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OCD Types

OCD Types can be Grouped by Symptoms

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Updated August 23, 2010

Everyone’s Experience is Different

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a broad definition of obsessive-compulsive disorder (OCD) that includes the presence of obsessions and/or compulsions that cause major distress or disruption to daily living. However, the way in which symptoms of OCD are experienced varies widely from person to person. Clinicians and researchers have suggested that OCD can be divided into different types based on the nature of the symptoms experienced.

There are Five Distinct OCD Types

Research and clinical experience has suggested five major OCD types:

  • Contamination obsessions with washing/cleaning compulsions: If you are affected by this symptom subtype you will usually focus on feelings of discomfort associated with contamination and wash or clean excessively to reduce these feelings of distress. For example, you might feel that your hands are dirty or contaminated after touching a door knob or worry that you will contaminate others with your germs. To get rid of these feelings, you might wash your hands repeatedly, for hours at a time.

  • Harm obsessions with checking compulsions: If you experience this symptom subtype you will often have intense thoughts related to possible harm to yourself or others and use checking rituals to relieve your distress. For example, you might imagine your house burning down and then continually drive by your house to make sure that there is no fire. In addition, you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.

  • Obsessions without visible compulsions or so-called “pure obsessions”: This symptom subtype often relates to unwanted obsessions surrounding sexual, religious or aggressive themes. For example, you could experience intrusive thoughts about being a rapist or that you will attack someone. You may often use mental rituals such as reciting particular words, counting in your head or praying to relieve the anxiety you experience when you have these involuntary thoughts. Triggers related to obsessions are usually avoided at all costs.

  • Symmetry obsessions with ordering, arranging and counting compulsions: When experiencing this subtype you feel a strong need to arrange and rearrange objects until they are “just right”. For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color. This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging and counting compulsions are carried out to ward off potential danger (“If I arrange my desk perfectly my husband won’t die in a car accident”); however, this is not always the case.

  • Hoarding: Hoarding involves the collection of items that are judged to be of limited value by others such as old magazines, clothes, receipts, junk mail, notes or containers. Often your living space becomes so consumed with clutter that it becomes impossible to live in. Hoarding is often accompanied by obsessional fears of losing items or possessions which may be needed one day and excessive emotional attachment to objects. People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes and are often unable to maintain steady employment. Importantly, compulsive hoarding can occur independent of OCD.

Is it Possible to Have Overlapping OCD Types?

Although the experience of a particular symptom types appears to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms over time. In addition, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.

Does OCD Type Influence Treatment?

Deciding on a course of treatment for OCD depends on many factors including:

In general, most OCD types respond to some combination of cognitive-behavior therapy, exposure and response prevention and medication. An important exception may be hoarding which does not seem to improve with medication, but does seem to respond to psychotherapy. Nevertheless, it may be useful for you to discuss with your psychologist and/or physician the ways in which ERP, CBT or medication can be adjusted for maximum benefit based on your symptoms.

Sources:

American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

Jefferys, D., & Moore, K.A. “Pathological Hoarding” Australian Family Physician 2008 37: 237-241.

McKay, D., Abramowtiz, J.S., Calamari, J.E., Kyrios, M., Radomski, A., Sookman, D., Taylor, S., & Wilhelm, S. “A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms” Clinical Psychology Review 2004 24: 283-313.

Starcevic, V., & Brakoulias, V. “Symptom subtypes of obsessive-compulsive disorder: are they relevant for treatment?” Australian and New Zealand Journal of Psychiatry 2008 42: 651-661.

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