There are many different types of obsessions and compulsions. But most of them can be grouped into four categories: checking, order and symmetry, contamination, and taboo thoughts.
Read on to learn more about the most common types of obsessive-compulsive disorder (OCD), risk factors, diagnosis, and treatment.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a common, long-lasting mental health condition that involves disruptive, unwanted obsessions and compulsions.
Obsessions refer to thoughts, worries, urges, preoccupations, or mental images that are persistent, disruptive, and intrusive. Common examples include:
- Fears of contamination, illness, or germs
- Extreme worries about organization, symmetry, or cleanliness
- Fear of losing or forgetting something
- Repetitive doubts or questions
- Violent or aggressive imagery or impulses
- Distressing sexual imagery or thoughts
- Religious/blasphemous thoughts
Compulsions refer to behaviors or rituals that people feel driven to repeat over and over. Usually, people participate in compulsive acts to reduce their distress about a recurring obsession. Examples may include:
- Excessive handwashing
- Repeatedly cleaning, arranging, or organizing
- Checking locks, appliances (such as the oven), or switches over and over
- Repeating certain phrases, words, or numbers
- Requesting reassurance
How Common Is Obsessive-Compulsive Disorder?
Estimates suggest that about 1.2% of adults in the U.S. meet the diagnostic criteria for OCD in a given year. OCD is more common among women than men.
Symptoms of OCD
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), someone meets the diagnostic criteria for OCD if:
- They have at least one obsession or compulsion that is time-consuming, causes significant emotional distress and interferes with their daily functioning.
- They feel powerless to suppress the urge to think about their obsessions or perform their compulsion.
- Their obsessions and/or compulsions are not primarily caused by another condition, such as generalized anxiety disorder (GAD) or an eating disorder.
Some people with OCD are not aware that their obsessions are excessive. Others know that their worries or impulses are not based on reality, but they still feel unable to control them.
Different Types of OCD
There is no single official way to divide OCD into subtypes. However, many researchers agree that there are certain common themes and symptom clusters among people with OCD.
One of the most common symptoms of OCD is compulsive checking. People with “checking OCD” may excessively check that their appliances are turned off, that their doors and windows are locked, or that they haven’t lost, damaged, or misplaced something important.
Checking rituals can also be related to excessive doubts and anxieties and a fear of losing control. There is often the fear of intentionally or unintentionally causing something bad to happen. For example, someone with OCD may not be able to leave the house for over an hour due to repeatedly checking the stove.
Order and Symmetry
Many people with OCD experience obsessions and compulsions related to order, symmetry, arranging, and counting. Symmetry-related compulsive rituals may involve lining things up over and over, constantly rearranging furniture to make it look “just right,” or repeatedly counting items to ensure they’re divided into equal groups.
Someone with an irrational preference for order may also become overly preoccupied with their body proportions and/or grooming habits, which can lead to disordered eating and poor self-image. Others feel compelled to perform excessive scheduling, planning, time management, and organizing rituals.
Fear of contamination is one of the most common obsessive themes among people with OCD. People who fear germs and/or contamination may clean surfaces or wash their hands compulsively, worry excessively about ingredients in food or household products, and even avoid touching things others have touched.
Some people with OCD also experience a fear of emotional contamination. Someone who fears emotional contamination may go out of their way to avoid people, places, or topics they see as “immoral” or “dirty.”
Ruminations or Intrusive Thoughts
Rumination refers to obsessive, intrusive, and unwanted thoughts around a certain theme. Rumination frequently involves taboo or forbidden topics, such as sexuality, violence, or religion.
Intrusive thoughts can take on many forms. Some people with OCD ruminate obsessively about their sexual orientation or constantly question their religious identity.
They may constantly worry that they will cheat on their partner, hurt themselves or someone else, or be sexually predatory, even in the absence of any evidence. Others experience intrusive, graphic sexual or violent mental imagery that they consider inappropriate or disturbing.
Often, rumination is related to an underlying obsession with guilt and excessive responsibility for harm. People who experience intrusive thoughts may perform compulsive rituals in an attempt to “neutralize” the perceived threat.
For example, someone who has forbidden thoughts around religion or blasphemy may pray excessively to protect themselves or others spiritually. Someone else may count, tap, or repeat certain movements or phrases because they believe it will save someone they love from harm.
