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Exploring the Subtypes of Obsessive-Compulsive Disorder (OCD)

Updated: Mar 25

Obsessive Compulsive Disorder (OCD) is a mental health condition that affects millions worldwide. In Canada, about 1 to 2% of the population has OCD. OCD is a disorder characterized by intrusive thoughts or images (obsession) that trigger intense discomfort and anxiety. As a result of experiencing these obsessions, individuals with this condition alleviate these distressing feelings by engaging in repetitive behaviours or mental rituals (compulsions).


Although there are some common ideas regarding how OCD presents itself, there are many subtypes of OCD that are not so widely recognized - each with its unique set of characteristics and behaviours. Living with this condition can be challenging since it can affect a person’s life significantly, regardless of the type. Its effects are impairing and distressing across all types. This highlights the importance of understanding and supporting individuals struggling with the impact of the different obsessive-compulsive disorder subtypes in their lives.


Subtypes of OCD Explained


People with OCD may notice that their obsessions and compulsions are focused on a specific theme. These themes are referred to as OCD subtypes. Knowing the various subtypes is essential in better understanding their unique symptoms and seeking treatment.


With this in mind, let us explore and understand the different subtypes associated with obsessive-compulsive behaviour.


Checking OCD


As its name implies, this subtype of OCD is known for its checking-based compulsive behaviours. People with this OCD subtype are known for their persistent doubts and fears that something terrible will occur if they do not give in to their compulsions. Their obsession may range from safety concerns to fears of making mistakes or behaving inappropriately.


For instance, a person with checking-based OCD will constantly check if the stove is turned off since they fear that they will be responsible if something bad happens. Using their checking-based compulsion as a neutralizing behaviour can help relieve their discomfort in the short-term but maintains the disorder over the long-term.


Common signs and behaviours of checking OCD:


  • Repetitive checking of appliances, locks, or switches

  • Constantly verifying that windows and doors are closed

  • Repeatedly checking written documents, texts, and emails to ensure they are free from errors

  • Feeling extremely anxious, distressed, or angry whenever their checking rituals are disrupted

Contamination OCD



There is more to contamination OCD than just the fear of germs. It is an obsession characterized by anxiety, distress, and intense fear of contracting a disease or transmitting germs.


The symptoms experienced by a person with contamination OCD can manifest differently depending on the person. For instance, avoiding the use of public restrooms or touching doorknobs for fear of bacteria or contracting illnesses. Individuals with this OCD subtype may compulsively wash their hands or shower to neutralize their fear of germs, dirt, or harmful substances. They find themselves spending too much time and energy to get rid of perceived threats and contamination – even though they may realize at a logical level that there is no need for this continued behaviour.


Common signs and behaviours of contamination OCD:


  • Excessively washing hands and using hand sanitizer

  • Avoidance of public transportation and crowded areas

  • Fear of getting in contact with objects or surfaces perceived as dirty or contaminated

  • Compulsive cleaning routines

Symmetry and Orderliness OCD


Individuals with symmetry and orderliness OCD are obsessed with arranging and rearranging objects until they are “just right”. While some may appreciate neatness and symmetry, it can be obsessive and frustrating for those with this condition. Individuals with this subtype often experience an intense need to arrange and organize things in symmetry.


Take, for example, constantly organizing your shoes according to type, material, and colour and meticulously lining them up so they’re all forming a neat row. Another manifestation of this subtype is repetitive thinking and stating words or sentences until the task is perfectly done. Unfortunately, their incessant pursuit of perfection can have a negative impact on their daily activities, causing significant distress.


Common signs and behaviours of symmetry and orderliness OCD:


  • Feelings of distress and discomfort when things are not arranged in the desired order

  • Spending too much time sorting and organizing stuff

  • Counting rituals or the need to count to a particular number a specific number of times

  • Anxious feeling that something unfortunate may occur if they fail to arrange or organize stuff in the right way

Intrusive Thoughts OCD (Pure O OCD)


Have you ever experienced thoughts that are intrusive, disturbing, and out of place? This flavor of OCD is often referred to as Pure O OCD as it looks like it primarily involves obsessions (however, it does include compulsions too, they just tend to be more internal and less visible to people when engaged in).


This subtype causes an individual to experience intrusive and distressing thoughts or mental images that are irrational, taboo, and violent. This can drive a person to seek reassurance from others or engage in mental rituals to neutralize these negative thoughts, like repeated affirmations of a specific phrase. This causes them to be extremely vigilant in terms of avoiding situations or triggers that will set off intrusive thoughts.


For some people intrusive thoughts are centered around harm-related concerns. The person may worry that they may spontaneously harm someone they love or even themselves. They may then try to avoid any possibility of this such as by avoiding kitchen knives, balconies, or other items or environments that their brain tells them are connected to the possibility of suddenly becoming a violent person. Intrusive thoughts can also be focused around sexual themes, with common unwanted intrusive thoughts for Pure O OCD including unwanted imagery regarding sexual acts, sexual activity with particular people, and worries about being a certain kind of person. For example, Pure O OCD sufferers may experience unwanted thoughts that lead them to believe they may be a pedophile, sexually deviant, or an unwanted sexual orientation. Common examples of these subtypes including Pedophilia OCD, Scrupulosity or Religious OCD, Homosexuality OCD, Transgender OCD, and other forms of Sexual Orientation OCD.


