Common Types of OCD: Subtypes, Their Symptoms and the Best Treatment

• Although all forms of OCD have symptoms in common, the way these symptoms present themselves in daily life differs a lot from person to person.
• OCD often fixates around one or more themes. Some of the most common themes are contamination, harm, checking and perfection.
• People with OCD can have more than one subtype, and their subtype can change over time. 
• Regardless of the OCD subtype, the treatment is the same. The gold standard of treatment for OCD is exposure and response prevention therapy, or ERP.
• For more stories, visit the NOCD blog.
  

Are there different types of OCD?

Although all forms of OCD have symptoms in common, the way these symptoms present themselves in daily life differs a lot from person to person. As we’ll see, the content of a person’s obsessions isn’t ultimately the important part. But it’s certainly what feels important in the moment.

Someone’s subtype is really just the particular way their OCD affects them. What does the mind focus on, and what thoughts result from this focus? Subtypes are relatively stable over time, though new symptoms can appear and old ones might fade.

Clinicians call a condition like OCD heterogeneous because it varies so much from one person to the next. But there are a few common “clusters” of symptoms that researchers have noticed.

1. Contamination obsessions
2. Harm obsessions with checking compulsions (fear-of-harm thoughts, taboo thoughts)
3. Symmetry obsessions

There’s a lot of discussion about what these symptom clusters might be, which explains why you may not see some familiar ones here. There’s even more debate about whether or not there are more specific categories called subtypes. These are groups of obsessions and compulsions that pop up regularly in people with OCD.

Many clinicians try not to talk about subtypes because there isn’t really any research backing them. And because they’re not perfect categories it’s generally not worth spending too much time trying to figure out which subtype you fit into. Still, for many people with OCD, the immediate recognition of their own experience in a list of subtypes is a powerful comfort at the start of the treatment process.

Imagine that you’ve thought of yourself as uniquely “messed up” for a long time. Suddenly, you see a list of symptoms that match yours exactly. And, recognizing yourself in the subtype you’re reading about, you no longer feel alone in your troubles. You don’t feel hopeless anymore, because other people have apparently faced similar struggles.

Even after this intense relief has passed and the hard work of treatment has begun, it’s helpful to know that other people are dealing with similar types of obsessions and compulsions. The important part, as a person trying to get better, is to never feel alone in it. Listing out subtypes is an imperfect way of doing that, because it often leads people to think of these subtypes as distinct conditions rather than common manifestations of the same condition.

Lastly, subtypes are here to stay in the global community of people dealing with OCD. People have heard about subtypes and want to know more about the ways this condition can manifest itself. So let’s go through some of them now.

What are some common OCD subtypes?

Harm OCD

Harm OCD causes people to be deeply disturbed by the violent thoughts that just about everyone has experienced. While most people are able to shrug off these thoughts, those with harm OCD can become completely overwhelmed by them.

Obsessions

• I could jump in front of the train right now.
• I could stab my husband with this knife.
• What if I drove into that person?
• What if I killed my nephew and I just can’t remember?

Compulsions

• Refusing to stand near train tracks
• Keeping all knives hidden away somewhere
• Repeatedly going back to check if you ran someone over
• Calling your sibling to check if your nephew is safe and sound

Learn more about harm OCD

• Your Complete Guide to Harm OCD
• Harm OCD: Thoughts, Symptoms, Causes, and Treatment
• Is ERP Therapy Best for Harm OCD?
• Hit-and-Run OCD? Overview, Symptoms and Treatment Options

SO-OCD

Sexual orientation OCD involves obsessions about one’s sexuality. It’s often called homosexual OCD (or HOCD), but this is misleading. It can happen to people of any sexuality, about any other sexuality.

Obsessions

• I was attracted to that guy back there. This means I’m gay.
• Other people can detect that deep down I’m into women.
• Was I really into her when we dated? Or am I more into guys?

Compulsions

• Looking at pictures of women to see if you’re attracted to them
• Asking people repeatedly if you seem straight to them
• Avoiding people of the same sex altogether to avoid confusion

Learn more about SO-OCD

• HOCD: Thoughts, Symptoms, Causes, and Treatment
• What Is Sexual Orientation OCD (SO-OCD)? Your Guide to This OCD Subtype
• Is SO-OCD (HOCD) Just Denial? The Truth About Sexual Orientation OCD
• Is HOCD the Same as SO-OCD? What You Need to Know

POCD

Pedophilia OCD is especially prone to stigma because of how strong people’s feelings are about pedophiles. However, as with all types of OCD, these obsessions are not desires. In fact, people are so distressed by these thoughts because they don’t reflect what they really want.

Obsessions

• What if I have sexual thoughts about the kid I’m babysitting?
• I just had a sexual thought when I was around my cousin’s kid, am I attracted to them?
• What if I molested a kid and I just can’t remember?

Compulsions

• Looking online for stories of real pedophiles so you can find evidence you’re not one
• Staying away from kids altogether
• Repeatedly beating yourself up in your head for these thoughts

Learn more about POCD

• Your Complete Guide to Pedophilia OCD (POCD)
• Why POCD Arousal Is Not a Sign of Real Desire
• POCD: Am I a Pedophile? Living With Pedophilia OCD

Relationship OCD

Relationship OCD leaves people completely unable to tolerate the uncertainty of intimate relationships, giving them obsessions about the “rightness” of their own relationship and the countless other possibilities that daily life brings.

