Obsessive-compulsive disorder (OCD) and the subtypes of OCD are one of the most misunderstood and mischaracterized mental health issues in modern media and public consciousness. However, it is also surprisingly common, with a lifetime prevalence of about 2.3 percent in US adults.
OCD is a difficult condition to live with. About half of adults diagnosed with OCD report severe impairment as a result of their condition. Over a third of the remaining half report moderate impairment.
Yet despite its prevalence, there is little awareness about how OCD and the themes or subtypes of OCD work in the general public. People tend to equate a need for perfectionism or a focus on cleanliness with OCD or conflate OCD with germ phobias. OCD is more complicated than that; recognizing these symptoms can help people identify them in others and themselves and get the help they need.
Signs and Symptoms of OCD
OCD consists of two core concepts: obsessions and compulsions. Both are unwanted, and both are uncontrolled. Both cause extreme anxiety. This means that a person with OCD has no choice as to what they obsess over or what behavior they use to soothe their obsessions. A person with OCD also does not want to continue having these thoughts or engaging in these behaviors. They are obsessed and feel compelled.
In general, obsessions are:
- Unwanted or intrusive thoughts.
- Thoughts that cause major distress or discomfort to the individual experiencing them.
- Often present without a trigger, meaning they can come out of nowhere. However, they can also be triggered.
- Themed and not generalized. They can even be hyper-specific, to the point that they become absurd or unrealistic (such as worrying about worms in your food for no reason).
On the other hand, compulsions are:
- Behaviors that soothe obsessive thoughts, sometimes with a clear link and sometimes with no clear link.
- Also specific and often following a certain theme, such as checking things X amount of times, counting up to a specific number, or compulsive ordering.
- Sometimes abstract and even mental, such as recounting mantras or going over an affirmation again and again.
Subtypes of OCD
Obsessions and compulsions both come in a massive variety of themes and subtypes of OCD. These illustrate just how widespread OCD can be by explaining how it can present itself as many different things, each with the same core crux.
1. Contamination-Based OCD
Many people equate OCD with extreme cleanliness, and this is often an example of how certain obsessions often link with their compulsions.
For example, it might not make much sense to turn a light switch on and off seven times to soothe inner anxieties. But for someone who struggles with constant intrusive thoughts of contamination and infection, it does make sense to develop a harmful cleaning habit, to the point that a person can damage their skin and surroundings through excessive use of cleaning solutions, rubbing alcohol, and force.
The difference between a “germophobe” and someone with OCD is often the degree to which their compulsions can actively harm them. A person with an acute fear of germs might act on that fear by regularly cleaning themselves and everything they touch – a person with OCD may develop more specific rituals that they must strictly follow to ensure that contamination isn’t possible, even if these rituals (and their intrusive thoughts) delve into non-realism. Both conditions are driven by intense anxiety, even when it isn’t realistic or needed.
2. Harm-Based OCD
All subtypes of OCD include intrusive or unwanted thoughts. This is part of the core of OCD. But sometimes, these intrusive thoughts are more violent than others, including violence towards others. Harm-based OCD may also involve self-harm or thoughts of suicide.
These violent thoughts and harm-related thoughts might never actually be acted upon, and they aren’t a sign of psychopathy or a lack of empathy. Instead, they tend to occur because they’re something the person fears strongly – and as such, it becomes the object of their mental obsession, the fear that they might harm those around them.
3. OCD and Perfectionism
OCD and perfectionism are a common combination. Making sure things are “just right” is a common compulsion, especially because it becomes an outlet of control in a condition defined by a lack of control.
By controlling something minuscule like the temperature of the room, the arrangement of the utensils on the table, or the exact layout of all miniatures on a shelf, a person with OCD can soothe their anxieties related to their unwanted and uncontrollable obsessive thoughts. Sadly, feeding these compulsions often makes things worse, as it creates a mental cycle without meaningfully or effectively addressing the root of the issue.
4. Taboo OCD
This subtype can be directly related to strong intrusive thoughts, such as harm-based OCD. Only instead of raw or unfocused violence, this type of OCD centers around specific taboo thoughts and concepts.
A particularly striking example is pedophilia-themed OCD. This is not to be confused with pedophilia as a disorder. This subtype of OCD may be underdiagnosed because, in some cases, people who struggle with these thoughts don’t want to talk about them and because these thoughts or feelings are often conflated with pedophilia itself.
In much the same way that people who struggle with harm-based OCD do not actually want to hurt anyone or themselves, pedophilia-themed OCD involves a person who is consistently worried that they might harm or assault children without any actual attraction or interest in children. In these cases, pedophilia becomes the fixation for OCD to latch onto because of its taboo nature.
As such, the crux of treatment should focus on addressing the OCD itself and the anxiety it causes rather than trying to address a non-existent attraction to minors.
Taboo-themed OCD can also revolve around other fears and concepts, including religious sacrilege, incest, suicide, or severe trauma (such as reliving moments of child abuse). OCD can also revolve around worrying about being straight or gay, or being perceived (or not perceived) as one’s preferential orientation, and developing hyper-awareness for how every individual action might be “coded” one way or another. These cases of OCD might be more common in communities or societies where alternative or non-heteronormative sexual orientation might be repressed.
5. Peripartum and Perinatal OCD
Some subtypes of OCD develop almost exclusively or become much stronger before, around, or after the birth of a person’s child. Peripartum, postpartum, and/or perinatal OCD may involve unwanted thoughts regarding the child, even to the point of worrying excessively about harming or hurting the child, and engaging or re-engaging in existing or new compulsions to soothe these anxieties.
6. OCD without Compulsions
Also known as purely obsessional OCD or pure-O OCD, this subtype revolves around overwhelmingly powerful obsessions but no specific or attached compulsive behavior. Meaning the same worries and anxieties are present as in other cases of OCD, but without the attached rituals or behaviors that might soothe them.
Pure OCD was categorized in an effort to recognize people who clearly struggled with symptoms of OCD but did not need to utilize outwardly manifesting compulsions to manage their anxieties. In such cases, people often talk about utilizing mental compulsions and rituals – such as mantras or affirmations – to deal with their anxiety.
Subtypes of OCD can be used to further differentiate between symptoms, while unifying different cases and helping explain how and why OCD might develop in wildly different ways.
These themes may all center around very different obsessions (such as religiosity or suicidality) and compulsions (such as hoarding or cleaning), but they serve mostly to illustrate how OCD can take existing worries and extremely exaggerate them in the mind.
Treatments for these cases vary from case to case, but all treatment plans center around addressing a person’s own unique cycle of intrusive, unwanted thoughts and compulsive behaviors. Therapy is key – intensive one-on-one therapy can help people differentiate between signs and symptoms of their OCD and “normal,” healthy thinking patterns, as well as utilize exposure therapy to slowly confront and eliminate their anxieties by taking power away from certain triggers around them.
In severe cases, such as OCD with self-harm or violent behavior, a person might require residential treatment and/or partial hospitalization to better manage their symptoms in the short term and move on to a more sustainable long-term treatment plan.
OCD Treatment in Malibu
No matter how hopeless things might seem now, there’s always a path toward getting better. Let’s start on that path today.
Contact Amend Treatment for more information.