Kinds of OCD

Whatever the theme, OCD follows the same pattern. An obsession brings distress, and a compulsion (seen or done in the mind) brings brief relief. That relief teaches the brain to repeat the loop.

Compulsions can be washing, checking, repeating, mental rituals, asking for reassurance or avoiding things.

OCD tends to attach to areas of personal importance. A caring parent may get harm thoughts. A person of faith may fear they have sinned. A loving partner may doubt their love.

These thoughts feel so upsetting because they clash with who the person is. Clinicians call this “ego-dystonic”: the thought goes against your values.

The IOCDF calls ERP the most effective, first-line therapy for OCD in adults, children and teens. It is used across themes, from contamination to relationship and religious OCD.

Most people notice a weird thought, maybe think “that was strange”, and move on. The thought doesn’t feel like it means anything about them.

Intrusive thoughts on their own are not a sign of OCD. They are something nearly everyone experiences.

In OCD, the problem is less the thought itself and more how it is read: as a warning, a secret wish, or something that must be fixed. That brings fear, and the urge to do a ritual.

Trying hard to push the thought away, argue with it or cancel it out tends to keep it coming back.

Some people fear that touching certain things will make them seriously ill. They may wash or clean for a long time, or avoid places such as public bathrooms or hospitals.

Washing and cleaning compulsions are one of the main groups of compulsions the IOCDF describes.

For many people the fear is less about themselves and more about making someone else sick, like a child or an older parent. This links contamination with a strong sense of responsibility.

Families may be asked to wash, change clothes or follow rules at the door. This is very common, and therapy can help everyone step back from it.

For some people the main feeling is disgust or “wrongness”, not fear of disease. Things like stickiness or certain substances can feel unbearable until washed away.

Whether it is fear or disgust, the loop is the same: discomfort, a ritual for relief, and the discomfort returning stronger next time.

The IOCDF lists emotional contamination among less familiar OCD themes. It can feel as if contact with a certain person or thing could change who you are or bring bad luck.

There may be nothing physically “dirty” at all, which can make this kind hard to explain to others.

Someone might check the stove many times before leaving, or drive back home to check the door. Each check brings a moment of relief, then the doubt creeps back.

In children, checking can happen quietly, such as rechecking doors and windows after parents have gone to bed.

Some people worry they hit someone while driving, or that a mistake at work will hurt others. They may retrace routes, re-read emails or replay events in their minds.

Mental reviewing is a compulsion too, even though nobody can see it.

Asking for reassurance is a common compulsion. It works like checking, just using another person instead of the lock or the stove.

People may avoid kitchen knives, avoid being alone with children or older relatives, or stay away from busy train platforms. They may keep asking for reassurance or mentally argue with the thoughts.

These rituals bring short relief but tend to grow and keep the problem going.

Some people get unwanted sexual thoughts about people or situations they find wrong. They feel deep shame and guilt and have no intent to act on them.

Because of shame, many people stay silent for years. An OCD-trained therapist has heard these themes before and will not judge.

Some new or expecting parents get intrusive thoughts about harming their baby, or worry too much about the baby’s movements. They may feel guilty and avoid caring for the baby.

These parents have no intent or desire to act on the thoughts. Gentle, specialist help is available.

Relationship-centred doubts focus on the relationship itself: whether it feels “right”, or whether your feelings are real.

People may keep checking their own feelings for proof, or replay happy memories to see if they still feel love.

Partner-focused doubts zoom in on things like a partner’s looks, intelligence, social skills or character. A common form involves getting stuck on a partner’s past relationships.

The two kinds of doubt often come together and feed each other.

Common compulsions

• Asking friends, family or others for reassurance
• Avoiding triggers, like romantic films or couples who seem perfect
• Comparing your relationship with other people’s
• Monitoring your own thoughts and feelings
• Replaying positive memories
• Testing or trying to “correct” your partner

Someone might walk through a doorway again, re-read a line, or tap a set number of times. Repeating is one of the main groups of compulsions.

At school, children may erase and redo work until it looks right, or re-read words until they “sound right”.

Some people feel they must even things out, like touching something with the other hand after touching it with one.

Sometimes there is a fear that something bad will happen. Sometimes there is no clear fear at all, just a strong sense of “wrongness”.

Arranging items, desks or bags until they feel exactly right can take a long time and cause distress if someone moves them.

Liking things tidy is not OCD. The difference is the distress, the time it takes and how it gets in the way of life.

The IOCDF lists identity as one group of obsessions. A person may feel they must be completely certain about parts of who they are, and keep checking their feelings for proof.

In OCD, the doubt is unwanted and distressing, and no amount of checking brings lasting certainty.

Some people get stuck on questions about death, existence or what is real. The IOCDF lists death and existence among OCD themes.

Big questions are normal. In OCD, the person feels they must find a final answer to feel safe, and the searching takes over.

The IOCDF lists “real event” and false memory themes. A person may replay a past moment over and over, trying to be sure they didn’t do something bad.

Mental reviewing like this is a compulsion, even though it can look like simply “thinking it through”.

Religious and moral OCD, also called scrupulosity, brings fears of offending God, going to hell or failing to be good. It can affect people of any faith, and people with none.

The IOCDF lists perfectionism-related obsessions, such as needing to know or remember things exactly, or fear of losing something important.

This can look like re-reading, re-writing, or asking others to confirm details again and again.

Body-focused repetitive behaviours (BFRBs) are repeated self-grooming behaviours, such as pulling hair or picking skin, that cause distress or damage. They are not driven by obsessions in the way OCD is.

Hoarding disorder is listed by the IOCDF as a related condition. It involves strong distress about parting with things, which can fill a home.

BDD is another condition the IOCDF lists as related to OCD. It involves heavy worry about a flaw in appearance that others may barely notice, often with checking or hiding it.

If this sounds familiar, talk with your clinical provider or a therapist who knows OCD-related conditions.