Obsessions

• Is this the right person for me?
• Couldn’t there be someone better out there?
• Are we meant for one another?
• What if we’re not meant to be but we still end up stuck together?

Compulsions

• Taking relationship quizzes online
• Looking up other people on social media to see if their relationships seem better
• Remembering situations over and over: did we really have fun together on vacation that time?

Learn more about Relationship OCD

• Why Do I Need Constant Reassurance in a Relationship?
• Your Complete Guide to Relationship OCD
• Is Relationship Anxiety the Same as Relationship OCD?
• Best Therapy for Relationship OCD
• When ROCD Tries to Ruin Your Valentine’s Day
• Relationship OCD or ROCD: Thoughts, Symptoms, and Treatment

“Just Right” OCD

“Just Right” OCD is a little different from these other subtypes, in that it’s difficult to identify a specific fear, or set of fears, underlying it. Instead, it’s usually more like a strong feeling that something just isn’t right when things aren’t a certain way. It’s one of the more caricatured forms of OCD, in TV shows, movies, and jokes.

Obsessions

• Something is just not right with this
• I need to start this over to make it perfect
• This just doesn’t feel right

Compulsions

• Performing any action over and over, e.g. closing doors
• Rearranging, reordering, organizing things repeatedly
• Changing wording many times in emails or notes

Learn more about “Just Right” OCD

• What Is Just Right (Perfectionism) OCD?

Contamination OCD

Contamination OCD is probably the most stereotyped form of OCD. People with this subtype are afraid of getting sick, or infecting someone they care about, after coming in contact with serious bacteria.

Obsessions

• Oh no, this time I’ve really gotten AIDS
• I just gave my sister’s baby a serious illness when I held him
• This whole place is full of bad bacteria, I can just tell

Compulsions

• Repeatedly washing hands, sanitizing things
• Always cleaning different sources around the house
• Avoiding being in public, doctor’s offices, being around kids

Learn more about contamination OCD

• Contamination OCD: Symptoms and Treatment
• Is OCD Just About Cleaning?

Pure-O OCD

Pure-O, or Pure Obsessional OCD, is one of the murkier subtypes, and some experts say it doesn’t even exist. The idea is that people with Pure-O have obsessions without visible compulsions, but since they still have compulsions they’re not exactly “purely obsessional.” But whether or not studies back it, many people identify with Pure-O because they don’t have the more obvious compulsions listed in subtypes above. The obsessions can be about sex, sexuality, religion, harm, personal health, romance, and really anything else we discussed above.

Obsessions

• What if I’m actually not a good person?
• How do I know that life is even worth it?
• What if I go over there and push that guy off this bridge?
• If I don’t clean my mess up well enough someone will get slip and get seriously hurt because of me

Compulsions

• Making sure to spend time only with people who will tell you you’re a good person
• Always thinking through the “meaning of life” question
• Looking for signs in your mind that you would never push someone off a bridge
• Trying repeatedly to remember a situation because you haven’t done it correctly if you’ve missed a detail

Learn more about pure-O OCD

• Your Complete Guide to Pure-O OCD
• When Terrifying Thoughts Are a Sign of Pure OCD

These common ones should provide a good idea of what lots of people with OCD struggle with on a daily basis. However, there are plenty of other subtypes. In fact there are hundreds of different ways OCD can show up in someone’s life. 

Other common OCD subtypes

For example, scrupulosity/religious OCD is a common subtype characterized by obsessions and compulsions around violating a religious, moral or ethical belief. A person’s OCD may center around fears related to sinning, praying incorrectly, lying or offending someone, or accidentally cheating or stealing.

Another example of an OCD subtype is hit and run OCD, a less frequently discussed subtype of OCD characterized by a fear of running someone over while driving. People with this subtype often find that their obsessions make them too afraid to drive, or that they must trace their route just to make sure a road bump was not actually a person.

OCD can take hold of the past, too. Real events OCD is a subtype characterized by obsessions and compulsions about the person’s past actions. A person with real events OCD may have obsessive thoughts about something they said to a friend five years ago and be concerned about whether or not they offended them. 

Ultimately, OCD subtypes follow the same cycle of obsessions and compulsions of OCD. While for some people, it might not be worth working too hard to figure out exactly what someone’s subtype is, for others, it can be comforting to know there are other people going through something similar.

How to treat OCD subtypes

Regardless of the subtype, the process of treating OCD is the same. Exposure and response prevention (ERP) therapy is the gold standard of treatment for OCD. This form of therapy involves specifically targeting the source of a person’s obsessions by directly exposing them to it. In some cases, people find that ERP helps their anxiety subsides to the point where they no longer experience intense fears related to their thoughts on a regular basis. 

ERP therapy is an active form of treatment and requires engagement from the patient by participating in exposures, a willingness to feel discomfort, and transparency with their therapist about their obsessions and compulsions (even if they are shameful or taboo). Often patients meet with their therapist more frequently at first, and then less often as their condition begins to improve. The good news is that ERP therapy has a proven track record of helping people with OCD. About 80% of OCD patients experience positive results, and the majority of patients experience results within 12 to 25 sessions.