Obsessive-compulsive disorder (OCD) is characterized by a cycle of obsessions and compulsions. Obsessions are intrusive thoughts, images, urges, feelings, and/or sensations that cause fear and anxiety. Compulsions are the physical or mental actions performed to cope with the distress caused by obsessions or prevent something bad from happening.
While everyone with OCD can experience these symptoms, the way they show up can vary from person to person. OCD often fixates on one or more themes—such as contamination, harm, checking, and perfectionism—known as subtypes. These are groups of obsessions and compulsions that pop up regularly in people with OCD.
Keep reading to learn more about the common types of OCD and how evidence-based treatment can help you manage your symptoms.
What are OCD subtypes?
“Subtypes are just a way to categorize how OCD shows up,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. “They’re not an official diagnosis, but an immediate way to take a look at how OCD manifests itself.”
According to Dr. McGrath, OCD subtypes can generally be placed into one of four categories: harm, contamination, “just right,” and taboo themes.
Why do subtypes matter?
Clinicians don’t use subtypes in any official capacity because there isn’t really any research backing them, and all OCD subtypes follow the same cycle of obsessions and compulsions. However, some therapists find that discussing them can be helpful, because for many people with OCD, recognizing their own experience in a list of subtypes can be comforting, particularly at the start of the treatment process.
“One of the big benefits about the categorization of subtypes is that people don’t feel alone anymore,” says Dr. McGrath. “They know there are other people who are like them.”
Also, it’s important to note that there’s no such thing as a “better” or “worse” OCD subtype. “Taboo themes of OCD are not worse than any other themes, because whatever somebody’s current OCD theme is, that’s the theme that feels worse at any time,” says Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer. “The reason why taboo themes can seem worse is that they often involve intrusive thoughts about things that are illegal, immoral, or highly judged by society. And for those reasons, they can feel more serious, but they’re not.”
Most common types of OCD
Here’s a look at the most common subtypes or themes of OCD, with examples of obsessions and compulsions that often appear with them:
Contamination OCD
Contamination OCD is a subtype characterized by the fear of becoming contaminated or contaminating others. The symptoms revolve around germs, dirt, and overall uncleanliness. Interestingly, not all contamination triggers are the same. Some are rooted in fear (“I’ll become seriously ill by coming into contact with germs”), while others are rooted in disgust (“I’ll never be able to feel clean enough”).
Contamination OCD obsessions can either be physical, mental (internal feelings of “dirtiness”), or emotional (being contaminated with undesirable personality traits or energies of others).
Obsessions
- What if I spread an illness to someone else, and they die?
- What if the food I ate was contaminated?
- If I make eye contact with that person or sit in the same seat where they were, I might be contaminated with some of their negative traits.
Compulsions
- Excessive hand washing, showering, and cleaning.
- Excessively researching germs, illnesses, and ailments.
- Avoiding the use of public bathrooms.
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Existential OCD
People with existential OCD may experience re-occurring intrusive thoughts and compulsions about deep philosophical questions regarding life and existence. While many people wonder about these big questions, existential OCD takes it up a notch by demanding answers with 100% certainty—and most often, these questions are impossible to answer.
Obsessions
- What if I’m not really here? Would I know?
- Is there really a God?
- What if there’s no meaning to life?
Compulsions
- Spending excessive amounts of time thinking about or researching these thoughts and questions to find answers.
- Asking for reassurance from others that you are real or that they are real.
- Constantly checking for signs of dissociation or detachment.
False memory and real event OCD
False memory or real event OCD is characterized by re-occurring intrusive thoughts about past events, leading to feelings of guilt, shame, anxiety, and other emotions. People with this OCD subtype may perform compulsions to neutralize these feelings and attempt to gain certainty about the past.
Obsessions
- Something will come out about me that will cause public shame or humiliation.
- Did I say or do something inappropriate to my friend?
- What if I cheated on my partner in the past and can’t remember?
