Understanding the different presentations of OCD

When you hear the term “OCD,” what do you think of? For many people, it calls to mind a person who is obsessed with organization or cleanliness. This is because, for the most part, these are the most common examples of OCD in movies, TV, and social media. These portrayals can certainly provide a glimpse into what it’s like to live with obsessive-compulsive disorder (OCD). But the truth is that OCD can take many forms. You don’t have to be obsessed with neatness or protecting yourself from germs to have OCD.  

By learning more about the different ways that OCD may present, you’ll be better equipped to know when it might be time to ask for help. And fortunately, no matter the object of your obsessions and compulsions, there is effective OCD treatment that can help you find relief.

What is OCD?

While there are many different presentations of OCD, everyone living with this condition shares one common experience. It involves a cycle of unwanted, intrusive thoughts called obsessions and resulting behaviors called compulsions.  Let’s look at a common example to illustrate this pattern. 

When a person lives with contamination OCD, they have acute anxiety around being exposed to germs or other substances that could harm them. They have frequent, upsetting thoughts about contamination, and these thoughts make it hard to function. In turn, they engage in ritualistic behaviors, like cleaning surfaces repeatedly. These behaviors are the person’s attempt to lessen the discomfort brought on by their intrusive thoughts. But the relief is short-lived, and without support, the cycle continues.

Twelve common presentations of OCD

Researchers have identified some common OCD themes that may help you better understand your experience. However, it’s important to note that these categories are unofficial subtypes that people use to help communicate their unique experiences with OCD.

1. Contamination or cleaning OCD revolves around germs or preventing exposure to any substance that could bring you harm. Common behaviors might include compulsive hand washing or excessive cleaning.

2. Symmetry and ordering OCD (aka “just right” OCD) causes distress if your objects are “out of order,” and you spend considerable time organizing things in “just the right way.” 

3. Harm OCD focuses on preventing future harm to oneself or others (even when no real risk is present). You may have intrusive thoughts about violence or injuries and may avoid using potentially dangerous objects like knives.

4. Checking OCD causes a fear that a person might do something harmful (either intentionally or unintentionally) or cause something harmful to happen unless they “check” to be certain that this isn’t the case. A common example is a person who compulsively and excessively checks that the stove is off or the doors are locked before bed.

5. Relationship OCD occurs when a person constantly questions their partner’s love and commitment even when there’s no real cause for suspicion.

6. Sexual orientation OCD revolves around uncertainties about one’s “true” sexual orientation. 

7. Religious or scrupulosity OCD typically causes a fixation on religious themes, attempts at hyper-morality, worry about sin, or excessive religious behavior.

8. Existential OCD causes extreme anxiety due to a fixation on unanswerable questions such as the meaning of life and what happens after death.

9. Sensorimotor OCD causes a person to fixate on the body’s internal processes and natural functions. For example, it might cause you to hyperfocus on your breathing, heartbeat, or swallowing. This can lead to the onset of health anxiety disorder.

10. Magical thinking OCD can cause a person to mistakenly believe that their thoughts have the power to shape real-life outcomes. This is different from common superstitions or cultural or religious beliefs that do not result in distress.

11. False memory OCD causes a person to focus on distressing uncertainty around past memories.

12. OCD-related hoarding is also known as compulsive hoarding. These behaviors make it difficult to part with possessions, which may result in safety or well-being concerns. Although compulsive hoarding is often a sign of hoarding disorder, it can also occur as a symptom of OCD.

As you can see, OCD can take many forms, and this list is far from complete. Your symptoms don’t have to fit into one of these categories, and many people with OCD experience a combination of symptom presentations. What’s most important to know is that if you’re having obsessive thoughts of any kind and engaging in compulsive behaviors, you may have OCD. 

Remember, you are not defined by your symptoms. Your intrusive thoughts do not necessarily reflect who you are, your history, or what you truly want to happen. Most people living with OCD experience upsetting thoughts that don’t reflect their values.

Common symptoms of OCD

The two main symptoms of OCD are obsessions and compulsions. While these can look different from one person to the next, recognizing them can help you know when it might be time to ask for help. If any of the following experiences sound familiar to you, it may be time to seek professional help.

• You experience frequent, unwanted, upsetting thoughts that you cannot control (obsessions).
• You engage in repeated behaviors (compulsions) in an attempt to lessen anxiety related to your intrusive thoughts.
• Although performing compulsions may help with your anxiety at first, the obsessions usually come back.
• You are unable to stop or reduce your obsessions and compulsions, even when you realize they’re excessive.
• You spend a lot of time focusing on your obsessions and compulsions — typically more than one hour a day.
• The cycle of obsessions and compulsions has impacted your mental health and your ability to function in daily life in significant ways.

What causes OCD?

Researchers are still working to understand the root cause of OCD. But they have identified some factors that may increase your risk of developing the condition, including:

• Being someone who is naturally very meticulous, neat, or detail-oriented 
• Experiencing heightened anxiety and feeling overly responsible for others from an early age
• Having a family history of OCD or other mental health conditions
• Having certain abnormalities in the area of the brain that are responsible for regulating serotonin 
• Experiencing trauma or major life events that affect you in profound ways
• Having a co-occurring mood disorder, eating disorder, or substance use disorder

How is OCD treated?

Your OCD treatment plan will be based on your unique needs. But it will likely include one or all of the following elements. 

• Therapy: Cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) are commonly used to treat OCD. CBT is a form of talk therapy that helps people uncover and challenge intrusive thoughts and interrupt compulsive behaviors. ERP is a subtype of CBT that can reduce your stress response and change the way you respond to triggers.
• Medication: Sometimes, certain prescription medications can help reduce OCD symptoms. You can talk to your doctor or psychiatrist to see if this approach is right for you.
• Self-help: While not a replacement for professional help, self-care can strengthen your mental and physical health as you work to get your OCD symptoms under control. What matters most is that you find a self-care routine that works for you. This might include using mindfulness to foster self-compassion and surrounding yourself with supportive friends and loved ones. 

Find the right therapist for you with Rula

At Rula, we know how challenging it can be to feel trapped within a cycle of obsessions and compulsions. But no matter which form of OCD you’re living with, know that with the right support, you can learn to manage your symptoms and regain control of your life. 

Take the first step toward healing today by exploring our therapist-matching program. In just a few clicks, we can connect you with a therapist within your insurance network who you can meet with as soon as tomorrow. And, if needed, we can also connect you with a psychiatric provider for medication management support. 

Find a therapist with Rula