Write It Right: The Subtypes of Obsessive-Compulsive Disorder

As we covered in the last Psychology & Storycraft post, How to Tell If Your Character Has Obsessive-Compulsive Disorder, OCD is very misunderstood. It isn’t all about washing your hands or meticulously arranging your desk and it doesn’t mean being a perfectionist or liking to check things often.

So what is obsessive-compulsive disorder? It’s an anxiety-related mental health condition characterised by “obsessions”—recurring and persistent thoughts, images or urges that are unwanted and can cause you great anxiety—and “compulsions”—the repetitive behaviours or mental acts you perform to reduce or neutralise your discomfort.

Exactly what those obsessions and compulsions are differs from person to person, but it’s possible to identify common themes or dimensions across the various experiences of OCD. And guess what? Those themes are the subject of today’s post.

To Keep in Mind:

The information in this post comes from the DSM-5 (see ‘Further Reading’). Please do not use it to diagnose yourself or others. It isn’t intended to be a substitute for professional advice so do consult a qualified clinical professional if you have any questions about the diagnosis criteria. Feel free to use this information to diagnose your characters, however.

The thing about obsessive-compulsive disorder is that there’s no one type, no single representation of what it is. This disorder is so different for each person experiencing it and so there are actually several subtypes of OCD. Today we’re going to take a look at the most common ones, as well as examples, both general and specific, of their related obsessions and compulsions.

There’s a lot to cover so let’s dive right in with our first subtype…

Contamination

This is the one that’s often portrayed in media and is typically the first thing that comes to mind when people think of OCD. It’s a lot more than repeatedly washing your hands or cleaning things though—a lot more—so we’ll break this category down a little bit further.

Contact Contamination

Obsession: The fear that something is contaminated and/or could cause a loved one or yourself illness or untimely death.
Compulsion: The need to clean or wash.

If you have this particular type of OCD, you might wash yourself or clean things until you ‘feel’ they are clean, whereas someone without OCD might wash or clean until they ‘see’ they are clean. The intense feelings of discomfort that come from feeling dirty, perhaps coupled with the fear that you might pass those germs on to others, could fill you with the need to scrub for hours, which comes with a lot of negative repercussions (that will have a whole section in the next post, So Powerful It’s Fact: Writing About Obsessive-Compulsive Disorder).

What kind of situations can trigger obsessions in this type of OCD? It may be:

• Using public amenities (e.g., toilets, transport, telephones)
• Touching door handles or banisters
• Waiting in a GP’s surgery or visiting a hospital
• Shaking hands with, hugging or kissing someone
• Eating out somewhere
• Being in a crowd
• Being in an untidy kitchen or bathroom
• Coming into contact with chemicals

Contamination is probably one of the more well-known subtypes of OCD, but it doesn’t just apply to physical contamination. It can be mental too.

Mental Contamination

Obsession: The fear that someone or something related to that person is contaminated.
Compulsion: The need to clean or wash.

Rather than objects being dirty, with mental contamination, you feel unclean. This feeling of internal dirtiness is caused by a psychological or physical violation and generally affects the whole of your body, rather than a localised part (e.g., your hands after touching a ‘germy’ banister). As with contact contamination, if you experience this OCD subtype, you may wash yourself excessively to relieve the discomfort those obsessive and intrusive thoughts cause.

What can cause feelings of mental contamination? Someone may have wronged you through:

• Hurtful criticism
• Abusive language
• Humiliation
• Degradation
• Betrayal

Being in direct or indirect contact with this person can trigger the start of the obsession-compulsion cycle. It’s pretty easy to imagine how direct contact can lead to feelings of mental contamination and possible avoidance behaviour as a result, but what’s this about indirect contact? This might be contact with the wrongdoer through your memories, images, items the person has touched, people they’ve interacted with, and so on. These triggers can be even more difficult to avoid than those of contact contamination, something you should keep in mind if writing about a character with this subtype of OCD.

Checking

Obsession: The fear that yourself or others may be harmed, or that damaged may be caused.
Compulsion: The need to check things.

In this subtype of OCD, anxiety can be sparked by intrusive thoughts of harm being done to someone or something, like the house catching on fire or a loved one being involved in an accident. It’s only through checking (and often checking many, many times) that this terrible anxiety can be alleviated.

