Types of Obsessive-Compulsive Disorder (OCD)
One of the key features of OCD is its highly diverse clinical manifestation. Symptoms can vary significantly from one person to another. While OCD includes a wide range of subtypes, we could identify four main categories, within which specific symptom patterns can be grouped.
1. Contamination Obsessions and Compulsions
Contamination obsessions involve intrusive, persistent thoughts or mental
images that trigger intense anxiety, fear or disgust about the possibility of
being contaminated by: germs and microbes, toxic or harmful substances, dirt or dust, bodily fluids (e.g., urine, feces, semen). In response to this distress, individuals often engage in repetitive compulsions
aimed at reducing the sense of threat or alleviating feelings of mental
contamination.
Examples of Compulsions:
• Excessive cleaning and washing: Frequent and prolonged
handwashing, multiple or time-consuming showers, or the use of
cleaning/disinfecting agents to a degree far beyond common hygiene
standards.
• Avoidance behaviors: Avoiding contact with objects seen as
“contaminated” (such as door handles, light switches, or elevator
buttons) or by avoiding certain places, social situations or even people
they fear might contaminate them or put them at risk.
2. Obsessions about increased sense of responsibility followed by
checking compulsions
Individuals with this type of OCD often experience an exaggerated sense of
responsibility and an overwhelming fear that they may, either intentionally or
unintentionally, cause harm or put others at risk.
Some examples of these obsessions may include: “What if I ran someone over with my car without realizing it?”, “What if I left the stove on and caused a fire?”. Even when they recognize these thoughts as excessive or unlikely, their
urgent need for certainty and heightened sense of personal responsibility
drive them to engage in repetitive checking compulsions.
Examples of Compulsions:
• Repeatedly checking appliances or spaces: Constantly verifying that
the door is locked, or that appliances like the oven, iron, or water
heater have been turned off in order to prevent potential harm (e.g.,
burglary, fire).
• Returning to the scene while driving: Going back to a location to check
if they may have accidentally caused an accident or injured someone.
• Reassurance-seeking: Frequently asking family members, friends, or
colleagues for confirmation that they have not harmed anyone (e.g.,
“Are you sure I didn’t hit that pedestrian?”).
3. Symmetry (“Just Right”) Obsessions and Compulsions
This type of OCD is linked to obsessions about order, symmetry, and the
need for things to feel ‘Just Right.’ The person may believe that objects
must be arranged in a particular manner or that actions must be carried
out in an exact way; otherwise, they experience intense discomfort or a
troubling sense of incompleteness.
Examples of obsessions include:
“The letters in my notebook aren’t perfectly straight and I can't handle it.”
“That picture frame isn’t aligned and something bad might happen.”
When something does not feel “Just Right,” the individual engages in compulsions to relieve the distress and re-establish a sense of correctness or balance.
Examples of Compulsions:
• Ordering and symmetry behaviors: Repeatedly arranging or aligning objects (e.g., books, clothes,
chairs). Repeating actions (e.g., opening and closing a door) until it feels
“right.” Writing and rewriting words or phrases to achieve perfect
presentation or symmetry.
• Avoidance behaviors:
As these rituals can be time-consuming and exhausting, the person
may begin to avoid certain tasks or activities. For example, they may
avoid writing altogether if they cannot ensure perfect alignment of their
text.
• Reassurance-seeking:
Frequently asking others for reassurance, such as: “Does this look
straight?” or “Is this written properly?”
4. Violent, Sexual, or Religious Obsessions and Mental Compulsions
This type of OCD is characterized by intrusive, unwanted thoughts or
images with violent, sexual, or religious content. Although individuals have
no intention or desire to act on these thoughts, they often experience guilt,
shame, and significant emotional suffering in response to them. These
obsessions frequently conflict with the person’s moral, ethical, or religious
values, leading to profound internal conflict and psychological strain. Due
to their sensitive and taboo nature, many people who experience these
obsessions hesitate to seek help, leading them to suffer in silence.
Examples of obsessions include:
“What if I suddenly stab my partner?”
“During the church service I thought of a blasphemous word. What if this
makes me a bad person?”
“What if I lose control in class and touch my classmate
inappropriately?”
Examples of Compulsions:
• Mental rituals: Repeating prayers or “neutralizing” phrases to undo a
blasphemous or immoral thought.
• Thought replacement: Substituting an unwanted thought with a “good”
or positive image to cancel it out.
• Removing or hiding objects: Avoiding access to sharp tools, knives, or
other objects that could be used to cause harm.
• Reassurance-seeking: Asking others questions such as “Did I seem
normal just now?” or “Did I do something strange?”
• Mental checking: Mentally replaying situations in the mind repeatedly to confirm
whether or not they had an inappropriate thought or acted improperly.
• Avoidance behaviors: Avoiding certain people (e.g., children, loved
ones) out of fear of harming them.
A more detailed presentation of these forms of OCD is provided on the Lesser Known Forms of OCD page.
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Sources:
• Abramowitz, J. S., McKay, D., & Storch, E. A. (Eds.). (2017). The Wiley handbook of obsessive compulsive disorders. Wiley Blackwell.
• Guzick, A. G., Reid, A. M., Balki, A. M., Flores, C., Hancock‐Smith, A. D., Olsen, B., Muller, G., Geffken, G. R., & McNamara, J. P. H. (2017). Diagnostic description and prevalence. In The Wiley handbook of obsessive-compulsive disorders (pp. 24-43). Wiley.
