The national OCD charity, run by and for people with lived experience of OCD
Obsessive-Compulsive Disorder presents itself in many guises, and certainly goes far beyond the common misconception that OCD is merely a little hand washing or checking light switches. Although those are valid OCD compulsions, such perceptions fail to acknowledge the distressing thoughts that occur prior to such behaviours and also fails to highlight the utter devastation that constant compulsions (no matter what they are) can cause.
Although there are infinite forms of OCD, it has been traditionally considered that a person’s OCD will fall into one of these five main categories, with themes often overlapping between categories too.
- Contamination / Mental Contamination
- Symmetry and ordering
- Ruminations / Intrusive Thoughts
There are infinite types of OCD, it can impact on any thought, on any subject, on any person, on any fear, and frequently fixates on what’s important in a person’s life. For example, if religion is important to someone, OCD fixates on unwanted intrusive thoughts around religion, perhaps making the sufferer believe their actions/thoughts will offend their god. Another example is if someone begins a new relationship, OCD can make a person question that relationship, their feelings, their sexuality resulting in almost constant rumination, perhaps with the sufferer worrying that they may be misleading their partner.
The drop-down lists below will attempt to explain some of the more common manifestations of Obsessive-Compulsive Disorder, click the check mark to display:
The need to check is the compulsion, but the obsessive fear might be to prevent damage, fire, leaks or harm. Common checking obsessive worries and compulsions include:
Checking is often carried out multiple times, sometimes hundreds of times and might last for an hour or even longer causing significant impact on the person’s life, being late for school, work, social occasions and other appointments. This can impact on a person’s ability to hold down jobs and relationships , which is why the phrase ‘a little bit OCD’ is so inaccurate and offensive.
Another consequence of checking compulsions is that they can often damage objects that are constantly being pulled and prodded or over tightened.
The fear of being dirty and contamination is the obsessional worry, often fear is that contamination might cause harm to ones self or a loved one. The common compulsions might be to wash or clean or avoid. Common contamination obsessive worries and compulsions include:
The cleaning or washing is often carried out multiple times often accompanied by rituals of repetitive hand or body washing until the person ‘feels’ it is clean, rather than someone without OCD who will wash or clean once until they ‘see’ they are clean.
The time this takes can have a serious impact on a person’s ability to hold down jobs and relationships and there is also a secondary physical health impact of the constant scrubbing and cleaning on the skin, especially the hands where people will scrub until the hands are bleeding. Some people have also gone to the extremes of bathing in bleach.
A person may also avoid entire places, people or objects if they experienced contamination fears previously.
There is also a cost implication of the constant use and purchase of cleaning products, and also of items, especially electrical items like mobile phones, that are damaged through excessive liquid damage.
In addition to the more familiar type of contamination OCD involving someone that washes their hands repeatedly after coming into contact with potentially dirty objects or environments, there is also a less obvious form called ‘mental contamination’.
Mental contamination is a more recent area that researchers have only just started to get an understanding of.
The feelings of mental contamination share some qualities with contact contamination but have some distinctive features. Feelings of mental contamination can be evoked by times when a person perhaps felt badly treated, physically or mentally, through critical or verbally abusive remarks. It is almost as if they are made to feel like dirt, which creates a feeling of internal uncleanliness — even in the absence of any physical contact with a dangerous/dirty object. A distinctive feature of mental contamination is that the source is almost always human, unlike the contact contamination that is caused by physical contact with inanimate objects.
The person will engage in repetitive and compulsive attempts to wash the dirt away by showering and washing which is where the similarities with traditional contamination OCD return, the key difference is the contaminated feeling does not need to come from a physical contact, often it is from feeling alone with mental contamination.
Another obsession long considered to be part of ‘OCD’ is the inability to discard useless or worn out possessions, commonly referred to as ‘hoarding’.
