What is OCD? Obsessive-Compulsive Disorder (OCD) is an anxiety disorder involving persistent, unwanted thoughts (obsessions) and repetitive actions (compulsions) intended to relieve anxiety. There are different types of OCD. Symptoms may look different for each person and often evolve over time. Although challenging, OCD can be managed effectively with therapy. Many people with OCD develop strengths including resilience, focus, and creative problem-solving.
Our Palo Alto, San Jose and Menlo Park therapists can help you recognize the strengths in OCD while working with you to relieve distressing symptoms.
Types of OCD
Understanding the different types of OCD helps in recognizing symptoms and finding the right support. Each type centers on specific obsessions and compulsions aimed at reducing distress. They can show up differently at different ages.
Contamination OCD
Contamination OCD is marked by an intense fear of germs, dirt, or harmful substances, leading to compulsions like excessive cleaning or avoidance. For example, a young child may refuse to touch toys that have fallen on the ground. An adult with contamination OCD might sanitize surfaces at home multiple times each day.
Harm OCD
Harm OCD can be one of the scariest types of OCD. However, it’s something that is common among people with OCD. It is manageable.
It’s scary because people with Harm OCD have intrusive thoughts about causing harm to themselves or others. They don’t actually want to harm anyone. Nevertheless, the thoughts persist. They may worry that they will act on them. Compulsions to deal with this often include rituals.
A young child with harm OCD might engage in “magical thinking,” believing that having a “bad” thought could actually make something bad happen, even though they don’t want to harm anyone. To cope with these fears, the child may perform various rituals, such as:
- Repetitive Actions: Tying and retying their shoelaces or stepping over cracks in specific ways.
- Checking and Asking for Reassurance: Frequently asking parents, “Is everyone okay?” or making sure doors and lights are properly set.
- Avoidance: Steering clear of certain objects or rooms associated with “bad” thoughts.
- Mental Rituals: Silently repeating “good thoughts,” specific words, or counting to counteract “bad” thoughts.
These rituals aim to reduce the child’s anxiety and create a sense of control, even though the child may recognize that the actions don’t truly influence events. Similarly, a teenager or adult with harm OCD might avoid using sharp objects, refrain from driving, or repeatedly check to ensure they haven’t accidentally harmed anyone.
Morality OCD (Scrupulosity)
Also known as scrupulosity, morality OCD involves fears of violating personal or moral beliefs, which may or may not be religious. Compulsions like confession or seeking reassurance are common. For example, a child may confess minor “bad” thoughts to their parents, fearing they make them a “bad” person.
In adults, morality OCD might manifest as constant self-monitoring to ensure they haven’t unintentionally harmed anyone or violated their moral code. For example, someone who values environmental ethics may spend hours reviewing their actions to make sure they have followed sustainable practices, such as obsessively checking that they’ve recycled everything correctly.
“Just Right” OCD
“Just Right” OCD centers on a need for things to feel balanced or symmetrical. Compulsions include arranging objects or adjusting clothing until things “feel right.” A child might meticulously align their toys and get upset if disturbed. In teens it can manifest as constantly editing a social media post to get it “just right.”
Symmetry, Checking, and Ordering OCD
Symmetry, checking, and ordering OCD often overlap with “just right” OCD but can also stand alone as distinct subtypes. Checking OCD centers on verifying tasks to prevent perceived harm or mistakes. Symmetry OCD involves the need for perfect balance.
A child with symmetry OCD might feel compelled to rearrange stuffies until they’re perfectly aligned. An adult with checking OCD may repeatedly ensure that doors are locked or appliances are off.
Relationship OCD (ROCD)
ROCD involves obsessive doubts about relationships. A young teen may constantly ask friends for reassurance that they still like them. An adult may frequently analyze their feelings toward a partner, questioning if the relationship is truly “right.”
Sexual Orientation OCD (SO-OCD)
SO-OCD is marked by intrusive doubts about one’s sexual orientation, leading to compulsive checking or reassurance-seeking. For instance, a teenager might analyze their feelings toward friends to confirm their orientation. In contrast, an adult might avoid social situations that could “test” their feelings.
Health Anxiety OCD (Hypochondriasis)
Health anxiety OCD involves fears of illness, leading to behaviors like checking symptoms or frequent doctor visits. A child may repeatedly ask if they are sick, for example. An adult may spend hours researching symptoms online, convinced they have a serious condition.
Sensorimotor OCD
Sensorimotor OCD is characterized by a hyper-focus on bodily functions, such as breathing, blinking, or swallowing. This can cause distress and lead to compulsive monitoring or attempts to control these processes.
Disorders Related to OCD
OCD often coexists with related disorders that share obsessive-compulsive characteristics but are distinct in focus:
- Body Dysmorphic Disorder (BDD): Obsessions with perceived physical flaws, often leading to mirror-checking or excessive grooming.
- Hoarding Disorder: Difficulty discarding items due to attachment or fear of needing them, resulting in clutter.
- Trichotillomania (Hair-Pulling Disorder): Repetitive hair-pulling done to relieve tension rather than due to fear.
- Excoriation (Skin-Picking) Disorder: Repetitive skin-picking, often triggered by stress, providing temporary relief.
What OCD is Not
It’s common to hear people casually say, “I’m so OCD” about their preference for cleanliness or organization. However, true OCD is far more than a desire for order. It’s an anxiety disorder involving distressing, intrusive thoughts and compulsions that significantly interfere with daily life. This trivialization often leads to misunderstandings and stigma, making those with OCD feel misunderstood. Statements like, “I’m so OCD” minimize the real, ongoing struggles people face when living with this condition.
Distinguishing OCD from Other Conditions
OCD can resemble other mental health conditions, so it’s essential to understand the differences. This can be very nuanced and a therapist can help you figure out what OCD is and isn’t. Briefly, here are some other conditions commonly mistaken for OCD:
- OCD vs. OCPD: OCD thoughts are distressing; OCPD individuals see their behaviors as rational.
- OCD vs. ADHD: OCD involves focused compulsions, while ADHD often presents with inattentiveness and impulsivity.
- OCD vs. Anxiety Disorders: OCD is an anxiety disorder but is characterized by specific obsessions and compulsions, unlike general anxiety.
- OCD vs. Autism Spectrum Disorder: ASD’s repetitive actions are self-regulatory, while OCD’s are anxiety-driven.
The Relationship Between Perfectionism and OCD
Perfectionism and OCD are closely related, as both involve intense attention to detail and a desire for things to be “just right.” However, while perfectionism is often goal-oriented and rooted in personal standards or ambitions, OCD-driven perfectionism is typically anxiety-driven, focused on preventing harm or reducing distress. In OCD, perfectionistic compulsions can emerge from obsessive fears of making mistakes, missing details, or violating personal or moral standards.
For example, someone with OCD might feel compelled to rewrite sentences multiple times to ensure they are “perfect,” not out of pride but out of a need to relieve anxiety. This form of perfectionism often disrupts daily routines, leading to excessive checking, arranging, or repeating tasks until they feel “right.” While perfectionism can have positive aspects, in OCD it usually leads to distress and frustration, making daily life challenging. Understanding this difference is essential for recognizing how OCD perfectionism is distinct and often requires professional support.
OCD Therapy
Understanding what is OCD and how it impacts daily life is a key step toward effective treatment. It’s possible to live well with OCD. Working with a therapist who is able to recognize your strengths and what makes you uniquely you is the best place to start. Read more about each of our therapists or contact us today to make an appointment for OCD therapy at our Menlo Park, Palo Alto or San Jose offices.