Compulsions
- Mentally reviewing a memory over and over again until you believe you’ve gained enough clarity.
- Seeking reassurance by asking others about their memory of a situation you’re concerned about.
- Confessing potential wrongdoings to people around you.
Harm OCD
Harm OCD involves obsessions about harming yourself or others. Having violent, intrusive thoughts happens to everyone occasionally, and most people can shrug them off. However, people with harm OCD are deeply disturbed by these thoughts and become overwhelmed by them.
Harm OCD is a broad subtype, and it can be further segmented into more specific themes, such as hit-and-run, sexual assault, and suicide.
Checking OCD can also be a form of harm OCD, where people fear that they will somehow cause something bad to happen to themselves or others, which leads to checking rituals as a way to get certainty that something bad has not or will not happen.
Obsessions
- I could jump in front of the train right now.
- I could stab my husband with this knife.
- What if I left the faucet running and someone gets electrocuted?
Compulsions
- Refusing to stand near train tracks.
- Keeping all knives hidden away.
- Repeatedly going back to check if you ran someone over.
- Repeatedly checking kitchen appliances, locks, or switches.
“Just right” or perfectionism OCD
People with just right or perfectionism OCD often experience intrusive thoughts related to order, symmetry, or precision, and they engage in compulsive behaviors to relieve their discomfort. The underlying anxiety isn’t necessarily about an external consequence, but rather about the unbearable feeling that something is incomplete or incorrect.
This OCD subtype can present in many ways, but symptoms typically revolve around physical sensations, symmetry, counting, or a need for precision in speech, writing, or movement.
Obsessions
- When I do my hair, it has to be perfectly even.
- If someone accidentally touches my left shoulder, I have to touch my right shoulder to make it even. I won’t be able to concentrate until I do.
- If I don’t tap my knee four times, it doesn’t feel ‘“right.”
Compulsions
- Repeatedly rearranging, reordering, or reorganizing things.
- Performing any action over and over again (e.g., closing doors, flipping light switches, etc.)
- Preferring odd or even numbers because you consider them “good” numbers and/or use them to reduce distress.
Pedophilia OCD
Pedophilia OCD, or POCD, is a subtype often prone to intense stigma because revolves around unwanted sexual thoughts about children. However, as with all types of OCD, these obsessions are not desires. In fact, people are severely distressed by these thoughts because they don’t reflect who they are.
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.
- Avoiding places where children could be.
- Watching how others behave around children and comparing it with your own behavior.
Pure obsessional OCD (pure O)
Pure obsessional OCD, or simply “pure O,” is a bit different from other subtypes, in that it could focus on any theme, as long as it doesn’t involve physical compulsions. People with pure O may experience distressing, intrusive thoughts and respond with “hidden” compulsions like rumination, mental reviewing, and silent reassurance-seeking.
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?
Compulsions
- Obsessively monitoring sensations, emotions, or thoughts.
- Replaying events or thoughts to analyze them for reassurance.
- Silent reassurance-seeking, such as repeating to yourself, “I would never do that” or “This thought doesn’t mean anything.”
Relationship OCD
Relationship OCD, or ROCD, is characterized by intrusive thoughts and compulsions related to close personal relationships, whether romantic or platonic. This OCD subtype leaves people unable to tolerate uncertainty about their relationships, involving obsessions about the “rightness” of their own relationships.
Obsessions
- Is this the right person for me?
- Am I still attracted to my partner?
- What if they cheat on me?
Compulsions
- Repeatedly taking relationship quizzes online.
- Looking up other people on social media to see if their relationships seem better.
- Avoiding certain relationship milestones to protect yourself from getting hurt.
Responsibility OCD
Persistent and re-occurring worry about the consequences of your actions falls under the subtype responsibility OCD. People with responsibility OCD may obsess about how their actions or thoughts could affect themselves or others. These fears will manifest differently for each person, typically focusing on whatever you value the most, such as your family, friends, and even pets.
