OCD Subtypes: Types of Obsessive-Compulsive Disorder

The ways in which symptoms of obsessive-compulsive disorder (OCD) are experienced varies widely from person to person. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a broad definition of obsessive-compulsive disorder that includes the presence of obsessions and/or compulsions that cause major distress or disruption to daily living.

Clinicians and researchers suggest that OCD can be divided into different types based on the nature of the symptoms experienced. There are also other disorders that include elements of obsession or compulsion.

This article discusses the main OCD subtypes, how the symptoms differ for each, and how they are treated. It also cover similar conditions that may be related to obsessive-compulsive disorder.

Symptoms of OCD Subtypes

Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.

Contamination Obsessions With Washing/Cleaning Compulsion

 If you are affected by this symptom subtype, you will usually focus on feelings of discomfort associated with contamination. You may wash or clean excessively to reduce these feelings of distress.

For example, you might feel that your hands are dirty or contaminated after touching a doorknob or worry that you will contaminate others with your germs. To get rid of these feelings, you might wash your hands repeatedly for hours at a time.

Harm Obsessions With Checking Compulsions

If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others. You use checking rituals to relieve your distress.

For example, you might imagine your house burning down and then repeatedly drive by your house to make sure that there is no fire. Or, you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.

Obsessions Without Visible Compulsions

This symptom subtype often relates to unwanted obsessions surrounding sexual, religious, or aggressive themes. For example, you could experience intrusive thoughts about being a rapist or that you will attack someone.

You may often use mental rituals such as reciting particular words, counting in your head, or praying to relieve the anxiety you experience when you have these involuntary thoughts. You will usually avoid riggers related to obsessions at all costs.

Symmetry Obsessions With Ordering, Arranging, and Counting Compulsions

When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are "just right." For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color.

This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example, you might think, "If I arrange my desk perfectly, my husband won’t die in a car accident." However, this is not always the case.

Hoarding

Hoarding is now recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items that are judged to be of limited value by others, such as old magazines, clothes, receipts, junk mail, notes, or containers. Often your living space becomes so consumed with clutter that it becomes impossible to live in.

People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes. They are often unable to maintain steady employment. Importantly, compulsive hoarding can occur independently of OCD.

Other OCD Subtypes

In addition to the main subtypes of OCD, a few others may also be commonly seen. Some of these include:

Relationship OCD

Relationship OCD is a subtype that involves experiencing obsessive and compulsive thoughts related to a person's romantic relationship. It is often marked by severe fears and doubts about the relationship, including whether their partner loves them, excessive concern for their partner's happiness, or wondering if they could find a better partner.

"Just Right" OCD

"Just right" OCD is driven by a general feeling that things are not quite right. To deal with this feeling, people often engage in compulsive behaviors related to counting, straightening, touching tapping, or lining things up. F

False Memory OCD 

People with this OCD subtype experience frequent doubting thoughts. For example, they might worry about things they may have accidentally done in the past, such as whether they accidentally stole something or forgot to pay for something at the store. 

Magical Thinking OCD

People with this type of OCD often engage in magical thinking, believing that if they don't engage in certain behaviors, completely unrelated events will occur. For example, they might believe something terrible will happen to a loved one if they don't look at their phone at 8:15 every night.

Obsessive-Compulsive Related Disorders

The DSM-5 included new definitions of these disorders or moved them to this category.

• Skin picking disorder (excoriation): This disorder was also recognized as a distinct diagnosis in the DSM-5. It is persistent picking at the skin that results in lesions, infections, and clinically significant distress. It is prevalent in approximately 1% to 2% of the population.
• Hair-pulling disorder (trichotillomania): In this OCD-related disorder, you have a strong urge to pull the hair from your head, eyebrows, eyelashes, or elsewhere on your body. It is usually treated with habit-reversal training and cognitive-behavioral therapy.
• Body dysmorphic disorder: This disorder is a "preoccupation with one or more perceived defects or flaws in appearance that are not observable or appear slight to others." The criteria include repetitive behaviors of grooming or checking appearance, or mental acts such as constantly comparing your appearance to others. Muscle dysmorphia is a subtype of body dysmorphic disorder.
• OCD and related disorders induced by a substance/medication or due to another medical condition: Exposure to certain substances and medications can induce the development of OCD symptoms. There also are certain medical and neurological conditions—including Tourrette's syndrome—that can be associated with the development of the disorder.

In addition, although it is not uncommon for new mothers to experience a wide array of emotions following the arrival of a new child, the postpartum period has long been known to be a time of increased risk for the appearance, worsening, or recurrence of mood and anxiety disorders.

OCD Subtypes in Children

Although many people think of OCD as a disorder that affects only adults, a similar percentage of children are also affected. While there are many similarities between adult-onset and childhood-onset OCD, there are also many important differences—particularly with respect to treatment and the nature of symptoms.

We usually think of OCD as being caused by a combination of stress, genetic factors, and an imbalance of chemicals in the brain. But there is growing evidence that a specific form of childhood OCD may actually be an autoimmune disorder called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Children with PANDAS develop OCD or tic disorders suddenly after a strep infection (such as strep throat) or scarlet fever (or have a worsening of existing OCD symptoms). Studies at the National Institute of Mental Health have shown that a strep infection can produce cross-reactive "anti-brain" antibodies that produce the symptoms of PANDAS in children between age three and puberty.

Treatment for OCD Subtypes

Choosing a course of treatment for OCD depends on several factors, including:

• What has worked in the past
• Your attitudes toward medication
• Your motivation to undergo exposure response prevention (ERP) or cognitive-behavioral therapy (CBT)
• The severity of your symptoms
• The presence of other disorders such as depression
  

An exception may be hoarding, which does not seem to improve with medication but does seem to respond to psychotherapy. Discuss with a psychologist or physician the ways in which ERP, CBT, and medication can be adjusted for maximum benefit based on your symptoms.

A Word From Verywell

If you have symptoms of OCD or its related disorders, see your health care provider as there is treatment available. You are not the only person with one of these disorders. You will find support and get the help you need to relieve yourself of these symptoms.