Mental health disorders are essentially comprised of various symptoms that typically appear together. In regard to obsessive-compulsive disorder (or OCD), four types of OCD have emerged as statistically more prevalent among individuals contending with this disorder.
Obsessive-compulsive disorder is defined by the American Psychiatric Association (APA) as an anxiety-based condition that combines obsessive thought content and compulsive behavior. Though initially OCD-related behavior is acted out in an effort to distract from OCD-related thinking, eventually it becomes its own trigger, bringing on the very thoughts it was meant to dissipate.
Within the US, 2.3% of adults and 1%-2.3% of children and adolescents are diagnosed with OCD. The condition can develop at any age, with OCD symptoms typically first appearing between the ages of ten and early adulthood. As OCD is often initially misdiagnosed as mere eccentricity, patients are usually only diagnosed—and begin receiving treatment—between 14-17 years of age.
Despite not being tied to a certain developmental stage, OCD does typically appear with different themes or thought content at different age groups. Specifically, children and adolescents have been shown to obsess over catastrophes or causing others harm, with sexual or religious taboo obsessions having been shown to appear more during adolescence.
Gender has not been emphatically determined to influence the chance of developing OCD. The American-based Diagnostic and Statistical Manual (DSM) finds OCD to be slightly more common among women in comparison to men, and more common in boys than in girls. The World Health Organization’s (WHO’s) International Classification of Diseases (ICD), on the other hand, cites OCD rates among women and men to be about the same.
Additional risk factors for developing OCD include a comorbidity with depression, hoarding, and tic disorders.
Types of OCD-Related Obsessions
Defining “types” of OCD is somewhat tricky, as numerous variations of this condition exist. This is particularly true when it comes to the seemingly endless ways that OCD-related compulsions are carried out: trying to calm down the anxiety or distress caused by this condition can happen via turning the lights on and off, scratching one’s arm, turning around counterclockwise four times, a phrase to silently repeat washing your hands, etc. Every patient can come up with their own ritual in an effort to regain a sense of composure.
For this reason, the DSM’s latest edition (DSM-V) distinguishes between the four most common types of OCD by mentioning the most prevalent obsessive themes. It should also be noted that these and other OCD-related obsessions can appear together. They are:
Cleaning: Being overwhelmed with thoughts about cleanliness, or fears of illness or contamination, is considered the most common OCD-related obsession. Individuals with this type of thought content spend their days excessively worried they or a loved one may have picked up a fatal or debilitating illness or have soiled their bodies by even the slightest of casual contact. It is often (but not necessarily) coupled with a compulsion to clean or sterilize their skin and overall body, food, home, and general surroundings. According to the DSM, women are more likely to develop cleanliness-based OCD
Symmetry: Sometimes referred to as “just right thinking,” this type of OCD thinking harangues the individual experiencing it with the constant thoughts over any perceived imperfection in their environment or personal appearance. They might exhaust themselves by setting every item in their home at a right angle, arrange and rearrange the contents of their drawers according to a cross-referenced labeling system, count how many letters appear in a given sentence, or make sure their clothes are all perfectly folded and put away in their designated place. Hours may be spent on such chores, leaving the individual (and oftentimes also those around them) frustrated and unnerved.
Taboo Thoughts: This theme of obsessive thoughts refers to aggressive content, sexual content, or actions that go against one’s religion. It includes ruminative thoughts that assail the individual with images or literal sentences that depict them harming, abusing, or exploiting another individual (at times someone helpless or an animal), committing a sacrilegious act or otherwise going against acceptable social norms. The DSM states that men are more likely to develop taboo thoughts or symmetry-based OCD.
Catastrophizing: This category mainly depicts incidents where they or a loved one fall victim to an accident or an “act of God” not intentionally perpetrated by the individual themselves. It includes intrusive and disturbing thought content on vehicular accidents, natural disasters, leaving the stove on and causing their house to burn down, and other accidental disasters. Catastrophizing often causes the individual experiencing it to develop a checking compulsion (i.e., repeatedly confirming for themselves they had indeed turned the gas off).
OCD: A Disorder in Flux
The mental health community’s understanding and categorization of OCD have changed a great deal over the past several years, as more information on its mechanism and more treatment experiences have been recorded.
Previous editions of the APA’s mental health guide, the DSM had included OCD under its anxiety disorders chapter. In 2013, though, OCD (and other OCD-related disorders) were given their own chapter, following several research developments:
An increased understanding of OCD has managed to identify the neural pathways and structures that play a part in this condition.
Empirical studies into the nature of OCD have also found unique genetic, familial, and neural commonalities that are unique to OCD and OCD-related disorders. Such discoveries further distinguished them from other anxiety-based conditions.
Due to the above scientific advancements, OCD-focused treatments have been developed to offer patients proven symptom relief. The FDA has presently recognized selective serotonin reuptake inhibitor medications (SSRIs), cognitive behavioral therapy (CBT) and transcranial magnetic stimulation (TMS) as safe and effective treatments for OCD.
Theoretical breakthroughs have also provided their own take on OCD, interpreting the condition’s intrusive, obsessive thoughts as causing distress, and not anxiety. Anxiety is defined as an adverse sense of hyperarousal—which feels very similar to fear—that persists even when not faced with a tangible threat. Distress, on the other hand, is defined as an extreme uneasiness that prevents the individual from feeling calm. While both anxiety and distress are seen as intrusive and maladaptive responses to a disruptive stimulus, distress is seen as more diffuse and unsettling, as opposed to the sharper sense of panic-stricken anxiety. Obsessive distress makes a further distinction by describing a troubling disquiet that focuses on adverse thought content.
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