The Themes of OCD
The cycle of OCD is consistent in every individual; however, the content of how OCD presents can vary from one person to the next. There are many subtypes, or “themes,” of OCD that can be helpful to identify to help reduce shame, increase insight, and build a treatment plan. Many people experience some level of these themes and distress; however, OCD takes everything to the extreme, leading to all-consuming distress and withdrawal from many experiences. Two things we do know for sure: 1) OCD always latches onto and attacks the things that are most important to us; 2) the intrusive thoughts & obsessions (regardless of their content) are very distressing and ego-dystonic (i.e. they’re unwanted & go against our values, morals, and beliefs). Because the underlying cycle & functioning of OCD is consistent, with each OCD theme, we are able to use the same skills and techniques from Exposure Response-Prevention (ERP).
Below are some (but not all!) of the themes of OCD. The first two are probably the most well-known themes, and lead to the increased stigma surrounding “oh, I’m sooo OCD.” In reality, these two themes cause such extreme distress that people are paralyzed by fear, stuck in endless loops of ritualized compulsions, and avoid interacting with others & the world around them. The other themes are the ones that are not often spoken about and/or carry so much shame that people keep them hidden away, terrified of other people finding out about them. The more we can all increase our awareness and share, the more individuals with OCD can receive appropriate, evidenced-based treatment to help them live the life they deserve.
Contamination - experiences of fear & disgust surrounding dirt, germs, chemicals, etc., leading to excessive & ritualized hygiene and cleaning practices, and avoidance
Ordering/Symmetry - intense distress when objects, words, numbers, etc. are not in the right order, orientation, or location (based on what OCD decides is right). This isn’t just about wanting things to look nice; this is about experiencing extreme distress and/or fearing horrible things will happen if things are out of place.
Not Just Right Experiences (NJRE) - feeling extremely uncomfortable when things aren’t just right. This could look like needing to repeat routine activities (walking in & out of doors, combing hair, placing an object down, blinking, etc.) until it feels right. Imagine feeling the urge to yawn without being able to yawn, and having dire consequences of feeling this way.
Harm - extreme fear surrounding harming other people. This shows up as having intrusive thoughts and fears of hurting others physically and/or emotionally, leading to avoidance of sharp objects, driving, saying certain words, standing close to a friend, leaving the house without unplugging every electronic device, etc.
Illness/Health - extreme fear about becoming sick, often with a chronic and/or incurable illness. This causes fear around any slightly off sensation or aspect of your body and health, leading to excessive reassurance seeking, doctor’s appointments, checking vitals, etc.
Scrupulosity (Faith & Morality) - excessive, extreme fear about doing the wrong thing, committing sin, and/or disrespecting a faith principle or Higher Power. This creates extreme rules and rigid rituals in faith practices outside of the norm, including praying for hours, excessive confession, repeatedly redoing faith practices, etc. It can also look like extreme guilt & shame about being a bad person, leading to always needing to say & do the morally just thing, difficulty in making decisions in case it’s wrong, excessive reassurance seeking, etc.
Perfectionism - this shows up in many of the other themes, always needing to do the right thing. This can also show up in Obsessive-Compulsive Personality Disorder, or extreme perfectionism, needing everything and everyone to follow the rules. This leads to challenges in relationships, enjoyment in life, and difficulty in task completion due to it not being perfect.
Relationship - extreme, excessive fears about the relationship being the best or right one. This shows up as obsessions about the partner being “The One,” and fears of harming others or being harmed. Common compulsions are researching what is a good relationship, reassurance seeking, checking and asking about every detail of a person’s life, excessive comparison, needing to be completely honest, and breaking up due to uncertainty.
Sexual - intrusive, unwanted thoughts, images, and feelings about sexual orientation, sexual acts, incest, and/or pedophilia. I emphasized unwanted because this indicates that these obsessions are a part of OCD, not a paraphilic disorder. These obsessions are some of the most distressing and challenging to talk about. They cause extreme shame and fear, often leading to complete avoidance of loved ones and children, and the person feeling unlovable and disgusting.