Obsessions
- What happens if I take out this book from the library and someone else wants to read it? What if that person is suffering, and this was the book that would change their life?
- What if I steal something or forget to pay for it?
- I should not spend money on food when people are starving.
Compulsions
- Seeking reassurance by asking friends and family if you’re responsible for something bad happening.
- Performing rituals to try to prevent bad outcomes or “control” the future.
- Checking to make sure you’re not responsible for presumed fearful outcomes.
Religious or scrupulosity OCD
Religious or scrupulosity OCD is characterized by obsessions and compulsions around violating religious, moral, or ethical beliefs, and it’s closely related to responsibility OCD. A person’s obsessions may center around sinning, praying incorrectly, lying or offending someone, or accidentally cheating or stealing. Religious scrupulosity can be further categorized by specific religions, such as Christian OCD or Islamic OCD.
Obsessions
- Have I prayed correctly? Have I prayed for the correct amount of time? I was a bit distracted. Maybe I should do it again.
- Today, I thought my religious leader was ugly. Does that make me a bad person?
- During religious services, I found it hard to concentrate and thought about my to-do list for a few minutes. Is that a sin?
Compulsions
- Excessive prayer.
- Mentally reviewing past experiences to determine whether or not you behaved in an immoral or sinful way.
- Avoiding religious practices or reminders of religion due to the fear of being triggered.
Sensorimotor or somatic OCD
Sensorimotor or somatic OCD is a subtype that causes intrusive thoughts and compulsive behaviors revolving around your somatic experiences—the physical sensations and automatic bodily functions that are outside of your control. You could fixate on your breathing, a particular physical sensation, or concerns that you’re not doing something right (“What if my heart is not beating enough?”).
Obsessions
- If I don’t blink enough, I could lose my ability to see.
- I can’t stop paying attention to my heart beating. What if I have a heart attack?
- What if I’m giving off the wrong message based on how close to or far away I am from this person?
Compulsions
- Seeking reassurance by asking questions like “How often do you notice yourself breathing?”
- Excessively researching as an attempt to find solutions to your distressing sensations, thoughts, or fears.
- Distracting yourself to make the intrusive thoughts go away.
Sexual orientation OCD
People with sexual orientation OCD (SO-OCD) experience obsessions and compulsions related to their sexuality or sexual identity. You may question if you have a different sexual orientation than the one you thought. SO-OCD has been referred to as homosexual OCD, but this term is no longer used as it is insensitive and misleading—SO-OCD can affect anyone, regardless of their sexuality.
Obsessions
- What if I’m actually straight, and I don’t know?
- I couldn’t help but notice how muscular those men were at the gym. Does that mean I’m gay?
- What if I’ve been lying to my partner for 17 years? Am I actually attracted to them?
Compulsions
- Avoiding interactions with people of certain genders to prevent intrusive thoughts.
- Compulsively dating to prove to yourself that you have the “right” sexual orientation.
- Praying excessively to ask for clarity on your sexual orientation or for forgiveness for perceived “sins.”
Magical thinking OCD
Magical thinking OCD involves irrational intrusive worries or fears about certain signs, actions, or thoughts having real-world consequences. People with magical thinking OCD may fear that if they don’t perform certain actions, they will be responsible for something awful happening. These fears can be specific (e.g., “If I don’t make the bed, my spouse will get into a car accident”), or they can be vague (e.g., “If I don’t turn my phone on and off three times every day, something bad will happen to my mother”).
Obsessions
- I had a bad thought about someone. Did I just curse them unintentionally?
- If I check my bank account on a day or month that ends with an odd number, I will lose my job and won’t be able to support my family.
- If I don’t text my parents before I take off from a flight, the plane might crash.
Compulsions
- Counting to a specific number in your head or repeating certain phrases or words to protect yourself or others from harm.