What Is Existential OCD?
Other OCD Subtypes
Researchers have identified several other possible OCD subtypes, including:
- Hoarding: Hoarding disorder is now a distinct diagnosis in the DSM-5. Hoarding refers to the compulsive, excessive collection of worthless or trivial items, often resulting in extreme clutter and disorganization. Some people with OCD hoard items that are related to an underlying obsession or fear.
- Somatic obsessions: Somatic obsessions refer to preoccupation with body parts, body functions, and/or illness. For example, someone with OCD who experiences somatic obsessions may hyperfocus on the way they breathe or swallow or monitor themselves for signs of illness.
- Pure OCD: Some researchers refer to OCD that involves only thought-based obsessions, with no behavioral or compulsive component, as “pure OCD.”
- OCD with obsessive slowness: Some people with OCD are highly prone to perfectionism. In some instances, their fear of failure may lead them to take excessive time to complete a task to ensure it’s done “just right.”
Causes and Risk Factors
There is no single known cause of OCD. Instead, researchers believe that many factors contribute to the development of OCD, including:
- Genetics: According to twin and family studies, OCD is often inherited. Having a sibling, parent, or child with OCD increases your risk of developing the disorder.
- Life events: Stressful and/or traumatic life events may trigger the onset of OCD, especially in people who are already genetically predisposed to the disorder.
- Brain structure: Studies suggest that certain differences in brain structure and function, such as hyperactivity in the orbitofrontal cortex (which helps manage emotions and decision-making), may influence the development of OCD symptoms.
- Comorbid conditions: Many people with OCD have other mental health conditions, such as attention deficit hyperactivity disorder (ADHD), depression, and anxiety.
Age and sex may also play a role in the onset and development of OCD. OCD is usually diagnosed before the age of 25, with many people first showing symptoms during childhood or adolescence. It’s rare (though not impossible) for someone to be diagnosed with the disorder after the age of 35.
Meanwhile, studies suggest that women are approximately 1.6 times likelier than men to develop OCD during their lifetime.
OCD and Comorbidity
It’s common for people with OCD to have more than one mental health condition. A 2021 review and meta-analysis found that 69% of people with OCD had at least one other mental illness over the course of their lifetime.
Diagnosis and Tests
If you suspect you may have OCD, your healthcare provider can refer you to a mental health therapist. They can diagnose you with OCD using your medical history, an understanding of your symptoms, and the criteria in the DSM-5.
Your healthcare provider may also perform a physical exam and other tests to rule out the possibility of any underlying physical conditions or comorbid mental health disorders.
In the DSM-5, OCD appears under the category of “obsessive compulsive and related disorders.” OCD-related conditions within this umbrella category include:
- Hoarding disorder: While hoarding is sometimes a symptom of OCD, hoarding disorder can also be diagnosed and treated as a distinct mental health condition. People with hoarding disorder have extreme difficulties in discarding items and controlling their impulses to collect items—even when their collections negatively affect their relationships, safety, health, and/or finances.
- Skin picking disorder: People with skin picking disorder, also known as excoriation disorder or dermatillomania, pick at their skin persistently. Harmful effects may include skin lesions, emotional distress, and social isolation.
- Trichotillomania: People with trichotillomania experience hair loss, emotional distress, difficulties with self-image, and poor self-esteem due to a persistent, uncontrollable impulse to pull or pluck out their hair.
- Body dysmorphic disorder: Body dysmorphic disorder (BDD) involves an overwhelming preoccupation with one’s body and looks. People with BDD often spend a great deal of time, money, and energy to improve or “fix” their appearance.
Other conditions that are sometimes mistaken for OCD or may appear alongside it include:
- Obsessive-compulsive personality disorder: Obsessive-compulsive personality disorder (OCPD) is a mental condition that involves rigidity in thinking and behavior, excessive devotion to rules and perfectionism, and a preoccupation with maintaining control. OCD shares some symptoms with OCPD, but they are different conditions.
- Anorexia nervosa: Certain eating disorders, such as anorexia nervosa (AN), are often comorbid with OCD. Some research suggests that about 35% to 44% of patients with AN also meet the diagnostic criteria for OCD. Meanwhile, about 10% of female patients with OCD also have AN.