Long considered to be a form of Obsessive-Compulsive Disorder, hoarding disorder was probably correctly reclassified in the 2013 publication of DSM-5 as a condition in its own right, however it does become somewhat complicated because some people with Obsessive-Compulsive Disorder will hoard for very specific obsessive worries/fears, and should still be diagnosed as having OCD rather than hoarding disorder.
More information about hoarding can be found here.
Rumination is a term often used to describe all obsessional intrusive thoughts, and the definition of rumination perhaps helps encourage that belief “a deep or considered thought about something”, but this is slightly misleading from an OCD context.
In the context of OCD a rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive. Unlike obsessional thoughts, ruminations are not objectionable and are indulged rather than resisted. Many ruminations dwell on religious, philosophical, or metaphysical topics, such as the origins of the universe, life after death, the nature of morality, and so on.
One such example might be where a person dwells on the time-consuming question: ‘Is everyone basically good?’. They would ruminate on this for a long period of time, going over in their mind various considerations and arguments, and contemplating what superficially appeared to them to be compelling evidence.
Another example might be someone that ruminates about what would happen to them after death. They would weigh up the various theoretical possibilities, visualise scenes of heaven, hell, and other worlds and try to remember what philosophers and scientists have said about death.
With most ruminations it inevitably never leads to a solution or satisfactory conclusion and the person appears to be deeply pre-occupied, very thoughtful, and detached.
In the context of OCD, are where a person generally suffers with obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature, for example, thoughts of causing violent or sexual harm to loved ones which don’t involve specific immediate compulsions these are called Intrusive Thoughts, and sometimes mistakenly referred to as ‘Pure O’.
However, the term is a little misleading like rumination above because everybody alive will have intrusive thoughts, of course it could be argued that everybody with OCD will have ‘intrusive thoughts’ i.e. their ‘obsessions’. But in reality even people without OCD will and do have intrusive thoughts, which can be both negative or positive, the thought of winning the lottery is technically an intrusive thought, just a pleasant one.
But from an OCD perspective it is generally assumed that the thoughts are both unpleasant and repetitive (constant) and it is generally accepted that when talking about OCD ‘Intrusive Thoughts’ it of the types listed below that can cover absolutely any subject, but the more common areas of OCD related concerns covers the following sub- categories:
Relationship Intrusive Thoughts – Obsessive doubts over the suitability of a relationship, one’s partner or one’s own sexuality are the main focus for the obsessional thoughts.
Obsessional thoughts include:
- Constantly analysing the depth of feelings for one’s partner, placing the partner and the relationship under a microscope and finding fault.
- Constantly needing to seek reassurance and approval from one’s partner.
- Doubts that one’s partner is being faithful.
- Doubts that one may cheat on their partner.
- Questioning one’s own sexuality, and having feelings, thoughts and impulses about being attracted to members of the same/opposite sex.
The constant analysing and questioning of the relationship and partner often places immense strain on the relationship, often causing a person with OCD to end the relationship to rid themselves of the doubt and anxiety. Unfortunately, this cycle is often repeated with any subsequent relationship.
Sexual Intrusive Thoughts – Obsessive thoughts of unintentionally causing inappropriate sexual harm (i.e. to children), or the constant questioning of one’s own sexuality are the main focuses for these obsessional doubts. Obsessional thoughts can include:
- Fearing being a paedophile and being sexually attracted to children.
- Fearing being sexually attracted to members of one’s own family.
- Fearing being attracted to members of the same sex (homosexual OCD) or for those who are gay fear of being attracted to members of the opposite sex.
- Thoughts about touching a child inappropriately.
- Intrusive sexual thoughts about God, saints or, religious figures.
The constant analysing and questioning of one’s own sexual preferences, or the thought of being attracted to a child, are perhaps two of the most mentally disturbing aspects of OCD and, because of the nature of the thoughts, many sufferers are reluctant to seek help from health professionals, fearing they may be labelled.
A person that experiences these types of intrusive thoughts will avoid public places, like shopping centres, in an attempt to avoid coming into close contact with children. They may also avoid spending time with younger members of the family. A parent with this type of OCD may avoid bathing and hugging their own children which can lead to emotional distress for both children and parent.