- Performing rituals during certain times of the day or under specific circumstances (e.g., praying for someone right at 11:11 a.m. every day).
- Excessively avoiding “unlucky” numbers, colors, words, places, and items.
Perinatal and postpartum OCD
Perinatal and postpartum OCD are similar OCD subtypes that can affect people who are pregnant or who have recently given birth. Perinatal OCD develops during pregnancy or the first year or after childbirth, while postpartum OCD impacts new parents after childbirth. These subtypes are characterized by intrusive thoughts about harm or failing as a parent, with compulsions performed to reduce this distress. It’s also possible that if you already have OCD, once you become pregnant or give birth, the content of your obsessions or compulsions may start to focus on your baby’s health and safety.
Obsessions
- What if I accidentally harm my baby?
- What if I’m not fit to be a parent?
- What if I pass on a mental health condition or physical condition to my baby?
Compulsions
- Repetitively checking your baby’s health or safety, such as their breathing, temperature, and movements while they’re awake or sleeping.
- Excessively researching baby care and safety.
- Avoiding activities or situations that might put your baby at risk of getting sick or hurt, such as allowing others to hold your baby or leaving the house (unless otherwise directed by your baby’s healthcare provider).
Can OCD subtypes switch over time?
According to Dr. McGrath, your OCD themes can switch for many reasons. “Life-changing stressors or major events like a new job, getting married, or moving can cause themes to switch. This is why when we do treatment, we don’t do it for a subtype–we do it for OCD.”
It’s also completely normal for your OCD themes to change without any obvious reason, explains Dr. McGrath. “I saw in a discussion group that, on average, a person might experience 4-5 themes throughout their lifetime, which is pretty typical. I’ve worked with people who are not on their very first theme. The vast majority of people have multiple themes occurring at the same time.”
Ibrahim also adds that just because you develop a new subtype doesn’t mean the initial theme(s) you had went away. Ibrahim, who has personal experience with OCD, shares “My very first theme was contamination OCD. While I’ve had other themes added since then, my contamination OCD has never gone away.”
What kind of OCD do I have?
There’s only one official diagnosis of OCD, but your symptoms may revolve around specific themes or subtypes, such as harm, contamination, perfectionism, or scrupulosity. These themes can shift over time or overlap.
If you’re wondering which subtype best matches your experience, a good starting point is to take an OCD test. From there, working with an OCD specialist can help you better understand your symptoms and begin a personalized treatment plan.
What if I can’t find my subtype?
If you can’t find your subtype, that doesn’t mean you don’t have OCD—everyone’s experience is unique, and many people have symptoms that don’t fit neatly into any specific theme. Speaking with a licensed therapist who has experience treating OCD is the best way to learn what your symptoms mean.
Treatment for all types of OCD
Regardless of how your OCD symptoms show up in your life, the recommended treatment to get them under control is a specialized form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy.
ERP breaks the OCD cycle by gradually, intentionally exposing you to your obsessions and teaching you how to address them without engaging in compulsions—an exercise known as response prevention. You’ll work with a therapist who has specialized in ERP who will collaboratively, carefully guide you through these exercises. Over time, you learn to manage your uncertainty and fear without relying on compulsions for a false sense of relief. And while symptoms may fluctuate from time to time, the skills you gain in ERP therapy can allow you to manage OCD for the rest of your life.
Depending on which symptoms you’re experiencing, you and your ERP therapist will create a customized treatment plan to address them. “If somebody came in and said, ‘I have harm OCD,’ I’d ask them what they meant by that,” says Ibrahim. “Are you afraid of harming somebody or yourself? Once I learn about your individual symptoms, I can specify what our approach should be. Interventions will be the same for all subtypes, but your treatment plan is going to be about how that subtype is specifically showing up for you.”
Frequently asked questions
The four major types of OCD are checking, contamination, order/symmetry, and intrusive thoughts focused on taboo or disturbing content, such as harm, violence, sex, or religion.
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 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.