While people with OCD may have intrusive thoughts connected to these themes, the thoughts are ego-dystonic, meaning they are meaningless thoughts that have nothing to do with the person’s actual desires, intentions, or wishes. For example, in the case of Pedophilia OCD, the person may have thoughts and worries about being pedophile and experience tremendous distress and anxiety around these thoughts. This is different from the experience of actual pedophiles who experience these thoughts in an ego-syntonic way, meaning they are connected to their actual intentions or desires. Pedophiles want pedophilia-related thoughts, the person with pedophilia OCD is terrified by the intrusion of these thoughts and desperately tries to push them away or cancel them out.


Note: This reassurance is usually not enough to treat pedophilia OCD on its own as OCD always finds a way to say, “Well, it’s different in my case…”, or “How can I really be sure… maybe I am a pedophile…” OCD treatment including ERP and CBT is typically needed to treat these debilitating and incredibly painful experiences of Pure O OCD. 


Common signs and behaviours associated with intrusive thoughts OCD:


  • Experiencing continuous distressing thoughts or mental images of harm or violence

  • Repeated experiences of intrusive sexual thoughts and concerns about potentially acting on these kinds of thoughts

  • Feelings of anxiousness or uneasiness of losing control and acting on impulses or undesirable thoughts.

  • Engaging in mental rituals to overcome intrusive thoughts

  • Trying to neutralize, cancel, or delete unwanted thoughts

  • Engaging in specific behaviours to try to reduce the perceived risk associated with intrusive thoughts

  • Avoiding people, places, or items associated with the obsessive thoughts


Hoarding OCD


Known as a distinct diagnosis in the DSM-5-TR, hoarding OCD is characterized by the excessive collection of items that are of no value to others, such as old newspapers, receipts, containers, and clothes. People with hoarding OCD strongly experience the feeling of inability to discard items. They also have obsessional fears of losing stuff that they might need in the future and have an irrational attachment to objects. As a result, their living space can be cramped and cluttered, making it an undesirable place to live.


While hoarding is also associated with other OCD subtypes, anxiety and depression tend to be higher in individuals with this subtype, making it difficult to maintain steady jobs.


Common signs and behaviours of hoarding OCD:


  • Constantly worrying about throwing something that could harm you or other people

  • Compulsive buying of similar multiple items even those that are not needed

  • Feeling incomplete when not finding a possession or accidentally losing or throwing it away

  • A strong feeling to check or review belongings.


Treatment of Obsessive-Compulsive Disorder



Fortunately, the symptoms of obsessive-compulsive disorder are treatable. Seeking professional help is vital to address and treat various subtypes of OCD. Treatment can include a combination of medication and therapy and support.


Adhering to your unique treatment plan can help significantly improve the quality of life for OCD individuals. Proper support and resources can effectively help individuals manage the symptoms and regain control over their lives.


Therapy

Seeking cognitive-behavioural therapy (CBT) can provide individuals with relief from OCD. Exposure and Response Prevention (ERP) is a specific form of CBT that exposes patients to their fears while preventing them from resorting to compulsive behaviours. This therapeutic approach enables individuals to identify their obsessive thoughts, develop healthier coping mechanisms, and reduce their anxiety over time. Acceptance and Commitment Therapy (ACT) is also often used to help people with OCD, especially those experiencing primarily intrusive thoughts (often referred to as Pure O OCD to denote the seemingly primarily obsessive nature of these subtypes). ACT can be used to help individuals change their relationship to their thoughts, stand back from them, and no longer live their lives dictated by the thoughts arising in their minds. With a new relationship to thoughts and feelings, the person with OCD becomes more able to engage in what is important to them and find lasting relief from their OCD symptoms.


The therapist will work with the patient to identify their obsessions and compulsions. After successfully identifying your unhealthy thoughts and behaviours, the therapist will introduce different healthier coping mechanism techniques designed to challenge or change your relationship to your thoughts and resist the impulse to engage in compulsions that feed and worsen cycles of OCD.


Medication

The professional therapist will prescribe certain medications to alleviate the symptoms of OCD. A group of anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used medications for treating OCD symptoms, as they help regulate the levels of serotonin in the brain, as well as relieve anxiety and obsessive thoughts. Other medications that help with some symptoms include anti-anxiety and antipsychotic medications.


Support Groups

Another helpful factor in the treatment process in some cases can be support groups or peer support. This enables you to connect with people who understand and support you through the challenges of living with OCD. Also, support groups are a great source of validation, encouragement, and practical strategies for managing symptoms.


Seek Therapy for OCD


When it comes to OCD treatment, choose a licensed OCD therapist in Toronto. At Radcliffe Psychotherapy Clinic, we are committed to supporting patients with OCD of various subtypes and watching them cope and manage their symptoms with confidence. Our therapists use a variety of approaches including Exposure and Response Prevention (ERP), Cognitive-Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) to help you develop a new way to work with your OCD and live life free from the constraints of this often debilitating disorder.


If you are interested in learning more about how we can help you, call us today at (289) 801-4133 to book a consultation


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