Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Common Types of OCD: Subtypes, Symptoms, and Treatment

By Patrick McGrath, PhD

Dec 16, 2024 • 10 minute read

Although all forms of obsessive-compulsive disorder (OCD) have symptoms in common, the way these symptoms present themselves in daily life differs a lot from person to person. The content of a person’s obsessions isn’t ultimately the important part—but it’s certainly what feels important at the moment.

OCD often fixates around one or more themes, some of the most common OCD themes are contamination, harm, checking, and perfection. At NOCD, we call these OCD themes subtypes, which we’ll explore in more detail in this article. Subtypes are groups of obsessions and compulsions that pop up regularly in people with OCD.

Regardless of the type of OCD symptoms you have, the treatment is the same—exposure and response prevention therapy (ERP) is used to treat all OCD themes and subtypes.

Are there different types of OCD?

Someone’s subtype is really just the particular way their OCD affects them. What does the mind focus on, and what thoughts result from this focus? Subtypes are relatively stable over time, though new symptoms can appear and old ones might fade.

Clinicians call a condition like OCD heterogeneous because it varies so much from one person to the next. But there are a few common “clusters” of symptoms that researchers have noticed. These include contamination obsessions, harm obsessions with checking compulsions (fear-of-harm thoughts, taboo thoughts), and symmetry obsessions, just to name a few of the more common groupings. There’s a lot of discussion about what these symptom clusters might be, which explains why you may not see some familiar ones listed in this article. 

Many clinicians try not to talk about subtypes because there isn’t really any research backing them. And because they’re not perfect categories it’s generally not worth spending too much time trying to figure out which subtype you fit into. Still, for many people with OCD, the immediate recognition of their own experience in a list of subtypes is a powerful comfort at the start of the treatment process.

Imagine that you’ve thought of yourself as uniquely “messed up” for a long time. Suddenly, you see a list of symptoms that match yours exactly. And, recognizing yourself in the subtype you’re reading about, you no longer feel alone in your troubles. You don’t feel hopeless anymore, because other people have apparently faced similar struggles.

Even after this intense relief has passed and the hard work of treatment has begun, it’s helpful to know that other people are dealing with similar types of obsessions and compulsions. The important part, as a person trying to get better, is to never feel alone in it. Listing out subtypes is an imperfect way of doing that, because it often leads people to think of these subtypes as distinct conditions rather than common manifestations of the same condition.

Lastly, subtypes are here to stay in the global community of people dealing with OCD. People have heard about subtypes and want to know more about the ways this condition can manifest itself. So let’s go through some of them now.

What are some common OCD subtypes?

Harm OCD

Harm OCD involves obsessions around harming yourself or others. Having violent intrusive thoughts happens to everyone on occasion, and most people are able to shrug them off. But people with OCD are deeply disturbed by these thoughts and become completely overwhelmed by them.

Obsessions

  • I could jump in front of the train right now.
  • I could stab my husband with this knife.
  • What if I drove into that person?
  • What if I killed my nephew and I just can’t remember?

Compulsions

  • Refusing to stand near train tracks.
  • Keeping all knives hidden away.
  • Repeatedly going back to check if you ran someone over.
  • Calling your sibling to check if your nephew is safe and sound.

Learn more about harm OCD

SO-OCD

Sexual orientation OCD involves obsessions about one’s sexuality. It’s been referred to as homosexual OCD (or HOCD), but this term is misleading and insensitive. SO-OCD can happen to people of any sexual orientation, about any other sexual orientation.

Obsessions

  • I’m a straight man, but I thought that guy was attractive. This means I’m gay.
  • What if I’m [gay, bi, straight, etc.] and just don’t know it?
  • Was I actually into my partner when we dated?

Compulsions

  • Asking people repeatedly if you seem straight or gay to them.
  • Dating in order to prove your sexual orientation.
  • Mentally reviewing past situations to check for romantic interest.

Learn more about SO-OCD

POCD

Pedophilia OCD is especially prone to stigma because of how strong people’s feelings are about pedophiles. However, as with all types of OCD, these obsessions are not desires. In fact, people are so distressed by these thoughts because they don’t reflect what they really want.

Obsessions

  • What if I have sexual thoughts about the kid I’m babysitting?
  • I just had a sexual thought when I was around my cousin’s kid, am I attracted to them?
  • What if I molested a kid and I just can’t remember?

Compulsions

  • Looking online for stories of real pedophiles so you can find evidence you’re not one.
  • Staying away from kids altogether.
  • Repeatedly beating yourself up in your head for these thoughts.

Learn more about POCD

Relationship OCD

Relationship OCD leaves people completely unable to tolerate the uncertainty of intimate relationships, giving them obsessions about the “rightness” of their own relationship and the countless other possibilities that daily life brings.

Obsessions

  • Is this the right person for me?
  • Couldn’t there be someone better out there?
  • Are we meant for one another?

Compulsions

  • Taking relationship quizzes online.
  • Looking up other people on social media to see if their relationships seem better.
  • Remembering situations over and over: did we really have fun together on vacation that time?

