Types of OCD: the 4 main types, and other common themes

OCD can attach itself to almost anything you care about. That’s why it can look so different from person to person: one person washes their hands until they crack, another checks the stove twenty times, and another silently replays conversations to make sure they didn’t say something terrible.

Here are the main types of OCD, what each looks like, and why they’re all treated the same way.

The 4 main types of OCD

In 2008, researchers combined 21 studies involving more than 5,000 people with OCD. They found that symptoms clustered into four main groups:

Type	Common obsessions	Common compulsions
1. Contamination and cleaning	Germs, dirt, illness, bodily fluids, chemicals	Washing, cleaning, avoiding “contaminated” things
2. Symmetry and ordering	Things feeling uneven, incomplete or “not just right”	Arranging, ordering, repeating, counting
3. Forbidden thoughts	Unwanted thoughts about harm, sex or religion, or worries about illness	Checking, mental reviewing, praying, seeking reassurance
4. Hoarding	Fear of throwing things away or losing something important	Saving and collecting

Many people have symptoms from more than one group, and the theme can change over time.

1. Contamination and cleaning

Intense fear of germs, illness or being “dirty”, or of spreading contamination to others. It can lead to long washing routines, cleaning, avoiding public places or touching things, and asking others to follow rules. For some people the fear is about feeling disgusted or “unclean” rather than getting ill.

2. Symmetry, ordering and “just right”

A strong need for things to be even, in order or feel exactly right. Doing things a certain number of times, rearranging objects, or repeating actions until they feel right. Sometimes there’s a feared consequence; sometimes it’s an unbearable feeling of incompleteness.

3. Forbidden thoughts and checking

Unwanted, distressing thoughts that go against your values, like:

• harm: fear of hurting someone, including loved ones, or of causing harm by mistake
• sexual: unwanted sexual thoughts or images, including ones that feel shocking or taboo
• religious or moral (scrupulosity): fear of sinning, offending God or being a bad person

Compulsions are often checking, mentally reviewing, confessing, praying, seeking reassurance or avoiding triggers. Many of these compulsions happen silently in the mind.

4. Hoarding

Difficulty throwing things away, and distress at the thought of losing them. Since 2013, hoarding disorder has been diagnosed as its own condition, related to OCD but separate. Some people with OCD still hoard because of obsessional fears, like fear that something bad will happen if they throw an item away.

Other common OCD themes

People with OCD and clinicians often use more specific names for themes. These aren’t separate diagnoses, but they can help people recognise themselves:

• Checking OCD: repeatedly checking locks, appliances, emails or whether you made a mistake
• Harm OCD: fears of hurting yourself or others, often loved ones
• Relationship OCD: constant doubts about whether you love your partner, or whether they’re “the one”
• Sexual orientation OCD: distressing doubts about your sexual orientation
• Health OCD: fear of having or catching a serious illness, with checking and reassurance-seeking
• Perinatal OCD: obsessions, often about the baby’s safety, during pregnancy or after birth
• “Pure O”: OCD where compulsions are mostly mental, like reviewing, analysing or mentally neutralising thoughts. The compulsions are still there, just hidden

Having the thoughts doesn’t mean you want them

People with harm, sexual or religious obsessions are often terrified that the thoughts say something about who they are. They don’t. Intrusive thoughts usually attach to what you care about most, which is why they feel so upsetting. Almost everyone has intrusive thoughts at times. Our post on how to stop intrusive thoughts explains why fighting them backfires.

Same cycle, same treatment

Every type of OCD follows the same cycle:

1. Obsession: an unwanted thought, image or feeling
2. Distress: anxiety, disgust or a sense that something is wrong
3. Compulsion: an action or mental ritual to feel better or prevent harm
4. Relief, for a while, which teaches your brain the obsession was dangerous
5. Repeat, often more strongly

That’s why the main treatment is the same whatever the theme: exposure and response prevention (ERP), a form of CBT in which you gradually face your triggers while resisting compulsions. Over time, your brain learns the fear passes on its own. Medicine, usually an SSRI, helps many people too.

When to get help

If obsessions or compulsions take up a lot of your time, cause distress or get in the way of your life, talk to a doctor. Our post on whether you might have OCD has a self-check you can bring to an appointment. The International OCD Foundation (iocdf.org) lists therapists trained in ERP.

If thoughts of harming yourself or someone else feel like urges or plans rather than unwanted thoughts, or you’re thinking about ending your life, get help right away: call or text 988 (US), or 911 in an emergency.

Frequently asked questions

What are the 4 types of OCD?

Research groups OCD symptoms into four main types: contamination and cleaning; symmetry, ordering and counting; forbidden thoughts (harm, sexual or religious) with checking; and hoarding. Hoarding is now diagnosed as a separate condition.

What is the most common type of OCD?

Studies differ, but checking, contamination, ordering and forbidden thoughts are all common. Many people have more than one type, and the theme can change over time. In a large US survey, more than a quarter of adults said they’d had obsessions or compulsions at some point, but only about 2 in 100 had ever had full OCD.

Can you have more than one type of OCD?

Yes. It’s common to have symptoms from several groups, either at the same time or at different points in life.

Is Pure O a real type of OCD?

It isn’t an official diagnosis, but it describes a real experience: OCD where the compulsions are mostly mental, like reviewing, analysing or seeking certainty in your head. It’s treated with ERP like other types.

How Breatheasy can help

Breatheasy includes a free tool for riding out urges. When an obsession brings a strong urge to wash, check, seek reassurance or do a mental ritual, open “Ride out an urge” and Luma helps you watch the urge rise and fall without acting on it. Luma is designed not to give endless reassurance about OCD doubts, because reassurance keeps them going. Breatheasy can support ERP but doesn’t replace it. Breatheasy is coming soon to iPhone and Android.

Sources

• Meta-analysis of the symptom structure of obsessive-compulsive disorder, Bloch and others, American Journal of Psychiatry, 2008
• Obsessive-compulsive disorder, National Institute of Mental Health
• Obsessive compulsive disorder (OCD), NHS
• The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication, Ruscio and others, Molecular Psychiatry, 2010
• International OCD Foundation