There may be as many as 34,000 different forms of obsessions (distorted thoughts) and their corresponding compulsions (rituals), all informed by the content of the themes personal to the individual.
Despite the staggering diversity of this disorder, researchers have identified the three most common types of OCD prevalent in the 3-4% of the population diagnosed. Following is information about each of these OCD subtypes.
SYMMETRY OCD
Think Jack Nicholson in the movie “As Good As it Gets.” Sufferers are excessively concerned with how things look, are arranged, aligned, and whether the experience “feels right” or complete.
Superstitious thinking can be involved that harm or something bad will happen if the situation isn’t corrected with specific rituals.
Common Obsessions:
Whether things are even, exact, misarranged or misaligned.
Whether an item is associated with possible harm to others.
Imbalance with behaviors or items.
Corresponding Compulsions:
Lining up or arranging items so they are perfectly spaced or even.
Throwing away items if associated with thoughts of harm.
Repeatedly rearranging items by categories; counting, tapping, touching to balance number of times the action occurs.
This subtype of OCD makes up 10% of those diagnosed. Thoughts and behaviors associated cause great distress to the sufferer, are considered unreasonable, and are unwelcome.
Compulsions result in being late for or missing school, work, appointments and social events.
There is significant mental, emotional, and physical fatigue due to the considerable time it takes to perform compulsions. Friends and family are seldom invited to visit to prevent symmetry and order being disrupted.
CONTAMINATION OCD
Associated with disproportionate fear that something is contaminated and may cause illness, even death, to oneself or family.
Responses to fear involve protective acts carried out to avoid contaminants or erase all contact with contamination. Commonly identified contaminants: Dirt, germs, blood, bodily fluids, and diseases. The list is exhaustive.
Fears are also associated with emotional contamination. The sufferer believes they will take on negative personality traits of other people (maliciousness, overbearingness), or physical disabilities.
Common Obsessions:
Getting or spreading illness through contact with people or objects.
Becoming ill through contact with bodily fluids.
Taking on negative personality traits or disabilities of other people.
Corresponding Compulsions:
Excessively washing hands or showering in a rigidly organized manner.
Disinfecting or sterilizing things repeatedly.
Avoiding certain places or not touching things with hands.
This subtype represents 25% of OCD in the United States. To keep clean and minimize compulsions, sufferers may create two different worlds for themselves — one clean and one dirty.
There is a physical health impact on the individuals’ skin and hands, related to the relentless cleaning rituals. Financial burden is also incurred by excessive purchases of cleaning products.
DOUBTING/HARMING OCD
Individuals have excessive fears of harming loved ones or others through carelessness and forgetfulness (passive harm) or morbid intentionality (active physical violence or sexual acts).
Sufferers experience severe doubt about whether they may have committed these acts in the past, as well as sudden impulses to carry out these acts in the present.
Common Obsessions:
Whether front door was locked or stove was turned off.
Drowning, suffocating, hitting, stabbing children or others.
Worry that they have committed harmful acts in the past with others.
Corresponding Compulsions
Excessively checking that door is locked or gas is off.
Avoiding being alone with children.
Checking other’s reactions to see if fear is detected.
This subtype makes up 25% of diagnosed OCD and is profoundly punishing for the sufferer.
Individuals label themselves bad or crazy for having morbid thoughts. They believe that having such thoughts means they are capable of acting upon them.
Research indicates that people with OCD are the least likely people to act on morbid thoughts as they find them repugnant and go to great lengths to avoid and prevent them happening.
Due to the horrific nature of these thoughts, many individuals are reluctant to seek help. Regardless of subtype, OCD is a disorder associated with shame, depression, and silent suffering, with negative impact on employment and relationships. It is not uncommon that family members or close friends of an individual with OCD are often at a loss regarding how to best respond to the sudden occurrence of ritualistic behaviors, once they occur in their presence.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.