab their children  avoiding contact with knives, scissors, and other sharp objects.
  • A person, who feared that they might catch AIDS/HIV,  avoiding certain areas of London which was, in their mind, associated with AIDS/HIV.
  • In some cases, certain ‘unsafe’ numbers, letters, or colours are avoided because  a person feels that such avoidance is necessary  to prevent something bad from happening.

Reassurance

The person affected by OCD will often seek reassurance that what they fear  isn’t a reality. The reassurance will usually be from a loved one or via sources such as Google or local news outlets, particularly if the worry is about causing an accident or  committing a crime. Frequently the obsessional worry is that something bad may have happened to a loved one, so they will repeatedly check that their  loved one is ok. Another obsessional fear leading to reassurance seeking compulsions is worries that their partner may no longer have feelings for them or love them or they may have upset their loved one.

There are several terms and acronyms used within the OCD community and amongst health professionals which often lead to confusion.

Ritual

One such term which sometimes causes confusion is the word ‘ritual’, which some people, even health professionals, confuse and refer to as a ‘compulsion’. Whilst it is true that a ritual is a compulsive behaviour (physical or mental), it is not just one specific compulsive behaviour, it is more a set pattern of behaviours with a clear defined starting point and end point . For example, ‘rub left side of face first, and then right side of face, then forehead’. In many cases if the sufferer is interrupted during their ritual process then their OCD will dictate they must start the ritual again from the very beginning.

Spike

The term ‘spike’ is also confusingly used, mainly by the OCD community on OCD message boards on the internet. There seems to be two main uses of the term. The first is when it is used to describe the initial obsessional 'trigger', which then causes the anxiety and distress. So for example, someone afraid of hitting a cyclist when driving will use the term ‘spike’ to refer to the cyclist they see ahead of them which triggers their obsessions and compulsions. Another use for the term ‘spike’ in an OCD context is when it is used to describe the increase in anxiety caused by the obsessional thoughts. So in the example above, the person afraid of hurting a cyclist when driving will find seeing a cyclist causes their obsessive thoughts to increase, 'spike' their anxiety. At present there is no official definitive explanation as to what the term ‘spike’ actually means, but the general consensus is that the term ‘spike’ is used to describe the combination of the OCD trigger, obsession, and distress caused by the anxiety. For this reason, and to avoid any confusion, we generally try and avoid using the term ‘spike’ in our writings where possible to ensure there is no loss of meaning or context.

Some people use acronyms to refer to different types of OCD. It is worth noting that these acronyms have no official medical meaning and are used mainly by the OCD community on OCD message boards on the internet. One of the problems with these acronyms is they have often been confused to mean different things to different people. For informational purposes the three main commonly used acronyms are:

HOCD

HOCD – Homosexual OCD. This in itself is an unhelpful term, because whilst it’s meant to refer to a straight person who fears being gay, we know that the exact same type of OCD can impact on gay people with obsessional fears about being straight. So really a much better acronym (if they have to be used) should be SOOCD - sexual orientation OCD.

POCD

POCD – Paedophile OCD. POCD is also used frequently to describe prenatal and postpartum OCD and 'Pure O', but it is widely accepted to mean Paedophile OCD. We know that those with this type of OCD often deliberately use the POCD acronym to avoid saying and using the word paedophile. Since part of recovery is accepting and getting used to the thoughts, accepting and using this word could be the first step towards that.

ROCD

ROCD – Relationship OCD. ROCD is also used frequently to describe Religious OCD and Rumination OCD, but it is widely accepted to mean Relationship OCD.

Because these terms have no medical meaning and to avoid any confusion, we generally try and avoid using the acronyms in our writings where possible to ensure there is no loss of meaning or context. In fact, we actively discourage their use because  we have seen on multiple occasions the use of the acronyms leading  to some users experiencing a delay in accessing treatment. This happens where a person will seek specialists in (H/P/R)OCD but are unable to find any,  since they’re not  medically recognised terms. In fact, we don’t recommend therapists that specialise in any one type of OCD, because all forms of OCD  have the same treatment approach, addressing the O part and the C part. It may also hinder progress in understanding and tackling OCD because we know that OCD frequently changes guise chameleon-like (remember what we said about it focusing on objects/people that were important to us), as that changes in life, often so does  OCD. So it’s important we treat  OCD and not the (H/P/R). The good news is they're all equally as treatable through Cognitive Behavioural Therapy (CBT) by any therapist that knows and understands OCD.

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