Understanding the Different Subtypes of OCD

Obsessive-Compulsive Disorder (OCD) is a complex mental health condition that goes beyond the common stereotype of excessive handwashing or a need for perfect organization. OCD manifests in various forms, with different subtypes affecting individuals in unique ways. Understanding these subtypes can help in recognizing symptoms and seeking appropriate treatment.

1. Checking OCD

What It Is

Checking OCD revolves around the fear of something bad happening due to negligence. Individuals repeatedly check things to ensure safety and prevent harm.

Common Compulsions

• Repeatedly checking locks, stoves, or appliances

• Re-reading emails or messages excessively to ensure no mistakes

• Seeking reassurance from others about safety

• Checking one’s body for signs of illness

Core Fear

Accidentally causing harm to oneself or others due to carelessness.

2. Intrusive Thoughts/Pure O OCD

What It Is

Often called “Pure O” (Purely Obsessional OCD), this subtype involves intrusive, unwanted thoughts, images, or urges that cause severe anxiety. Unlike other subtypes, compulsions may be mostly mental rather than physical.

Common Obsessions

• Fears of harming loved ones (e.g., “What if I lose control and hurt someone?”)

• Disturbing sexual thoughts (e.g., intrusive fears about inappropriate desires)

• Existential or philosophical obsessions (e.g., questioning reality excessively)

Common Compulsions

• Mentally analyzing or “undoing” disturbing thoughts

• Repeating prayers or affirmations to neutralize anxiety

• Avoiding triggers (e.g., staying away from children due to intrusive thoughts of harm)

• Seeking reassurance from others

Core Fear

That these thoughts mean something bad about the person or that they will act on them.

3. Hoarding OCD (Different from Hoarding Disorder)

What It Is

Hoarding OCD involves a fear of discarding objects due to the belief that something bad will happen if they do. While similar to Hoarding Disorder, Hoarding OCD is driven more by obsessive fears rather than attachment to possessions.

Common Compulsions

• Holding onto items due to fear of needing them in the future

• Avoiding discarding things that seem unimportant

• Repeatedly organizing and checking saved items

Core Fear

That discarding something will lead to regret or disaster.

4. Relationship OCD (ROCD)

What It Is

ROCD involves obsessive doubts and fears about relationships, whether romantic, platonic, or familial. Individuals constantly question their feelings or their partner’s commitment.

Common Obsessions

• “Do I really love my partner?”

• “What if I’m with the wrong person?”

• “What if my partner doesn’t love me enough?”

Common Compulsions

• Repeatedly analyzing feelings toward a partner

• Seeking reassurance from friends or family

• Comparing one’s relationship to others

• Avoiding relationships due to fear of making the wrong choice

Core Fear

Being trapped in the wrong relationship or making a catastrophic romantic mistake.

5. Harm OCD

What It Is

Harm OCD involves intrusive thoughts about causing harm to oneself or others, even though the person has no actual desire to act on them. These thoughts create significant distress.

Common Obsessions

• “What if I lose control and stab someone?”

• “What if I push someone into traffic?”

• “What if I harm my child?”

Common Compulsions

• Avoiding sharp objects or dangerous situations

• Seeking reassurance that they are not dangerous

• Mentally checking or reviewing past behavior to confirm they haven’t harmed anyone

Core Fear

Causing harm due to loss of control.

6. Scrupulosity OCD (Religious or Moral OCD)

What It Is

Scrupulosity OCD involves obsessive concerns about morality, sin, or religious purity. Individuals fear they have done or thought something blasphemous or immoral.

Common Obsessions

• “What if I offended God by accident?”

• “What if I’m living sinfully?”

• “What if I didn’t confess my sins properly?”

Common Compulsions

• Excessive praying or confessing

• Avoiding religious discussions for fear of blasphemy

• Seeking reassurance from religious figures

• Ruminating on past mistakes

Core Fear

Being morally or spiritually condemned.

Treatment for OCD

While OCD can be challenging, effective treatment is available. Common approaches include:

• Cognitive Behavioral Therapy (CBT) – Specifically, Exposure and Response Prevention (ERP), which helps individuals gradually face their fears without engaging in compulsions.

• Medication – Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed to help manage symptoms.

• Mindfulness & Acceptance-Based Approaches – Learning to accept uncertainty and let thoughts pass without engaging in compulsions.

Final Thoughts

OCD is not a “one-size-fits-all” disorder—its subtypes can look vastly different from person to person. If you or someone you know is struggling, seeking professional help can make a huge difference. In treating OCD, I use research-backed therapies (ERP & CBT) to help change your response to your fears. With this kind of treatment, individuals with OCD can learn to manage their symptoms and live fulfilling lives. Please reach out to me if you have any questions about my approach to treating OCD or if you are interested in scheduling a consultation for therapy.