The Types of Obsessive-Compulsive Disorder

Subtypes of OCD and Related Disorders

Obsessiv Compulsive DIsorder
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The ways in which symptoms of obsessive-compulsive disorder (OCD) are experienced varies widely from person to person. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a broad definition of obsessive-compulsive disorder that includes the presence of obsessions and/or compulsions that cause major distress or disruption to daily living. Clinicians and researchers suggest that OCD can be divided into different types based on the nature of the symptoms experienced.

5 Symptom Subtypes of OCD

Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.

1. Contamination Obsessions With Washing/Cleaning Compulsions: If you are affected by this symptom subtype, you will usually focus on feelings of discomfort associated with contamination and wash or clean excessively to reduce these feelings of distress. For example, you might feel that your hands are dirty or contaminated after touching a doorknob or worry that you will contaminate others with your germs. To get rid of these feelings, you might wash your hands repeatedly for hours at a time.

2. Harm Obsessions With Checking Compulsions: If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others and use checking rituals to relieve your distress.

For example, you might imagine your house burning down and then continually drive by your house to make sure that there is no fire. Or you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.

3. Obsessions Without Visible Compulsions: This symptom subtype often relates to unwanted obsessions surrounding sexual, religious or aggressive themes.

For example, you could experience intrusive thoughts about being a rapist or that you will attack someone. You may often use mental rituals such as reciting particular words, counting in your head or praying to relieve the anxiety you experience when you have these involuntary thoughts. Triggers related to obsessions are usually avoided at all costs.

4. Symmetry Obsessions With Ordering, Arranging, and Counting Compulsions: When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are "just right." For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color. This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example: "If I arrange my desk perfectly my husband won’t die in a car accident." However, this is not always the case.

5. Hoarding: Hoarding is now recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items that are judged to be of limited value by others such as old magazines, clothes, receipts, junk mail, notes, or containers.

Often your living space becomes so consumed with clutter that it becomes impossible to live in. Hoarding is often accompanied by obsessional fears of losing items or possessions that may be needed one day and excessive emotional attachment to objects.

People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes and are often are unable to maintain steady employment. Importantly, compulsive hoarding can occur independently of OCD.

Obsessive-Compulsive Related Disorders

The DSM-5 included new definitions or moved these disorders to this category.

  • Skin Pricking Disorder (Excoriation): This disorder was also recognized as a distinct diagnosis in the DSM 5. It is persistent pricking at your skin that results in lesions, infections, and clinically significant distress. It is prevalent in between 1 percent and 2 percent of the population.
  • Hair-Pulling Disorder (Trichotillomania):  In this OCD-related disorder, you have a strong urge to pull the hair from your head, eyebrows, eyelashes, or elsewhere on your body. It is usually treated with habit-reversal training and cognitive-behavioral therapy.
  • Body Dysmorphic Disorder: This disorder is a "preoccupation with one or more perceived defects or flaws in appearance that are not observable or appear slight to others." The criteria include that you have performed repetitive behaviors of grooming or checking your appearance or have mental acts such as constantly comparing your appearance to others. Muscle dysmorphia is a subtype of body dysmorphic disorder in which you think your body is too small or not muscular enough.
  • OCD and Related Disorders Induced by a Substance/Medication or Due to Another Medical Condition: Exposure to certain substances and medications can indue the development of OCD symptoms. There also are certain medical and neurological conditions that can be associated with the development of the disorder.

In addition, although it is not uncommon for new mothers to experience a wide array of emotions following the arrival of a new child, the postpartum period has long been known to be a time of increased risk for the appearance, worsening, or recurrence of mood and anxiety disorders. A number of studies have suggested that the postpartum period may also present a risk for the onset or worsening of OCD.

OCD in Kids

Although many people think of OCD as a disorder that affects only adults, a similar percentage of children are also affected. While there are many similarities between adult-onset and childhood-onset OCD, there are also many important differences—particularly with respect to treatment and the nature of symptoms.

Although we usually think of OCD as being caused by a combination of stress, genetic factors, and an imbalance of chemicals in the brain, there is growing evidence that a specific form of childhood OCD may actually be an autoimmune disorder. In Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), children develop OCD or tic disorders suddenly after a strep infection (such as strep throat) or scarlet fever or have a worsening of already existing OCD symptoms. Studies at the National Institute of Mental Health have shown that a strep infection can produce cross-reactive "anti-brain" antibodies that produce the symptoms of PANDAS in children between age 3 and puberty.

Treatment for OCD

Choosing a course treatment for OCD depends on several factors, including:

In general, most OCD types respond to some combination of cognitive-behavior therapy, exposure response prevention, and medication. An important exception may be hoarding, which does not seem to improve with medication but does seem to respond to psychotherapy. Nevertheless, it may be useful for you to discuss with your psychologist or physician the ways in which ERP, CBT, and medication can be adjusted for maximum benefit based on your symptoms.

A Word From Verywell

If you have symptoms of OCD or its related disorders, see your health care provider as there is treatment available. You are not the only person with one of these disorders. You will find support and get the help you need to relieve yourself of these symptoms.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Fifth edition). Washington, D.C.: American Psychiatric Association; 2013.

da Rocha FF, Correa H, Teixeira AL. Obsessive-compulsive disorder and immunology: a review. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2008 32: 1139-1146.

Lomax CL, Oldfield VB, Salkovskis PM Clinical and treatment comparisons between adults with early- and late-onset obsessive-compulsive disorder. Behavior Research and Therapy< 2009: 99-104.

PANDAS—Questions and Answers. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/pandas/index.shtml.

Starcevic V, Brakoulias V. Symptom subtypes of obsessive-compulsive disorder: are they relevant for treatment? Australian and New Zealand Journal of Psychiatry 2008 42: 651-661.

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