The Diversity of OCD

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Obsessive-Compulsive Disorder (OCD) causes sufferers to obsess continuously over their moral character. Intrusive thoughts occur about anything and everything, but it’s primarily the dark ideations that become obsessions. Unsurprisingly, the breadth of individual principles yields an extensive diversity of obsessions and an even greater compulsive dimension. However, there are many near-universal standards—don’t harm the innocent, don’t cheat in a closed relationship, don’t sexually assault people (especially children), avoid lying, maintain your moral or religious beliefs, and so on—that create common themes in intrusive thoughts and their resulting obsessions.

Categorizing common motifs improves and expedites discussions of OCD. Grouping threats enables statements like “I have X OCD” to communicate a significant amount of information and orient a conversation.  The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) doesn’t recognize any subsets of OCD, but I don’t think they need to or even should do so. Colloquial definitions of OCD themes satisfy daily conversations.

The rest of this article will summarize the most common subcategories of OCD. If I’ve missed any categories, please contact me (link contact form), and I’ll research it as soon as I have time. The category titles will also link to in-depth articles that I publish concerning that sub-type of OCD.

Disclaimer

As noted in my site disclaimer, I am not a medical or legal authority. The following sub-types are based on personal experience, conversations with friends, and common categories found in support circles and online.

OCD Sub-types

Contamination

Perhaps the most well-known subset of OCD, contamination fears derive from excessive disgust. People with contamination fears may be strongly germaphobic but could also fear certain sensations. Common compulsions include excessive washing to the point of cracked skin and even bleeding, avoiding certain locations—such as restrooms—and objects, and avoiding offering people items. As an example, the article “The Cockroach, I Guess” details one of my contamination fears.

Existential OCD (EOCD)

Many people speculate about philosophical questions such as “What is the purpose of life?” Those with EOCD become completely obsessed with finding the “right” answer to such questions. The sufferer endlessly and futilely searches for certainty that they will never find as many philosophical questions either have no right answer or many people claiming different “right” answers. People with EOCD may study and question excessively, seek constant reassurance about their beliefs, and desperately seek out philosophers or religious authorities to inform them.

Harm OCD

No category, in my opinion, contains more threats and compulsions than Harm OCD; this doesn’t necessarily mean it’s the “worst sub-type” (there is no such thing), but rather comments on the breadth that harm threats cover. People with Harm OCD fear injuring others in some form and experience disturbing intrusive images. The sufferer doesn’t have to be the perpetrator either: believing that inaction will bring harm can trigger Harm OCD. Furthermore, the intrusive thoughts can include the future desire to harm others. In other words, harm threats include fears of direct actions, desiring to perform direct actions, and indirectly enabling harmful events. Between the temporal and functional flexibility of Harm OCD, almost anything may become a harm threat.

Direct Harm Threats

  • hitting someone with your car
  • stabbing your family with the kitchen knife you’re holding
  • becoming a serial killer
  • throwing that child off the mall balcony
  • infecting your patient

Indirect Harm Threats

  • not picking up that specific piece of thrash
  • not cleaning everything thoroughly
  • not checking for intruders in your house
  • not locking all your doors and windows

Interestingly, Harm OCD often incorporates other sub-types of OCD. The “infect your patient” fear stems from a contamination threat. They might see themselves as diseased and fear transferring that illness to people in their care and thus killing them. Causing harm can also amplify fears of sexually harming others, damning others for your actions, and so on.

HOCD compulsions include:

  • constantly checking your dashboard
  • never driving alone
  • refusing to touch a knife
  • only cutting vegetables when you’re alone in your residence
  • excessive cleaning
  • checking all locks in your house twice
  • avoiding train stations and balconies

Let’s finish this sub-type with a brief discussion of intrusive images. As discussed in “What is OCD Really?“, intrusive images are mental images akin to reliving a memory or imagining a future event. Harm OCD intrusive images can be quite graphic and may involve death or severe injury:

Warning: The following examples of harm intrusive images may be unsettling to some readers
  • slit wrists
  • burning bodies
  • eviscerated peers
  • mangled bodies in a crash
  • stabbed customers

I cannot tell you how many times I unwillingly envisioned wolves slaughtering my Scout troop when we were hiking or throwing hydrochloric acid on a lab mate at work.

Summarily, Harm OCD is both broad and can amplify other forms of OCD. You may notice harm threats sneaking into many open conversations with sufferers.

Homosexual OCD (HOCD)

I’m going to start this discussion with a personal hypothesis: HOCD only occurs when either the sufferer believes homosexuality is a sin or if the sufferer fears familial or social repercussions of being homosexual. People with HOCD worry that they are or may become homosexual. As aforementioned, OCD often questions a person’s moral system. While public acceptance of homosexuality in the United States continues to grow, enough people believe that homosexuality is immoral for HOCD to warrant an independent category. Individuals with HOCD may even be homosexual, but their OCD attacks them for their sexual interests. However, heterosexuals likely represent the majority of people with HOCD. Compulsions can include seeking reassurance of being heterosexual, consuming homosexual pornography and hyper-vigilantly monitoring their reaction, and constantly monitoring their emotional and physical states when around others of the same sex.