Magical Thinking Intrusive Thoughts – is the fear is that even thinking about something bad will make it more likely to happen – sometimes also called ‘thought-action fusion’.
Sufferers are beset by intrusive bad thoughts. They try to dispel them by performing rituals – magic rituals, in effect – that are often bizarre and time-consuming and involve linking actions or events that could not possibly be related to each other. For example having the thought ‘I may strangle someone’ is regarded as being as reprehensible as actually strangling a person. Another example is believing that simply imagining a horrific car crash will increase the likelihood of such a crash taking place, or a person may feel that if they don’t count to ten ‘just right’ harm will come to a family member. Other examples of magical thinking, or thought-action fusion intrusive thoughts include:
- A certain colour or number has good or bad luck associated with it.
- Certain days have good or bad luck associated with them.
- A loved one’s death can be predicted.
- One’s thoughts can cause disasters to occur.
- Stepping on cracks in the pavement can make bad things happen.
- Whatever comes to mind can come true.
- Breaking chain letters will actually bring bad luck.
- Attending a funeral will bring death.
- One can inadvertently cause harm to others with thoughts or carelessness.
- Hearing the word ‘death’ will mean repeating the word ‘life’ to prevent death.
In each example listed above, the thoughts and events happening could not possibly ever be linked, but the person with OCD will believe that this possibility does exist, and as a result, this will cause them immense stress and anxiety. As a result, their silent internal compulsive behaviours will take hours, and often prevent them interacting with anyone else during this time.
Religious Intrusive Thoughts – OCD often fixates on areas of great importance and sensitivity and religion and matters of religious practice are prime candidates for OCD obsessions. Sometimes referred to as scrupulosity, religious intrusive thoughts include:
- Sins committed will never be forgiven by God and one will go to hell.
- One will have bad thoughts in a religious building.
- One will scream blasphemous words loudly in a religious location.
- Prayers have been omitted or recited incorrectly.
- Certain prayers must be said over and over again.
- Religious objects need to be touched or kissed repeatedly.
- One is always doing something sinful.
- Repetitive blasphemous thoughts.
- That the person has lost touch with God or their beliefs in some way.
- Intrusive sexual thoughts about God, saints or, religious figures.
- That the person has broken religious laws concerning speech, or dress or modesty.
- Intrusive bad thoughts that occur during prayer will contaminate and ruin or cancel out the value of these activities.
- The constant analysing and questioning of a person’s faith places immense strain on their beliefs and prevents the person deriving peace from their religion. As a result they will often avoid church and all religious practice out of fear of their thoughts.
Violent Intrusive Thoughts – obsessive fears of carrying out violent acts against loved ones or other people. Intrusive thoughts include:
- Violently harming children or loved ones.
- Killing innocent people.
- Using kitchen knives and other sharp objects (compulsion will include locking away knives and sharp objects).
- Jumping in front of a train or fast moving bus.
- Poisoning the food of loved ones (compulsion will include avoiding cooking for family).
- Acting on unwanted impulses, e.g. running someone over, stabbing someone.
- Thoughts about accidentally touching someone inappropriately, with the aim of hurting them.
Most sufferers with these types of fears often end up labelling themselves as a bad person, simply for having the thoughts. They falsely believe that having the thoughts means they are capable of acting upon them. The constant analysing and questioning of these disturbing aspects of OCD becomes incredibly upsetting and because of the nature of the thoughts many sufferers are reluctant to open up to health professionals to seek help, fearing they may be labelled.
A person with these types of intrusive thoughts will avoid public places like shopping centres and other places, where social interaction may be required, to avoid coming into close contact with people that may trigger the obsessive thoughts.
An hyperawareness of particular bodily sensations, also sometimes called sensorimotor obsessions. Symptoms might include:
- breathing, obsession over whether breathing is shallow or deep, or the focus is on some other sensation of breathing.
- blinking, an obsessive fixation on blinking.
