When most people think of obsessive-compulsive disorder (OCD), they may think of a “neat freak,” someone who loves cleaning and keeping their space organized and mess free. Did you know that this is actually a common and harmful misconception surrounding this disorder? While worrying about cleanliness is a potential symptom of OCD, it is not the only one. This belief perpetuates the idea that OCD is not that bad of a mental illness. I mean, who wouldn’t want to love cleaning? The reality is that there are many subtypes of OCD that present with a multitude of different symptoms. These debilitating symptoms negatively impact the daily lives of people who have OCD, and this is what distinguishes someone from being a “neat freak” and someone with the disorder.

People who suffer from OCD have distressing, intrusive thoughts that they involuntarily obsess over. This causes the person to engage in repetitive behaviors or actions, called compulsions, to prevent, stop, or alleviate the anxiety from these thoughts. Such thoughts can stem from many areas, and this is where the subtypes of OCD come in.

Contamination OCD: Contamination OCD is more than just a person who enjoys keeping their space neat and clean. Intrusive thoughts can be centered around fear of catching an illness or of surfaces having germs, chemicals, or mold. They could be based on the fear that certain people or memories have made you unclean or that if you are not clean, then harm will come to the people around you.

Compulsions for contamination OCD could include excessive hand washing or showering, changing clothes frequently, avoiding people or places, or constantly using gloves and wipes. These compulsions may need to be done a certain number of times before the person feels that they have relieved themselves of their intrusive thoughts, which is what makes these actions disruptive to their daily lives. When a person cleans because of these intrusive thoughts, they are not doing it for fun, they are trying to find relief. 

Exposure and response prevention (ERP) therapy can be helpful in breaking a person out of their compulsions. For example, a person who worries about becoming contaminated from surfaces will be asked to touch a door handle and only wash their hands one time rather than whatever number they usually do. The patient has to sit with their intrusive thoughts and will hopefully realize that nothing bad will come from this. The goal is to take away power from the intrusive thoughts by stopping the compulsions.  

Relationship OCD (ROCD): For people who have ROCD, intrusive thoughts center around their romantic relationships. Some examples of intrusive thoughts include, “Do I really love X? Since I am questioning this, does that mean I’m dragging them along?” or “I don’t think X actually loves me. They seemed off earlier, so something must be wrong.” For someone without OCD, they may think that questioning a relationship like this means it's time to break up. But for someone with OCD, these thoughts become obsessive and extremely distressing. 

These intrusive thoughts play on a loop constantly, even if they aren’t true. ROCD especially loves to attack someone whose romantic relationship is healthy. Since the person cares so much about their partner, the fear of losing them creeps in, and ROCD latches onto that. OCD thrives on uncertainty and fear. 

Then come the compulsions. These compulsions commonly present through reassurance seeking. They might go to their partner and ask over and over again if they really love each other, even if their partner says yes every time. Each time they seek reassurance, the relief is only temporary and they are actually making their obsessive thoughts worse.

ERP is one of the most effective ways to stop this line of thinking. For ROCD, this could look like sitting with these uncomfortable thoughts and not seeking reassurance from a partner. While the intrusive thoughts might not go away completely, they stop being reinforced and may die down in intensity. 

Religious OCD (Scrupulosity): For someone with religious OCD, also known as scrupulosity, intrusive thoughts are based on their moral beliefs and religious practices. For example, they might worry about properly practicing their religion or performing prayers correctly. Again, these thoughts sound like normal worries for religious people, but for someone with OCD, they are repetitive and obsessive. They may fear that what they are doing for their faith is never enough, leading to feelings of shame.

Compulsions for scrupulosity could look like repeatedly conducting religious acts until they feel they have gotten it “just right,” constantly repenting, even when it is unnecessary, double-checking their every move to ensure they are following their beliefs correctly, or punishing themselves for any thought they perceive as going against their religious beliefs. These compulsions are done to reassure themselves that they are properly practicing their religion. Since the reassurance is temporary, these acts start to disrupt their everyday lives.

ERP therapy is one of the best treatments used to stop this constant worry surrounding religion and morality. For someone suffering from scrupulosity, this could include attending religious services outside of their beliefs or reading material that they deem nonreligious. While this will be difficult at first, the person might realize that nothing bad came from these acts, showing that these thoughts and fears don’t hold power over them. 

Harm OCD: For people who have harm OCD, intrusive thoughts are based on violent imagery of committing aggressive acts against someone else. Because of these thoughts, they may believe they could possibly be violent towards others, and might begin to distrust themselves. These thoughts are obsessive, and even though the person does not want to harm anyone, their fears and worries persist.|

Compulsions for harm OCD could look like hiding objects that could be used as weapons out of fear of using them on someone else, reviewing their previous actions to ensure they did not hurt someone accidentally, avoiding violent news or movies to prevent triggering violent thoughts, or seeking reassurance from others to confirm they aren’t capable of hurting people. Just like the above subtypes, these compulsions only provide temporary relief and continue to reinforce the intrusive thoughts. 

ERP therapy can be used to help combat harm OCD. For example, if a person struggles with driving because they have intrusive thoughts about running someone over, they may avoid driving altogether. With ERP therapy, the patient would be asked to drive around in their car with their therapist in order to challenge the intrusive thought. While this can be distressing at first, it’ll show the patient that their intrusive thoughts do not control their actions, taking power away from OCD.

Health OCD: For people with health OCD, intrusive thoughts are based on their health and wellness. These people are commonly dismissed as hypochondriacs, but these thoughts disrupt their everyday lives. They may worry about getting cancer, having a deadly illness they are not aware of or having a heart attack. Anything that might feel “off” could be categorized as a possible health symptom, causing the person to obsess over any feeling in their body, even if it is imagined.

Compulsions for health OCD focus on reassuring the person that they are healthy and not dying. This could look like googling possible causes of the symptoms they are experiencing, visiting the doctor repeatedly, seeking advance testing even when it is not medically needed, or avoiding places and people who might give them an illness. Even if a medical professional tells the person they are completely healthy, the intrusive thoughts can still find a reason that something must be wrong. The reassurance is only temporary, and the intrusive thoughts will continue.

Similarly to the above subtypes, ERP therapy can be extremely helpful for dispelling intrusive thoughts for health OCD. For example, rather than turning to Doctor Google when these intrusive thoughts present, the patient will be asked to sit with these thoughts. A crucial part of treating health OCD is being okay with the unknown by saying, “I might get sick, I might not.” Life is full of uncertainties, and health OCD causes the person to obsess over the possibility that they could get ill one day. Accepting this uncertainty and not seeking reassurance online or from health professionals can help the person stop constantly worrying about their health.  

OCD is an extremely complex mental disorder, and this list only scratches the surface of the many subtypes people could present with. 1 in 40 adults will develop OCD in their lifetime, which is about 8.2 million people. The stereotypes that surround this mental illness are harmful to those 8 million individuals. A lack of awareness and understanding leads to people with OCD not having the support they need to recover.

If you or someone you know is suffering from OCD, there are treatment options. ERP therapy should be done with the help of a trained therapist. This style of therapy can be extremely difficult for someone with OCD, and if not done right, it can cause more harm than good. There are also a variety of medications for OCD. You don’t have to suffer alone from this debilitating mental disorder, so be sure to look for a licensed therapist near you.