Pedophilia OCD (POCD)

POCD: the fear that one has, is, or will sexually abuse children. People with POCD believe that almost any interaction they have with a child is or will become sexually abusive. Similarly, sufferers obsess over previous interactions with children analyzing whether or not they abused them. Even just saying hello to a child can elicit intrusive thoughts and images of molestation and rape. Compulsions include avoiding children, staying inside, ensuring other adults accompany you if you cannot avoid being around children, and consuming legal pornographic material to reassure themselves that their only sexually attracted to adults.

Discussing this category of OCD in a broad sense doesn’t feel appropriate. Only a deep, emotionally difficult discussion feels suitable. As such, I will immediately conclude this discussion with a fact: there are parents with POCD.

Perfectionism

Another publicly recognized form of OCD, perfectionism encompasses any behavior involving exactness. Sufferers become obsessed over making errors in any given task and must complete them free of error. Popular examples include organizing and color coordinating items. However, these cases are misleading: the act of organization is rarely an end unto itself, but rather an attempt to neutralize an obsession. Basal perfectionism fears typically revolve around affecting others negatively if they complete a task imperfectly. This OCD category affects teaching, grading, painting, repairing, and much, much more. People with perfectionism may also excessively explain everything about a topic for fear that anything less than everything will result in loss of vital information. Superlative projects require immense amounts of time and effort—people with perfectionism OCD often take a long time to complete a project, possibly exceeding deadlines. However, the final result is often top-notch. While stressful excess in the pursuit of quality may be an intuitive compulsion, many sufferers completely avoid hobbies, activities, and projects as they know the stress they will incur.

Relationship OCD (ROCD)

People with ROCD constantly fear they will cheat on or similarly damage their relationship with a significant other. Every action feels like the first step down a dark road; every person becomes an unfaithful threat. Sufferers may entirely avoid people of their attractive gender, refuse to comment on others’ bodies or evade people entirely.

Scrupulosity

Scrupulosity questions the sufferers’ actions in the immediate context of their moral and ethical frameworks.

I view scrupulosity as a meta-category: scrupulosity OCD involves obsessions about offending a moral code. As opposed to other categories that oppose sufferers’ morals indirectly, scrupulosity questions the sufferers’ actions in the immediate context of their moral and ethical frameworks. Scrupulosity, sometimes referred to as Religious OCD, is easily defined within a religious framework. Any action, or a situational lack thereof, against a prescribed faith becomes grounds for instant and damningly severe repercussions. Interestingly, some sufferers hyper-focus on a single aspect of their religion while disregarding others. Since some public faith-based moral frameworks have clear delineations between right and wrong, intrusive thoughts have a clear offensive target. Outside of religion, scrupulosity is less obvious but not less common. Instead, the sufferer’s specific, often less public, ethics become the target of obsessions. Common compulsions include excessive praying, avoiding functions perceived as being morally risky, and constantly seeking forgiveness.

Sexual OCD

Sexual obsessions span the gamut from sexual attraction to rape. Truly anything involving sex or sexuality may become the subject of intrusive thoughts. I’ve known many sufferers afraid that they’re somehow and unintentionally flirting with a colleague. They become overly concerned with every word and bodily action they make in their coworker’s presence and actively attempt to avoid the appearance of flirting. Others also have intrusive images of having consensual sex with most everyone they see. The envisioned sexual acts might even occur at the person’s present location: in a store, school, or on a sidewalk. It’s common of OCD, in general, to fear that others know what you are thinking and that they’re judging or fear you because of them. Believing that every stranger you see knows you’re having sexually intrusive thoughts about them drives strong social anxiety. I intentionally specified consensual sex in the previous example as obsessions can include fears and images of committing rape—these scenarios may also include incest. Given the pervasiveness of intrusive thoughts, Sexual OCD latches on to numerous daily situations and turns them into sexually terrifying encounters.

Sexual OCD vs. Sexual Addiction

These two conditions are not synonymous. Individuals unable to control sex-related impulses—especially when the sexual activity causes negative consequences for the afflicted—suffer from sex addiction, not Sexual OCD. With OCD, the obsessions generate a fear of performing a sexual act, resulting in compulsive responses such as avoiding people, avoiding the attractive sex, and self harm. As a general rule, a person with OCD fears their obsession and act excessively and unnecessarily to avoid them. As such, they rarely, if ever, perform the content of the obsession, e.g. a sufferer with Harm OCD fears stabbing their family, so they hide their knives, but they don’t ever physically harm their loved ones.

Synthesis

Obsessive-Compulsive Disorder produces morally relevant obsessions that drive enormous amounts of fear and harmful compulsive activities. While grouping symptoms holds great utility, we must remember that each category does not exist in isolation. Most sufferers I know have several or even all of the aforementioned OCD sub-types. Harm OCD impacts most other OCD categories; I view POCD as a subset of Sexual OCD; Sexual OCD and ROCD are tightly knit; and so on. The forces of intrusive thoughts flow and ebb, mingle and twist, forever entwined as they thread through the brain. Each individuals’ OCD is unique, but understanding common trends provides a vital communication and empathy tool for connecting us all.

Have a great day and always practice self-compassion!

A Fantastic Friend of Mine

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