- Tourette syndrome: Tourette syndrome (TS) is a nervous system disorder that causes involuntary tics (repeated movements, sounds, and/or twitches). OCD and TS are related and often comorbid, especially in children and adolescents. About 60% of people with TS also meet the diagnostic criteria for OCD, and up to half of the children with OCD have experienced tics at some point.
OCD vs. OCPD: What Are the Differences?
How OCD Is Treated
Many people with OCD experience improvements with treatment. Studies suggest that about 50% of people with OCD will experience full remission of their symptoms after treatment. Many others are able to significantly improve their quality of life over time.
Psychotherapy is the typical first-line treatment for OCD. Many people with OCD benefit from a particular type of cognitive behavioral therapy (CBT) known as exposure and response prevention (EX/RP) therapy. In EX/RP therapy, patients gradually learn to confront their obsessions (exposure) while resisting the urge to perform compulsions in response (response prevention).
In some cases, antidepressants may be used in combination with psychotherapy to ease OCD symptoms. Selective serotonin reuptake inhibitors (SSRIs)—antidepressants that work to increase the level of serotonin in the brain—have been found to be especially effective in treating people with OCD, particularly at higher dosage.
What Is Serotonin?
Serotonin, or 5-hydroxytryptamine (5-HT), is a neurotransmitter—a chemical messenger—in the central nervous system that helps to regulate mood, emotions, memory, pain tolerance, sleep, appetite, and sexual desire.
What Is Exposure Therapy?
Obsessive-compulsive disorder (OCD) is a chronic mental disorder that involves obsessions (intrusive, persistent, and unwanted thoughts or worries), compulsions (rituals or behaviors that one feels driven to repeat), or both.
There is no single known cause of OCD. Multiple factors, including genetics, trauma, and differences in brain structure, may contribute to the development of the condition.
Researchers have identified several common subtypes of OCD. OCD symptoms often fall into one of four clusters: checking, order/symmetry, germs/contamination, or rumination/intrusive thoughts. Other subtypes of OCD include hoarding and somatic obsessions.
OCD can be diagnosed by a mental health therapist using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). It is typically treated with antidepressants, psychotherapy, or both.
A Word From Verywell
Many people feel nervous to talk about their obsessions and compulsions with a healthcare provider. However, OCD is common, treatable, and manageable. If you think you may have OCD, talk to your healthcare provider about seeing a specialist to address your symptoms and improve your quality of life.
Frequently Asked Questions
How many types of OCD are there?
There is no single agreed-upon list of OCD subtypes. However, many researchers agree that OCD obsessions and related compulsions often fall into five main clusters. These symptom clusters include contamination, ordering and symmetry, rumination (including over-responsibility for harm, illness anxiety, and persistent doubts), taboo impulses and imagery (such as violent and/or sexual images), and hoarding.
Are there different levels of OCD?
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not specify different levels of OCD severity. However, the DSM-5 does categorize OCD according to the patient’s level of insight.
A person with OCD who has good or fair insight knows that their obsessions are not based on reality, while someone with poor insight thinks their obsessive beliefs are probably true. Meanwhile, a person with absent insight is entirely convinced that their beliefs are true.(Video) 2-Minute Neuroscience: Obsessive-Compulsive Disorder (OCD)
Is OCD an anxiety disorder?
OCD was previously categorized as an anxiety disorder. However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) moved OCD out of that category and placed it under the umbrella of “obsessive compulsive and related disorders.” Other OCD-related disorders include hoarding disorder, body dysmorphic disorder, trichotillomania, and skin picking disorder.
Can perfectionism be considered a form of OCD?
On its own, the trait of perfectionism is not a form of OCD. However, research suggests that perfectionism is common among people with OCD.
A 2019 study found that children and adolescents who exhibited a tendency towards perfectionism were more likely to develop severe OCD symptoms and to meet the diagnostic criteria for OCD.
OCD can manifest in four main ways: contamination/washing, doubt/checking, ordering/arranging, and unacceptable/taboo thoughts. Obsessions and compulsions that revolve about contamination and germs are the most common type of OCD, but OCD can cover a wide range of topics.What are the rare types of OCD? ›
- Relationship Obsessions.
- Somatic (Body-Focused) Obsessions.
- Existential Obsessions.
- Need to Know Obsessions.