What different forms of checking are there? The most common ones include checking:

• Appliances to make sure they don’t cause damage (e.g., ovens causing fires or explosions, taps causing flooding and property damage, candles or lights causing fires, etc.)
• Locks and alarms to prevent break-ins (e.g., door, car and window locks and house alarms)
• Symptoms of illnesses for fear of being sick (e.g., online symptom checking)
• Wallets or purses to make sure important cards or documents haven’t been lost
• Documents or books to ensure no important information has been missed
• Mail or texts before sending them to prevent anything inappropriate or offensive being sent
• Various sources to make sure no one was hit while you were driving (e.g., checking the route you drove down for bodies or police/ambulance activity, searching the papers and TV for stories of a hit-and-run, etc.)

Checking can also take more subtle forms, like memory checking to make sure an intrusive thought really was just a thought and not something that actually happened (more on that in the next section), calling or texting loved ones to make sure they’re unharmed, and repeatedly seeking reassurance (e.g., asking a partner if they love you or if something is safe).

Intrusive Thoughts

These are unwanted thoughts that surface in your head involuntarily and cause great distress because of their content. We all have intrusive thoughts from time to time, but the fear that those thoughts are genuine and might be acted on is ramped up in the case of OCD. These intrusive thoughts can make you feel scared, ashamed, guilty, disgusted or embarrassed, and generally focus on the thing you are most afraid of being or doing, which is why these thoughts have such an impact.

The obsessions in this form of OCD often relate to certain themes, such as intrusive magical, violent, sexual or religious thoughts, with the compulsions taking a more mental, non-visible form. Let’s take a closer look at some of the main themes of intrusive thoughts.

Magical Thinking

Obsession: The fear that thinking about something bad makes it more likely to happen.
Compulsion: The need to perform mental and/or physical rituals.

This form of OCD is called ‘magical thinking’ because it involves an illogical thought pattern in which unrelated actions or events are linked together. For example, magical thoughts might include believing that:

• Your thoughts have the power to cause harm or disaster (e.g., thinking about a car accident can cause it to happen)
• Certain numbers, colours or days have good or bad luck (e.g., three is a lucky number but one is bad luck and must be avoided)
• You know when people will die
• Certain actions can change the outcome of events

I mentioned rituals. What are they? A ritual is a set pattern of behaviour that can be mental or physical, and in this form of OCD, it’s performed to counteract an intrusive, bad thought. To those observing, the actions in rituals can seem bizarre and unrelated to each other, or to the intrusive thought, but the fear that something bad will happen unless they’re performed exactly right is incredibly powerful if you experience this subtype. Rituals might include:

• Repeating specific words or phrases (e.g., repeating ‘life’ to counteract hearing or thinking ‘death’ or repeating someone’s name to prevent harm befalling them)
• Counting to a special number (e.g., counting to ten ‘just right’ to make sure harm doesn’t come to a family member)
• Performing certain actions (e.g., praying, tapping or checking things a particular number of times)

If rituals are interrupted, you may feel compelled to start over again from the very beginning, which takes even more time and causes even more anxiety.

Violent Thoughts

Obsession: The fear that you’ll do something violent to loved ones, other people or yourself.
Compulsion: The need to perform specific actions or avoid certain people or places.

These intrusive, aggressive thoughts could make you believe that you’re a bad person, someone capable of acting on them—more than that, someone who very well could do unless you do something to prevent it. However, that’s usually far from the case.

What form of intrusive thought could this theme take? It could be:

• Harming children, loved ones or someone vulnerable (e.g., a disabled person or a pregnant woman)
• Using something to hurt others (e.g., using knives from the kitchen or poisoning food)
• Killing innocent people
• Losing control and acting on unwanted impulses (e.g., stabbing someone)
• Jumping in front of a train or bus

In response to these violent intrusive thoughts, you might perform compulsions like locking away sharp objects or not cooking for loved ones, or you might avoid certain situations or people, like public places or your children. In avoiding triggers for the obsessional thoughts, you might believe you can prevent them. The sad reality is, though, that this actually feeds the cycle of obsession and compulsion.

Sexual Thoughts

Obsession: The fear of inappropriate sexual attraction toward others or causing sexual harm to them.
Compulsion: The need to avoid contact with or places frequented by these certain people.

There are two main focuses with this subtype of OCD: the questioning of your sexual preferences and the fear that you’ll act on those preferences in an inappropriate and/or harmful way. However, as with the other forms of intrusive thoughts, the people who experience these obsessional doubts are some of the least likely to act on them. The fear that they will is incredibly strong though.

