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Types of OCD
as explained by OCD-UK
The need to check is the compulsion, the obsessive fear might be to prevent damage, fire, leaks or harm.
The checking is often carried out multiple times, sometimes hundreds of times, and for hours on end, resulting in the person being late for work, dates and other appointments. This can have a serious impact on a person’s ability to hold down jobs and relationships. The checking can also cause damage to objects that are constantly being checked.
The need to clean and wash is the compulsion, the obsessive fear is that something is contaminated and/or may cause illness, and ultimately death, to a loved one or oneself.
The cleaning or washing is often carried out multiple times often accompanied by rituals of repetitive hand or body washing until the person ‘feels’ it is clean, rather than someone without OCD who will wash or clean once until they ‘see’ they are clean. The time this takes can have a serious impact on a person’s ability to hold down jobs and relationships and there is also a secondary physical health impact of the constant scrubbing and cleaning on the skin, especially the hands. A person may also avoid entire places if they experienced contamination fears there previously. There is also a cost implication of the constant use and purchase of cleaning products, and also of items (especially electrical) that are damaged through excessive liquid damage.
Another obsession long considered to be part of ‘OCD’ is the inability to discard useless or worn out possessions, commonly referred to as ‘hoarding’.
In the past it was suggested that hoarding, as a subtype of OCD, may be less responsive to treatment than other forms. However, as a result of more recent research, and due to a greater understanding of this problem, there is now significant evidence to suggest that treatment can be just as effective for this type of OCD, as with others.
In addition to the more familiar type of contamination, that is commonly perceived to be the stereo-typical image of OCD, involving someone that washes their hands repeatedly after coming into contact with potentially dirty objects or environments, there is also a less obvious form called 'mental contamination'.
The feelings of mental contamination share some qualities with contact contamination but have some distinctive features. Feelings of mental contamination can be evoked by times when a person perhaps felt badly treated, physically or mentally, through critical or verbally abusive remarks. It is almost as if they are made to feel like dirt, which creates a feeling of internal uncleanliness — even in the absence of any physical contact with a dangerous/dirty object. A distinctive feature of mental contamination is that the source is almost always human, unlike the contact contamination that is caused by physical contact with inanimate objects.
The person will engage in repetitive and compulsive attempts to wash the dirt away by showering and washing which is where the similarities with traditional contamination OCD return.
Symmetry and Orderliness
Ruminations and Intrusive Thoughts
'Rumination' is a term often used to describe all obsessional intrusive thoughts, but this is misleading. In the context of OCD a rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive. Unlike obsessional thoughts, ruminations are not objectionable and are indulged rather than resisted. Many ruminations dwell on religious, philosophical, or metaphysical topics, such as the origins of the universe, life after death, the nature of morality, and so on.
One such example might be where a person dwells on the time-consuming question: 'Is everyone basically good?'. They would ruminate on this for a long period of time, going over in their mind various considerations and arguments, and contemplating what superficially appeared to them to be compelling evidence.
Another example might be someone that ruminates about what would happen to them after death. They would weigh up the various theoretical possibilities, visualise scenes of heaven, hell, and other worlds and try to remember what philosophers and scientists have said about death.
With most ruminations it inevitably never leads to a solution or satisfactory conclusion and the person appears to be deeply pre-occupied, very thoughtful, and detached.
Intrusive thoughts, in the spectrum of OCD, are where a person generally suffers with obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature. For example, thoughts of causing violent or sexual harm to loved ones.
Because the intrusive thoughts are repetitive and not voluntarily produced, they cause the sufferer extreme distress - the very idea that they are capable of having such thoughts in the first place can be horrifying. However, what we do know is that people with Obsessive-Compulsive Disorder are the least likely people to actually act on the thoughts, partly because they find them so repugnant and go to great lengths to avoid them and prevent them happening.
The need to have everything lined up symmetrically just ‘ right’ is the compulsion, the obsessive fear might be to ensure everything feels ‘just right’ to prevent discomfort or sometimes to prevent harm occurring.
Sufferers spend a lot of time trying to get the symmetry ‘just right’ and this time consuming checking can result in them being extremely late for work and appointments. They may also become mentally and physically drained if the compulsions take a considerable amount of time. The sufferer may also avoid social contact at home to prevent the symmetry and order being disrupted which can have a negative impact on social interaction and relationships.
This above list categorises the various common forms of Obsessive-Compulsive Disorder and some of the fears associated with them. However, it is not an exhaustive list and there will always be forms of OCD that are not listed. However, the following three components are generally present whatever the theme, avoidance, triggers and reassurance.
Hoarding
Mental Contamination
Contamination
Checking