Because obsessive-compulsive disorder (OCD) is more often characterized as a mental illness rather than physical, it can make getting disability approval more complicated. Your insurance company may limit or deny you your benefits unless you're able to prove a physiological cause for your condition.What mental illness is related to OCD? ›
These include the obsessive preoccupations and repetitive behaviors found in body dysmorphic disorder, hypochondriasis, Tourette syndrome, Parkinson's disease, catatonia, autism, and in some individuals with eating disorders (eg, anorexia nervosa).Is OCD a mental illness or Neurodivergent? ›
Some people would consider OCD to be a neurodivergent condition, while others would not. OCD can affect the brain's circuitry, influencing social communication, judgment, planning, and body functioning. If “neurodivergent” simply means having a brain different from the most common brain type, then OCD would qualify.Is OCD a form of anxiety? ›
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions).What is the most common OCD behavior? ›
- cleaning and hand washing.
- checking – such as checking doors are locked or that the gas is off.
- ordering and arranging.
- asking for reassurance.
- repeating words in their head.
- thinking "neutralising" thoughts to counter the obsessive thoughts.
To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person's daily activities and social interactions.What is the biggest symptom of OCD? ›
If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours. An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.Is OCD a form of trauma? ›
Not a few patients with obsessive-compulsive disorder (OCD) have experienced events that affected the onset. The onset of OCD is not limited to the original meaning of trauma; rather, traumatic experiences such as unexpected exposure to contaminants or various stressful life events often cause the onset of OCD.
Experts aren't sure of the exact cause of OCD. Genetics, brain abnormalities, and the environment are thought to play a role. It often starts in the teens or early adulthood. But, it can also start in childhood.What type of personality is OCD? ›
Obsessive-compulsive personality disorder (OCPD) involves an extensive preoccupation with perfectionism, organization and control. People with OCPD have rigid beliefs and need to have control of themselves, others and situations.What is a mild form of OCD? ›
In the cases of mild OCD, the intrusive thoughts are not time-consuming in a significant way (at least, at first glance). Or maybe, even though the person is troubled by the thoughts, they do not notably impair his or her daily functioning.What is somatic OCD? ›
Somatic OCD is a form of OCD that causes intrusive thoughts are focused on autonomic, or non-conscious body processes and functions, like breathing, blinking, or physical sensations.Can OCD be mistaken for something else? ›
People struggling with Obsessive Compulsive Disorder (OCD) are often misdiagnosed as having other psychological conditions. One of the most common misdiagnoses for this population is Generalized Anxiety Disorder (GAD).What are the benefits of having OCD? ›
- People who have OCD are usually very attentive and pay great attention to detail.
- They want everything to be perfect and consider themselves to be perfectionists.
- That means they're great at meeting deadlines, completing excellent work, and managing time.
Can someone with OCD be eligible for benefits? If OCD is impacting a person's day-to-day life or making it difficult for them to work, then they may be eligible to claim benefits to help pay for living costs like food, rent, and childcare.Can you get SSI if you have OCD? ›
You may be able to qualify for Social Security disability benefits based on OCD if your condition is well documented and severely debilitating. OCD is evaluated by the Social Security Administration (SSA) as an anxiety-related disorder.What does undiagnosed OCD look like? ›
Signs and symptoms of OCD
Obsessive thoughts: These obsession symptoms typically intrude other thoughts when you're trying to do or think about other things and may include: Fear of being contaminated by germs or dirt. Intrusive sexually explicit or violent thoughts. Fear of having a serious illness.
1 Schizophrenia and OCD are entirely independent of each other, both in their cause and symptoms, but share characteristics that place some individuals at higher risk of both.
The obsessive-compulsive spectrum is an important concept referring to a number of disorders drawn from several diagnostic categories that share core obsessive-compulsive features. These disorders can be grouped by the focus of their symptoms: bodily preoccupation, impulse control, or neurological disorders.Is OCD physiological or psychological? ›
Prevailing theories indicate that OCD is a biological disease. Functional brain imaging studies have produced a model for pathophysiology of OCD which involves hyperactivity in certain subcortical and cortical regions.Does OCD categorize with autism? ›
Autism Spectrum Disorder (ASD) and OCD are two different conditions, however, it is true that some symptoms of autism overlap with those of other disorders, such as OCD, and can look similar (Højgaard et al.What kind of medication is used for OCD? ›
Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include: Clomipramine (Anafranil) for adults and children 10 years and older. Fluoxetine (Prozac) for adults and children 7 years and older. Fluvoxamine for adults and children 8 years and older.How do you stop OCD triggers? ›
- Begin a mindfulness practice. Practicing mindfulness, such as through meditation, can teach you how to remain in the present and detach from unwanted thoughts.
