Briana Gonzalez-Evans, MA, LPC-Associate
Supervised by Jennifer Buffalo, LPC-S, LMFT
When some people hear "OCD," the first thing that often comes to mind is a person obsessively cleaning, organizing, or rearranging objects to be symmetrical. Popular portrayals of OCD in TV shows and movies tend to focus on these symptoms, leading to misconceptions about what the disorder truly entails. While it is true that some individuals with OCD experience these symptoms, the reality is far more complex. Obsessive-Compulsive Disorder (OCD) can manifest in many different ways, and it goes far beyond the commonly recognized behaviors of tidiness or symmetry.
Pure OCD (Intrusive Thoughts)
Pure OCD, also known as "just thoughts," doesn’t necessarily involve any visible compulsions. Instead, it centers around distressing, unwanted thoughts, often violent, sexual, or socially inappropriate. These thoughts can be so intrusive and disturbing that the person fears they will act on them, even though they have no intention of doing so. For example, someone with Pure OCD may have thoughts about harming a loved one, but never actually act on these thoughts. However, the anxiety and fear that come with these obsessions can be overwhelming and lead to significant distress.
Relationship OCD
Relationship OCD involves obsessive doubts and fears about one's romantic relationship. Someone with relationship OCD might constantly question whether they truly love their partner, worry about their partner's love for them, or fixate on perceived flaws. These doubts lead to compulsions such as seeking reassurance, comparing their relationship to others, or mentally reviewing past interactions. Relationship OCD can cause distress even in healthy, loving relationships.
Harm OCD
Harm OCD is characterized by intrusive thoughts or images of causing harm to oneself or others. People with this form of OCD may fear accidentally harming someone (e.g., thinking they will run over someone while driving) or may become fixated on the idea that they will hurt someone intentionally, even though they have no desire to do so. These thoughts often lead to intense anxiety and compulsions such as avoiding certain situations, checking that harm hasn’t occurred, or seeking constant reassurance that no damage has been caused.
Contamination OCD
Contamination OCD involves the obsession that one might become contaminated by dirt, germs, or chemicals. This type of OCD can lead to compulsive behaviors like excessive washing, disinfecting, or avoiding certain places or people out of fear of contamination. The anxiety surrounding contamination is not always related to cleanliness or hygiene in the conventional sense but can be a much deeper and more debilitating fear of illness or contamination.
Rumination OCD
Rumination OCD involves obsessive and repetitive thinking about a specific topic or issue. This can include constant overthinking about past events, perceived mistakes, or hypothetical scenarios. For example, someone might repeatedly worry about a comment they made years ago or obsessively replay past interactions. This ruminating is often done to "figure it out" or make sense of the situation. Still, it can trap the individual in a cycle of endless thinking that only increases anxiety and prevents emotional resolution.
Checking OCD
Individuals with checking OCD feel a strong urge to check things repeatedly, such as locking doors, turning off appliances, or ensuring that they haven’t harmed someone. These compulsions are driven by a fear that something will go wrong if they don’t check multiple times. For instance, someone with checking OCD may constantly check that they haven’t left the stove on, even after they’ve already checked it several times. The checking often provides temporary relief, but the anxiety inevitably returns, fueling the need for more checks.
Organizational/Symmetrical OCD
Organizational or Symmetrical OCD involves a compulsion to arrange objects in a certain order, often based on personal preferences for symmetry or organization. Anxiety arises when things are "out of place" or asymmetrical, which can lead to extensive organizing, rearranging, or aligning objects to reduce distress. While this may seem similar to a preference for neatness, it goes beyond mere organization—it becomes a compulsion driven by a need to achieve a specific sense of order to reduce anxiety.
Magical Thinking OCD
Magical Thinking OCD is the belief that specific actions, thoughts, or rituals can influence outcomes in the world, even when there is no logical connection. For example, someone with Magical Thinking OCD may feel that if they don’t perform a specific ritual, something bad will happen to their loved ones. These rituals can range from specific numbers or arrangements to mental rituals like saying certain words or phrases. The individual’s anxiety is rooted in the fear that their thoughts or actions have power over real-world events, which leads to compulsive behaviors meant to counteract perceived bad outcomes.
Religious OCD (Scrupulosity)
Religious OCD, also known as scrupulosity, involves obsessive fears or doubts about religious or moral conduct. This can include excessive fear of sinning, concerns about not being "good enough" in the eyes of God, or compulsive rituals meant to ensure one’s moral purity. For example, someone with religious OCD may engage in constant prayer or repetitive confessions to alleviate the fear of offending their faith. These rituals can become all-consuming, leading to extreme guilt, shame, and emotional distress.
Health Anxiety OCD (Hypochondriasis OCD)
Health Anxiety OCD involves obsessive fears about having or developing a serious illness. Unlike general health anxiety, which may involve occasional worry, those with Health Anxiety OCD experience relentless, intrusive thoughts about their health, leading to compulsions such as:
- Constantly checking their body for symptoms
- Googling diseases excessively
- Seeking frequent medical tests or reassurance from doctors
- Avoiding medical settings for fear of bad news
Even when medical tests confirm that they are healthy, they struggle to believe it, leading to further checking and reassurance-seeking behaviors.
Breaking the Stigma: OCD Is Not Just About Cleanliness
OCD affects people in diverse and complex ways. It’s not just about being neat, organized, or obsessing over cleanliness. While some may experience those symptoms, OCD can manifest in many other forms, each one with its own unique challenges. Understanding these various presentations of OCD is essential in destigmatizing the disorder and offering support to those who suffer from it.
If you or someone you know is struggling with OCD, it’s important to recognize that treatment is available. Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), is a well-established and effective treatment for OCD. Therapy helps individuals challenge their compulsions and learn to tolerate distressing thoughts without performing the rituals. Medication, such as SSRIs, may also be helpful for some individuals in managing symptoms.
If you are struggling with OCD, consider reaching out for a complimentary 30-minute consultation. This consultation lets you discuss your experiences and needs with a qualified therapist. Therapy can provide a safe and supportive environment to process these experiences and begin the journey toward healing.
