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  • Writer's pictureDr. Niemeyer

OCD is not just handwashing!




I wanted to write an educational post as a reminder to everyone that Obsessive Compulsive Disorder can take many forms – it doesn’t just mean being “neat” or “orderly.” Many of us have heard of OCD in terms of cleanliness or being afraid of germs, but that is really just one category of many.


I think one of the things that I find so fascinating about OCD is that it is a reflection of how intelligent, creative, and imaginative the human mind can be. If you take the time to listen and understand someone’s OCD thinking, it is often very amazing how intricate the thought process is. I always joke to my patients that part of the problem is you just have “too much brain!” Sometimes a person’s intelligence and creativity can run away with itself to overcomplicate and over-stress ourselves.


I want to share this post so people can learn more about themselves or their family members. But it’s also important in general for this information to be more widely spread in the community – both the general public and amongst the therapeutic community. Some therapists who do not work routinely with OCD are not always aware of the many types of OCD and so can inadvertently misdiagnose or stigmatize their patients without intending to cause harm.


So, I hope this list is not only educational, but also validating – you are not alone! These types are the most common types of OCD thinking, which means many other people have these same thoughts. But know if you do not see your own subtype listed here, that is only because there are limitless routes that OCD can take.


I am not going to go in depth about each subtype because that is what you will learn in therapy and because each person’s experiences are different, but you will find a general overview below:


Contamination OCD


Yes, people with contamination OCD are often worried about germs, being dirty, or being sick. This is one of the most common types of OCD, but even the types of fears within this category vary wildly. Some people may worry about getting themselves sick, getting other people sick, just “feeling gross,” or even being contaminated with bad thoughts or feelings. Common behaviors with this type of OCD involve cleaning rituals, frequent washing, checking to see if other people or places are clean, or doing behaviors to block contamination such as wearing gloves or staying home.


Scrupulosity OCD


The themes of scrupulosity OCD often have to do with questioning whether they are a “good or “bad” person who is acting in ways that are “moral” or “correct.” I put these words such as “good” or “moral” into quotes because they are hard concepts to define and individuals can often find themselves involved in hours of rumination trying to define these words and judge themselves to see if they measure up. Oftentimes scrupulosity will include religious themes of good and bad as well as fears of upsetting God or not showing true faith. It is not religious that causes they OCD and even non-religious people can have some religion-based fears. Often people with this theme of OCD will spend quite a bit of theme ruminating on these themes, seeking reassurance from others, “confessing” bad thoughts or actions, or engaging in prayer or other religious rituals.


Harm OCD


People who fit into this category often have fears of harming themselves, harming others, or accidentally causing harm or damage in some way. It is very important to note that these obsessive fears do not mean that the individual is dangerous to themselves or others, only that this is where their OCD fears have centered. This category can be very scary for people because not only is it confusing for themselves, but it can also be confusing to some mental health practitioners. Common fears here include fear of committing suicide, fear of injury or killing others, or fear of causing bad things to happen to others such as a house burning down or being robbed. Common actions include checking to make sure nothing bad has happened, checking to make sure that everything in the house is safe, checking for evidence of a crime, and avoiding triggers (i.e., tv shows about murder, sharp objects, etc).


Hit and Run OCD


Related to Harm OCD is the theme of Hit and Run OCD. People who suffer from this fear are constantly worried they may hit someone with their car or have unknowingly hit someone with their car. Because of the constant uncertainty, individuals often will look in their rearview mirrors or even drive back multiple times to make sure they haven’t accidentally hurt someone while driving.


Sexual Themes of OCD


This is another category that can be misunderstood or bring shame to individuals, but really it is a quite common category of OCD. Individuals in this subgroup often question their own sexuality and are either fearful of misunderstanding themselves or of having inappropriate thoughts. Some individuals in this category spend quite a bit of time questioning their own sexual orientation. This is not normal questioning, but distressing rumination about how to know where their “true” sexual orientation lies. Other people in this category are fearful of acting on “taboo” sexual thoughts, such as incest or pedophilia. Again, these are not fear desires, but fears about having these desires. This category can be very painful, but treatment is effective.


Other Categories of OCD


-Just Right or Perfectionistic OCD

  • Doing an action or repeating an action until it feels “just right” or “perfect.”

- Symmetry OCD

  • Needing objects in the environment or on your body to be symmetrical, “just so,” or “balanced.”

-Reassurance Seeking or Confessing

  • Need to confess your bad thoughts to others or seek constant reassurance from others about your obsessive fears

-Repeating OCD

  • Repeating actions such as walking through doorways, getting in and out of cars, putting on seatbelt, standing or sitting down, swallowing, etc. Fear that if actions are not repeated a certain number of times or until “just right,” that something bad could happen.

  • Rereading, rewriting, or reviewing written or academic material.

-Superstitious or Magical OCD

  • Needing to follow certain rules or engage in certain behaviors to prevent bad things from happening.

-Existential OCD

  • Questioning reality, questioning your own mental processes, questioning the meaning of life.


And there you go. This list is simply an overview of possible types of OCD. It is not exhaustive or all encompassing, so there could be other types not listed here. But I wanted to provide this overview to those who are seeking treatment so you can know you are not alone in your fears. And to an OCD therapist, these fears and behaviors are not “weird” or “embarrassing.” These are things we help people with every day and we are happy to explain and validate what is happening to you.


Please reach out if you are seeking therapy for OCD. It is important to be seen by a specialist who truly understands these categories and the treatments that go along with them. You can learn more or find additional therapists at www.iocdf.org.


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