Obsessive-Compulsive Disorder is one of the most common mental disorders in the United States and has been popularized on shows like Oprah and The OCD Project as well as movies like As Good as it Gets and The Aviator. As the name suggests, the main features of OCD are the presence of obsessions and/or compulsions. Obsessions are unwanted, intrusive thoughts that cause anxiety or distress. Compulsions are repetitive, ritualized behaviors designed to reduce the distress associated with obsessive thoughts. Since most people have unwanted or intrusive thoughts and do compulsive behaviors at times, to be diagnosed with OCD these thoughts and behaviors must take up more than an hour each day or significantly interfere with a person’s life in some important way.
The International OCD Foundation estimates that OCD affects about 2 to 3 million adults in the US. The NIMH report on OCD also notes that the onset of OCD typically occurs during childhood, adolescence, or early adulthood and most people with OCD receive a diagnosis before they reach their twenties.
Common types of OCD include:
- Contamination: One of the most common types of OCD, contamination OCD consists of fears of coming into contact with things such as dirt, germs or bodily fluids or fear of contacting a disease such as HIV. Contamination fears often lead to compulsive hand washing, showering, and cleaning.
- Checking: This type of OCD is characterized by persistent and intrusive doubting thoughts that lead to repetitive checking behaviors. For example, some people with checking OCD have intrusive thoughts about whether they’ve locked the door or turned off the stove. Since these thoughts create anxiety, they lead to repeated checking to make sure the door is locked and the stove is off. Checking can also occur in many other ways as well, such as repeatedly checking your body to make sure that you are healthy, verbally checking with loved ones (e.g., reassurance-seeking) or frequently checking on your sleeping newborn to make sure she is ok.
- Harming: In harming OCD, people have unwanted, intrusive thoughts of harming themselves or causing harm to someone else. For example, if you open the knife drawer in your kitchen, you might think, “What if I just grabbed this knife and stabbed myself?” Harming OCD often leads to avoidance of items that might trigger harming thoughts (i.e., knives, horror movies) or reassurance-seeking (i.e., trying to convince yourself that you’re not a dangerous person). Harming intrusive thoughts are also common in both mothers and fathers of newborns. Variations of harming OCD include “Hit and Run” OCD (intrusive thoughts that you hit someone while driving) and indirectly causing harm by performing or failing to perform certain actions (i.e., “step on a crack, break your mother’s back”)
- Sexual: Those with sexual obsessions experience unwanted, intrusive sexual thoughts that cause anxiety and distress. These intrusive thoughts often consist of forbidden sexual thoughts, obsessive questioning one’s sexual orientation, or unwanted, intrusive sexual thoughts about children. Like harming OCD, sexual obsessions often lead to compulsive avoidance or reassurance seeking behaviors.
- Scrupulosity: This type of OCD is characterized by intrusive, blasphemous thoughts. For example, you may have thoughts such as “I hate God”. Those with scrupulosity OCD often engage in religious-based compulsions, such as excessive praying or frequent confession.
- Perfectionism: In perfectionism OCD, the obsessive thoughts consist of a fear of making some sort of mistake or a need for things to be “just right” or perfect. A person with perfectionism OCD might have intrusive thoughts about symmetry or evenness or fear throwing something important away or forgetting some important piece of information. These obsessive thoughts can lead to compulsions such as checking, ordering or straightening, and avoidance.
- Repeating: Those with this type of OCD feel compelled to repeat certain actions over and over again until it feels “right” to the point that these repeating behaviors cause significant problems in their lives. For example, a child with repeating OCD might feel compelled to reread or rewrite his homework multiple times, resulting in either unfinished work or homework that takes much longer than necessary. Other types of repeating OCD include repeating routine daily activities (i.e., going up and down stairs or in and out of doors), doing things in a certain multiple (e.g., doing things in multiples of five), and repeating body movements, such as tapping or touching something.
In addition to the types of OCD listed above, there is a group of disorders known as OCD-Related Disorders. These disorders have similar characteristics to OCD but are also different in some way. OCD-Related Disorders include:
- Body Dysmorphic Disorder (BDD): Those with BDD are preoccupied with flaws in their appearance that are either not noticeable by others or seen as very slight to others. The concern about the flaws in appearance also results in some sort of repetitive, compulsive actions such as checking the mirror, seeking reassurance, excessive grooming, or plastic surgery.
- Hoarding Disorder: Hoarding is the accumulation of possessions and difficulty discarding items to the point that the items interfere with functional space (e.g., at home, in an office, or in a car). Items are often kept for sentimental value or because of the belief that they might be needed in the future. Hoarding behaviors can cause conflicts in relationships and financial difficulties as well.
- Trichotillomania (Hair-Pulling Disorder): This term refers to compulsive hair pulling resulting in significant hair loss. People with “trich” can pull hair from their head, arms and legs, eye lashes, eye brows, or pubic area. In order to be diagnosed with trichotillomania, the hair pulling must interfere with your life in some meaningful way, such as taking too much time pulling, causing significant distress or affecting one’s appearance in a significant way.
- Excoriation (Skin-Picking) Disorder: Those with skin-picking disorder repeatedly pick their skin to the point of damage and continue this behavior despite efforts to stop. The picking results in difficulties in relationships or at work or school and often takes up a significant amount of time both engaged in the picking behavior and attempts to conceal the behavior.
- Illness Anxiety Disorder and Somatic Symptom Disorder: Once called Hypochrondriasis, Illness Anxiety Disorder and Somatic Symptom Disorder are the clinical term for excessive worry about health. Like OCD, people with health anxiety have intrusive thoughts about their health that cause anxiety (“I have cancer”) and engage in compulsive behaviors to reassure themselves (i.e., going to the doctor, researching symptoms online).
PANS stands for Pediatric Autoimmune Neurological Syndrome (PANS). Formerly known as PANDAS, this syndrome consists of a sudden, rapid onset (i.e., “overnight”) of OCD symptoms that occurs as a result of an autoimmune reaction triggered by an infection or illness. Illnesses that are known or suspected to trigger PANS include strep throat, Lyme disease, and mono.
In addition to a sudden onset of OCD, the International OCD Foundation lists several other symptoms that also occur in children with PANS. These include:
- Separation anxiety or other irrational fears
- Depressed mood
- Rapidly changing emotions
- Oppositional or aggressive behaviors
- Sudden deterioration in school performance
- Trouble with handwriting
- Physical complaints such as stomach ache or headache
To learn more about OCD, please visit the International OCD Foundation’s website at www.iocdf.org