Learn more about relationship OCD

“Just Right” OCD

“Just right” OCD is a little different from these other subtypes, in that it’s difficult to identify a specific fear, or set of fears, underlying it. Instead, it’s usually more like a strong feeling that something just isn’t right when things aren’t a certain way. It’s one of the more caricatured forms of OCD in TV shows, movies, and jokes.

Obsessions

  • Something is just not right with this.
  • I need to start this over to make it perfect.
  • This just doesn’t feel right.

Compulsions

  • Performing any action over and over, e.g. closing doors.
  • Rearranging, reordering, organizing things repeatedly.
  • Changing wording many times in emails or notes.

Learn more about “just right” OCD

Contamination OCD

Contamination OCD is probably the most stereotyped form of OCD. People with this subtype are afraid of getting sick, or infecting someone they care about, after coming in contact with some form of serious contamination. 

Obsessions

  • I touched a doorknob and now I have a virus or disease.
  • I just gave my sister’s baby a serious illness when I held him.
  • This whole place is full of bad bacteria, I can just tell.

Compulsions

  • Repeatedly washing hands and/or sanitizing things.
  • Excessively cleaning, changing clothes, and showering.
  • Avoiding being in public, doctor’s offices, being around kids.

Learn more about contamination OCD

Pure-O OCD

Pure-O, or pure obsessional OCD, is one of the murkier subtypes, and some experts say it doesn’t even exist. The idea is that people with pure-o have obsessions without visible compulsions. However, since people with pure-O still have compulsions they’re not exactly “purely obsessional,” the compulsions are just harder to see.

But whether or not studies back it, many people identify with pure-o because they don’t have the more obvious compulsions listed in subtypes above. The obsessions can be about sex, sexuality, religion, harm, personal health, romance, and really anything else we discussed above.

Obsessions

  • What if I’m actually not a good person?
  • How do I know that life is even worth it?
  • What if I go over there and push that guy off this bridge?
  • If I don’t clean my mess up well enough someone will get slip and get seriously hurt because of me.

Compulsions

  • Making sure to spend time only with people who will tell you you’re a good person.
  • Always thinking through the “meaning of life” question.
  • Looking for signs in your mind that you would never push someone off a bridge.
  • Trying repeatedly to remember a situation because you haven’t done it correctly if you’ve missed a detail.

Learn more about pure-O OCD

Other common OCD subtypes

The above list of common themes should help provide a good idea of what lots of people with OCD struggle with on a daily basis. However, there are plenty of other subtypes. In fact there are hundreds of different ways OCD can show up in someone’s life. 

  • Scrupulosity/religious OCD is a common subtype characterized by obsessions and compulsions around violating a religious, moral or ethical belief. A person’s OCD may center around fears related to sinning, praying incorrectly, lying or offending someone, or accidentally cheating or stealing.
  • Hit and run OCD is a less frequently discussed subtype of OCD characterized by a fear of running someone over while driving. People with this subtype often find that their obsessions make them too afraid to drive, or that they must trace their route just to make sure a road bump was not actually a person.
  • Real events OCD is a subtype characterized by obsessions and compulsions about the person’s past actions. A person with real events OCD may have obsessive thoughts about something they said to a friend five years ago and be concerned about whether or not they offended them. 

Ultimately, OCD subtypes follow the same cycle of obsessions and compulsions. For some people, it might not be worth working too hard to figure out exactly what their subtype is, for others, it can be comforting to know there are other people going through something similar.

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How to treat OCD subtypes

Regardless of the subtype, the process of treating OCD is the same. Exposure and response prevention (ERP) therapy is the gold standard of treatment for OCD. This form of therapy involves specifically targeting the source of a person’s obsessions by directly exposing them to it. In some cases, people find that ERP helps their anxiety subsides to the point where they no longer experience intense fears related to their thoughts on a regular basis. 

ERP therapy is an active form of treatment and requires engagement from the patient by participating in exposures, a willingness to feel discomfort, and transparency with their therapist about their obsessions and compulsions (even if they are shameful or taboo). 

Often patients meet with their therapist more frequently at first, and then less often as their condition begins to improve. The good news is that ERP therapy has a proven track record of helping people with OCD.

Learn more about ERP

What happens in ERP therapy? 

4 Reasons to Find a Specialized Therapist (and Why It Matters)

Here’s why response prevention is the key to OCD recovery 

Bottom line

OCD may take many forms, but at its core, the condition follows a shared cycle of obsessions and compulsions. While it’s not necessary to spend a lot of time figuring out if you belong to a specific subtype, some people may find subtypes help them feel less alone. 

Regardless of your OCD subtype, exposure and response prevention (ERP) therapy can help make your symptoms more manageable. With the willingness to put in the work, and with the support of a trained therapist, it’s possible to conquer OCD.

Key takeaways

  • OCD subtypes are patterns of obsessions and compulsions that help people recognize shared experiences, though they are not distinct conditions.
  • Regardless of subtype, exposure and response prevention (ERP) therapy is the most effective treatment for OCD.
  • Understanding OCD subtypes can provide comfort and clarity, but recovery comes from addressing the underlying OCD cycle.

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