- Eye floaters/visual distractions, an obsessive fixation on eye floaters.
- swallowing/salivation, focussing on how frequently one swallows, the amount of salivation produced, or the sensation of swallowing itself.
- awareness of specific body parts, for example perception of the side of one’s nose while trying to read.
This form of OCD should not be confused with BDD where the obsession is more about perceived defects with body parts.
The intrusive thoughts are repetitive and not voluntarily produced, they cause the sufferer extreme distress – the very idea that they are capable of having such thoughts in the first place can be horrifying. However, what we do know is that people with Obsessive-Compulsive Disorder are the least likely people to actually act on the thoughts, partly because they find them so repugnant and go to great lengths to avoid them and prevent them happening.
To sufferers and non-sufferers alike, the thoughts and fears related to OCD can often seem profoundly shocking . It must be stressed, however, that they are just thoughts, and they are not voluntarily produced. Neither are they fantasies or impulses which will be acted upon.
We have chosen not to list anything about Pure O on this page because it’s an unhelpful and not an officially recognised medical term. But more information about ‘Pure O’ can be found here. But all of the above will include both mental and physical compulsions, which is why the term ‘Pure O’ remains unhelpful.
The need to have everything lined up symmetrically just ‘right’ is the compulsion, the obsessive fear might be to ensure everything feels ‘just right’ to prevent discomfort or sometimes to prevent harm occurring (see Magical Thinking). Examples include:
Those affected will spend a lot of time trying to get the symmetry ‘just right’ and this time consuming checking can result in them being extremely late for work and appointments. They may also become mentally and physically drained if the compulsions take a considerable amount of time. The sufferer may also avoid social contact at home to prevent the symmetry and order being disrupted which can have a negative impact on social interaction and relationships.
The above list categorises the more common forms of Obsessive-Compulsive Disorder and some of the fears associated with them. But this is by no means an exhaustive list and there will always be other OCD types not listed here. So if you’re experiencing distressing and unwanted obsessions or compulsions not listed here, this does not mean it is definitely not OCD, if these impact significantly on your everyday functioning this could still represent a principal component in the clinical diagnosis of Obsessive-Compulsive Disorder and you should consult a doctor for a formal diagnosis.
Regardless of the type of OCD a person may be suffering with, the following three components are generally present, triggers, avoidance and reassurance, but what do they all mean?
A trigger is the original source of the obsessional worry, that could be a place, person or object that sets off the obsession, a feeling of discomfort, or indeed a compulsive urge.
A trigger may be a physical object or an internal mental thought. For example, a person had the obsessional thought about stabbing someone every time they saw a knife or any other sharp object, so seeing the knife was the trigger that provoked the obsessions and compulsions.
In order to avoid hours of anguish this person would avoid knifes at all costs.
An example of an internal mental trigger is where a person experienced distressing obsessions about death every time they thought about their deceased father. The memory of their father was the internal trigger for the obsessional thoughts.
What generally happens is a person with OCD will find their obsessions and compulsions so frightening, scary and mentally and physically draining, that they will go to great lengths to avoid triggers that instigate hours of obsessions and compulsions.
Avoidance is a common compulsive behaviour, and is where a person with OCD avoids the objects, places or person/people that they feel trigger their OCD. This will be their way of preventing the distress and anguish, and the hours of rituals they will be compelled to perform.
- Examples include those with checking compulsions that may avoid tasks or situations that will increase their sense of responsibility and/or feel unsafe.
- A person who had the obsessional thought that they might stab their children avoiding contact with knives, scissors, and other sharp objects.
- A person, who feared that they might catch AIDS/HIV, avoiding certain areas of London which was, in their mind, associated with AIDS/HIV.
- In some cases, certain ‘unsafe’ numbers, letters, or colours are avoided because a person feels that such avoidance is necessary to prevent something bad from happening.
The person affected by OCD will often seek reassurance that what they fear isn’t a reality.
