Obsessive-compulsive disorder (OCD) can look different from person to person. OCD can center around many different thoughts and fears, some of which can be difficult to understand or talk about.
Rogers Behavioal Health’s Dr. Andrea Hartman, PsyD, regional clinical director, explains common OCD themes, how they can affect daily life, and how treatment offers hope.
What is OCD?
OCD is a mental health condition that involves obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images or urges, while compulsions are behaviors or mental acts a person feels driven to perform. They’re very overwhelming and create a lot of anxiety. They also take up a lot of a person’s time and energy, making it difficult to engage in everyday life.
What is an OCD subtype?
OCD can show up in many different ways. We often use the term subtype to describe the different themes within someone’s OCD. Identifying the subtype helps to give clarity and understanding to a person’s experience.
What are different OCD subtypes?
Common OCD subtypes include:
- Contamination
- Harm
- Sexual thoughts, including pedophilia or sexual orientation
- Moral or religious scrupulosity
- Relationship
- Worries about physical sensations or health
- Just right – a strong need to feel or be “just right”
- Checking
There’s no rhyme or reason as to why someone has a particular subtype or theme. For example, a person may have a fear that the soap in their home isn’t safe or is dirty, even though soap is used for cleaning. They know that logically it doesn’t make sense, and that creates a lot of frustration.
Are some OCD subtypes more common than others?
We often hear about contamination OCD, but harm-related and sexual obsessions are also very common. These thoughts can be especially frightening and upsetting, so people tend to be hesitant to talk about them or ask for help. There can be a lot of stigma around these themes, which can cause people to feel ashamed or even afraid.
How do the different subtypes affect someone’s daily life?
Regardless of the theme or subtype, one of the main characteristics of OCD is that it impacts a person’s ability to function in their everyday life. OCD may make it difficult to:
- Go to work or school
- Spend time with friends and family
- Complete everyday activities such as showering, eating, getting dressed, brushing their teeth, or washing their hands
- Drive or use public transportation for appointments or errands
Physical symptoms
Due to the anxiety the thoughts create, people can experience physical symptoms including:
- Rapid heart rate
- Nausea
- Sweating
- Dizziness
Emotional symptoms
OCD can affect a person emotionally in several ways, including:
- Distress: OCD can be extremely distressing. For example, someone may have intrusive thoughts about hurting their baby. Because they love their baby and would never want to hurt them, it can feel terrifying.
- Mental space: OCD takes up a lot of mental space. Someone may get stuck on a thought and have trouble moving past it, making it difficult to focus on other things. For example, a person at the grocery store may find it hard to shop because they’re consumed by an intrusive thought or the need to perform a compulsion.
- Isolation: Oftentimes, people we see at Rogers have such severe OCD that their world has gotten very small. They have less contact with loved ones and don’t participate in hobbies or activities they enjoy, like sports or volunteering. Over time, this isolation can contribute to feelings of loneliness and depression.
Can OCD themes switch or could someone have multiple themes?
It’s very common to have multiple themes. In fact, I would say it’s rare to experience just one. It’s also very common for themes to switch over time, and there isn’t a set time period for when that can happen. For example, someone could mostly struggle with contamination or perfectionism OCD when they’re 12, then as a young adult, they can start to have more harm or sexual obsessions. There isn’t a rule about how many themes you can have at any given time.
In addition, sometimes, OCD can latch on to the things that we care about the most. I like to think of OCD as a bully. It doesn’t want you to get better.
Is the same treatment effective for all OCD subtypes?
Yes! The same treatment is effective for all OCD subtypes. The skills a person learns in treatment can translate across all subtypes and are relevant for all ages.
During exposure and response prevention (ERP) therapy, a person identifies and rates their fears, and a clinician works with them to gradually face their fears while resisting compulsive behaviors. Over time, people learn that what they feared may not happen. Or if it did, they learn that they can cope with the anxiety without doing their compulsions, and the outcome isn’t as bad as they thought it was going to be.
How can loved ones offer support, especially for more stigmatized themes?
I have four recommendations for supporting someone with OCD:
First and foremost, listen. Validate that it’s scary. I’ve worked with individuals who haven’t shared what they’re experiencing with anyone for fear of people’s reactions.
Be mindful of language. Don’t say things like, “That’s so OCD.” OCD is a complex mental health challenge that makes life very difficult. Making blanket statements like that can minimize the true challenges people with OCD experience.
Support them in getting help from someone who specializes in treating OCD.
Recognize that they’re doing the best they can. I’ve yet to meet a person who enjoys checking their lock 50 times before leaving home. Giving them grace and compassion that they’re doing their best can help them feel supported while making that next step to get help
What is the one thing you want people to know about OCD?
With all mental health disorders, we want an explanation. We want an answer to the question of, “Why am I experiencing this?” Someone may be depressed because they’re going through a divorce or they just lost a friend. A lot of times with OCD, there isn’t a why.
One of the things I love most about working with people who have OCD is being able to offer real hope. We do not have to figure out exactly why someone developed OCD or know the why in order for them to get better. It doesn’t matter why you have OCD. Regardless of the cause, we know how to treat OCD and that recovery is possible.
Rogers offers OCD treatment
We understand how difficult it is to live with OCD. We offer OCD treatment for children, teens, and adults. Our experienced and compassionate care teams can help you manage your symptoms so that you can get back to the life you want to live.
For a free, confidential screening, call 833-308-5887.
OCD subtypes, also called themes, describe the different thoughts, fears or concerns that can become part of a person’s OCD.
Common OCD themes include contamination, harm, sexual thoughts, moral or religious scrupulosity, relationship concerns, worries about health or physical sensations, “just right” concerns and checking.
Yes. It’s common for someone with OCD to experience multiple themes at the same time.
Yes. OCD themes can change throughout a person’s life, and there is no set timeline for when a new theme may emerge.
Regardless of the theme, OCD can take up significant time and mental energy. It may make it difficult to work, attend school, spend time with loved ones or complete everyday activities.
Yes. Exposure and response prevention (ERP) can be used to treat different OCD themes. During treatment, people gradually face their fears while learning to resist compulsive behaviors.