What are some examples of those obsessional thoughts? They could be the fear of:

• Being sexually attracted to members of the same sex or, for those who are gay, the fear of being sexually attracted to members of the opposite sex
• Being sexually attracted to members of your family
• Being a paedophile and being sexually attracted to children
• Touching a child inappropriately
• Intrusive sexual thoughts about God, saints or other religious figures

The fear of being labelled can often lead to a reluctance to seek help from others, like health professionals, and so instead you might hide it and compulsively avoid places frequented by the object of your intrusive thoughts, like public places, religious buildings or family members’ homes. If your intrusive thoughts feature members of your own household, it can lead to even greater emotional distress, with avoidance behaviours like never hugging or bathing your children negatively impacting both you and your child.

Religious Thoughts

Obsession: The fear that you’re guilty of religious, moral or ethical failure.
Compulsion: The need to think or do something specific, or avoid certain things.

Another name for this form of OCD is Scrupulosity and it isn’t just limited to unwanted religious thoughts; it includes intrusive moral and ethical thoughts too. Religious, moral and ethical Scrupulosity can be particularly devastating because the obsession is completely at odds with who you believe you are. Your core values and beliefs, the parts of yourself that define your purpose in life, are challenged by these unwanted and intrusive thoughts and suppressing them doesn’t solve the problem. If anything, it can make it worse. Remember this if any of your characters experience this form of OCD.

So what are some of the common obsessions found in Scrupulosity? They can include:

• Repetitive thoughts about committing a sin or doing something immoral/unethical (e.g., believing you’re a bad person because you found someone other than your spouse attractive)
• Excessive fear of shouting obscenities in a religious or public place
• Disproportionate focus on religious, moral and/or ethical perfection (e.g., prayers must be recited perfectly, you must always tell the truth, the speed limit must never be exceeded, etc.)
• Inordinate fear of having offended God (e.g., by mispronouncing a few words when praying)
• Unwanted sexual thoughts about God, saints or other religious figures
• Repeated fears of going to hell or that your actions will doom loved ones

The compulsion listed at the start of this section was pretty vague, mainly because it differs from person to person, but that’s not a great help if you want to write about this. Let’s expand upon it and look at some of the more common types of compulsion. For example, there’s:

• Repeatedly confessing actions or thoughts (e.g., to priests, religious elders, friends, family, etc.)
• Ritualised praying, reading of religious texts and/or repeating of specific verses
• Unreasonable acts of self-sacrifice (e.g., donating large amounts of money or possessions)
• Avoiding religious places, figures or practices
• Avoiding things associated with immorality or sin (e.g., types of clothes, certain numbers, films related to certain themes, etc.)

Something else to bear in mind: religious Scrupulosity can be found across many belief systems and faiths. It isn’t limited to religions like Christianity, Judaism or Islam.

Symmetry and Orderliness

Obsession: The fear that things don’t feel ‘right’ or that harm may befall someone because these things aren’t right (see ‘magical thinking’).
Compulsion: The need to arrange things symmetrically or ‘just right’.

The anxiety caused by the obsessions in this subtype of OCD can compel you to arrange and rearrange objects until they’re ‘just right’, which can take an inordinate amount of time, drain you mentally and physically, and result in several other negative repercussions, like being late for work or appointments. You also might avoid inviting people into your home to stop anything disturbing what you’ve meticulously arranged, which can have an impact on your social life and relationships.

Okay, so what about some specific examples of this subtype’s obsessions? You might need to have:

• Pictures hang straight or in perfect alignment on the walls
• Jars and tins all face the same way
• Clothes sit neatly on their hangers, all facing the same way
• Books lined up in a row on a bookshelf
• Everything be spotless, with no marks or smudges
• Everything be tidy and in its place at all times

And if things are not orderly or arranged in the right way? The compulsion is to rectify that. Again, please remember that simply feeling the need to arrange things in just the right way does not mean you have this subtype of OCD. You also need to meet the criteria described in the previous post, like performing these clearly excessive behaviours to alleviate an intense anxiety, spending lots of time doing so, experiencing significant impairment in other areas of functioning, etc. (more on that last point in the next part of the series).

With that, we’ve reached the end of the post! This is by no means a complete list of all the subtypes of OCD and their common obsessions and compulsions. If you want to learn more about the other types of OCD that aren’t listed here or find more specific examples of obsessions and compulsions, reference books and the internet are your friends. Research thoroughly, read widely and write sensitively.