The reassurance will usually be from a loved one or via sources such as Google or local news outlets, particularly if the worry is about causing an accident or committing a crime. Frequently the obsessional worry is that something bad may have happened to a loved one, so they will repeatedly check that their loved one is ok. Another obsessional fear leading to reassurance seeking compulsions is worries that their partner may no longer have feelings for them or love them or they may have upset their loved one.
There are several terms and acronyms used within the OCD community and amongst health professionals which often lead to confusion.
One such term which sometimes causes confusion is the word ‘ritual’, which some people, even health professionals, confuse and refer to as a ‘compulsion’.
Whilst it is true that a ritual is a compulsive behaviour (physical or mental), it is not just one specific compulsive behaviour, it is more a set pattern of behaviours with a clear defined starting point and end point . For example, ‘rub left side of face first, and then right side of face, then forehead’. In many cases if the sufferer is interrupted during their ritual process then their OCD will dictate they must start the ritual again from the very beginning.
The term ‘spike’ is also confusingly used, mainly by the OCD community on OCD message boards on the internet. There seems to be two main uses of the term.
The first is when it is used to describe the initial obsessional ‘trigger’, which then causes the anxiety and distress. So for example, someone afraid of hitting a cyclist when driving will use the term ‘spike’ to refer to the cyclist they see ahead of them which triggers their obsessions and compulsions.
Another use for the term ‘spike’ in an OCD context is when it is used to describe the increase in anxiety caused by the obsessional thoughts. So in the example above, the person afraid of hurting a cyclist when driving will find seeing a cyclist causes their obsessive thoughts to increase, ‘spike’ their anxiety.
At present there is no official definitive explanation as to what the term ‘spike’ actually means, but the general consensus is that the term ‘spike’ is used to describe the combination of the OCD trigger, obsession, and distress caused by the anxiety. For this reason, and to avoid any confusion, we generally try and avoid using the term ‘spike’ in our writings where possible to ensure there is no loss of meaning or context.
Some people use acronyms to refer to different types of OCD. It is worth noting that these acronyms have no official medical meaning and are used mainly by the OCD community on OCD message boards on the internet. One of the problems with these acronyms is they have often been confused to mean different things to different people. For informational purposes the three main commonly used acronyms are:
This in itself is an unhelpful term, because whilst it’s meant to refer to a straight person who fears being gay, we know that the exact same type of OCD can impact on gay people with obsessional fears about being straight. So really a much better acronym (if they have to be used) should be SOOCD – sexual orientation OCD.
POCD is also used frequently to describe prenatal and postpartum OCD and ‘Pure O’, but it is widely accepted to mean Paedophile OCD. We know that those with this type of OCD often deliberately use the POCD acronym to avoid saying and using the word paedophile. Since part of recovery is accepting and getting used to the thoughts, accepting and using this word could be the first step towards that.
Because these terms have no medical meaning and to avoid any confusion, we generally try and avoid using the acronyms in our writings where possible to ensure there is no loss of meaning or context.
In fact, we actively discourage their use because we have seen on multiple occasions the use of the acronyms leading to some users experiencing a delay in accessing treatment. This happens where a person will seek specialists in (H/P/R)OCD but are unable to find any, since they’re not medically recognised terms. In fact, we don’t recommend therapists that specialise in any one type of OCD, because all forms of OCD have the same treatment approach, addressing the O part and the C part.
It may also hinder progress in understanding and tackling OCD because we know that OCD frequently changes guise chameleon-like (remember what we said about it focusing on objects/people that were important to us), as that changes in life, often so does OCD. So it’s important we treat OCD and not the (H/P/R).
The good news is they’re all equally as treatable through Cognitive Behavioural Therapy (CBT) by any therapist that knows and understands OCD.
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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of Obsessive-Compulsive Disorder or any other medical condition. OCD-UK have taken all reasonable care in compiling this information, but always recommend consulting a doctor or other suitably qualified health professional for diagnosis and treatment of Obsessive-Compulsive Disorder or any other medical condition.