- Pace yourself to avoid stress. ...
- Take care of yourself. ...
- Don't hesitate to ask for help from loved ones. ...
- Try therapy.
How do doctors test for OCD? Doctors and mental health professionals test for OCD by talking with you about your symptoms, determining if you have obsessions and compulsive behaviors, and by evaluating if these thoughts and behaviors interfere with your functioning.What is daily life like for someone with OCD? ›
OCD can make it difficult for people to perform everyday activities like eating, drinking, shopping or reading. Some people may become housebound. OCD is often compounded by depression and other anxiety disorders, including social anxiety, panic disorder and separation anxiety.At what age does OCD typically develop? ›
OCD usually begins before age 25 years and often in childhood or adolescence. In individuals seeking treatment, the mean age of onset appears to be somewhat earlier in men than women.What age does OCD affect the most? ›
Although OCD can occur at any age, there are generally two age ranges when OCD tends to first appears: Between the ages 8 and 12. Between the late teen years and early adulthood.What does OCD do to you physically? ›
Ritualistic, compulsive behaviors may damage your body. Some OCD behaviors include pulling your own hair, picking at your skin until it bleeds, or vomiting food to avoid weight gain (bulimia). Even excessive hand washing can be harmful.
Studies show that OCD patients have excess activity in frontal regions of the brain, including the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC), which could explain their intrusive thoughts and high levels of anxiety, respectively.How do I know if I have OCD or just anxiety? ›
A person with an anxiety disorder will experience excessive worry, but not engage in compulsive behavior to reduce their anxiety. A person with OCD, however, will use repetitive, typically unhelpful behaviors to try and thwart the obsessive thought they have.What are the 9 symptoms of OCD? ›
- cleaning and hand washing.
- checking – such as checking doors are locked or that the gas is off.
- ordering and arranging.
- asking for reassurance.
- repeating words in their head.
- thinking "neutralising" thoughts to counter the obsessive thoughts.
Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over.Does OCD show up on a brain scan? ›
OCD was one of the first psychiatric disorders in brain scans showed evidence of abnormal brain activity in specific regions.Is OCD a chemical imbalance? ›
Individuals with OCD often have certain chemical imbalances present in the brain. Changes in the neurochemicals serotonin, dopamine, and glutamate are normally present in OCD cases.What is the best treatment for OCD? ›
In treatment-resistant cases, other options may be offered:
- Intensive outpatient and residential treatment programs. ...
- Deep brain stimulation (DBS). ...
- Transcranial magnetic stimulation (TMS).
Psychotic disorders, such as schizophrenia and bipolar disorder, can cause delusions, hallucinations, and other symptoms of psychosis. Non-psychotic disorders, which used to be called neuroses, include depressive disorders and anxiety disorders like phobias, panic attacks, and obsessive-compulsive disorder (OCD).Is OCD manic? ›
The anxious behaviors associated with OCD may be signs of manic or hypomanic bipolar episodes. As with diagnosing OCD, a doctor is likely to conduct a physical exam, lab tests, and a psychological evaluation to help determine a diagnosis of bipolar disorder.What is it called when you want everything to be even? ›
People who suffer from Symmetry OCD become fixated on the position and arrangement of certain objects and will feel uncomfortable and distressed when encountering items that are not aligned correctly or that or appear somehow incomplete.
While people often talk about the emotional and mental effects of OCD, its physical effects are often left out of the discussion. Compulsions like handwashing can physically hurt your hands, self-soothing behaviors like hair-pulling can harm your skin, and studies have also linked OCD with chronic pain.How long do OCD symptoms have to be present? ›
International Classification of Diseases and OCD
For a definite diagnosis, obsessional symptoms or compulsive acts, or both, must be present on most days for at least two successive weeks and be a source of distress or interference with activities.
The doctor rates obsessions and compulsions on a scale of 0 to 25 according to severity. A total score of 26 to 34 indicates moderate to severe symptoms and 35 and above indicates severe symptoms.