When most people think of Obsessive Compulsive Disorder (OCD), stereotypes of repeated washing hands or meticulously arranging of objects may come to mind. While these are common manifestations, OCD is a complex and multifaceted condition that can involve a wide array of themes. Many of these themes are not as widely discussed, often because they can be uncomfortable, misunderstood, or stigmatized. If you are suffering with a less discussed theme, chances are you feel more alone and fear being judged, as OCD can often strike with fear themes opposite to your character. Let’s take a closer look at some of the lesser-known OCD themes and shed some light on this hidden side of the disorder.
You are not alone.
Intrusive Sexual Thoughts
One of the most misunderstood themes of OCD involves intrusive sexual thoughts. People with this form of OCD might have unwanted, distressing thoughts about sexual content. This can include intrusive thoughts about identifying with a different sexual orientation than you are in reality (sexual orientation OCD), intrusive thoughts about sexually harming a child (pedophilia OCD), intrusive sexual thoughts about animals, intrusive sexual thoughts about family members, or sexual intrusive thoughts about strangers or sexual violence. Oftentimes, intrusive thoughts can be even more distressing due to unwanted physical arousal, which does NOT confirm the validity of the thoughts. It is simply a human bodily response. These thoughts are NOT a reflection of the person’s desires or intentions but are rather rooted in their OCD. The shame, guilt, and distress associated with these thoughts often prevent individuals from seeking help, making it a particularly isolating experience. Know that you are not alone. OCD specialists understand the obsessive-compulsive cycles and can be a safe person for you to seek help from.
Harm OCD
Harm OCD involves intrusive thoughts about causing harm to oneself or others. These fears can include intrusive thoughts, urges, and images of accidentally hurting someone, such as hitting a pedestrian with a car, or more deliberate actions, like stabbing someone with a knife. These thoughts can be incredibly distressing and lead to significant anxiety. People with harm OCD might go to great lengths to avoid situations where they believe they could cause harm, which can severely impact their daily lives. An OCD specialist can help you regain your trust in yourself that you are a safe and kind person who has intrusive thoughts you didn’t ask for.
Religious OCD (Scrupulosity)
Religious OCD, or scrupulosity, involves obsessive fears and compulsions related to religious beliefs and practices. Individuals might constantly worry about committing blasphemy, not praying correctly, or being sinful. They may engage in excessive religious rituals, prayer, seek reassurance from religious leaders, or avoid situations they believe might lead to sin. This can create a cycle of guilt and anxiety that interferes with their ability to practice their faith normally. Within this form of OCD, the goal in Exposure and Response Prevention treatment is to help you regain your faith without OCD attaching itself to it.
Relationship OCD (ROCD)
ROCD is characterized by obsessive doubts and fears about romantic relationships. This can include constant questioning of one’s feelings for their partner, doubts about the partner’s feelings, doubt about attraction or compatibility with one’s partner, or fears of infidelity. Individuals with ROCD might frequently seek reassurance, engage in excessive research online regarding relationships, hypervigilant check how they feel about their partner, check their desire to be intimate with their partner, compare their relationship to others, or excessively analyze their partner’s behavior. This can put a significant strain on relationships and lead to misunderstandings and conflicts. OCD treatment can help you (and your partner if you want them to be informed) parse out and manage the OCD, so you can focus on what is really important to you, your relationship.
Contamination OCD (But Not Just Germs)
While contamination OCD often involves fears of acquiring and spreading germs, illness, and disease, it can also include fears of contamination from chemicals, toxins, or even moral (emotional) contamination. For example, someone might fear that touching certain objects could lead them to take on unwanted characteristics of a person they know. These fears can lead to elaborate rituals of washing, avoiding certain places, or discarding items they perceive as contaminated. Those with contamination OCD contain insight into their fears being irrational or excessive, but OCD treatment can help you to stop the compulsive behavior that takes up an inordinate amount of time and help you get back to living the life you want to lead, with minimal to no distress.
Symmetry and Order OCD
This theme involves an overwhelming need for things to be symmetrical, even, or in a particular order. It’s not just about having a tidy room; it’s about feeling extreme distress if things aren’t “just right.” This can apply to objects, actions, even thoughts, or even how we feel things in our body. For example, someone might feel compelled to touch a doorknob a certain number of times on each side to complete a feeling of evenness or rearrange items until they feel ‘just right’. ERP can help someone learn to tolerate not feeling right or things feeling out of order or uneven, and with practice, one’s brain will naturally not feel a high need to complete symmetry or order in the same demanding way it previously did.
Existential OCD
Existential OCD revolves around obsessive questioning about the nature of existence, reality, and the meaning of life. Individuals might constantly ponder questions like “What is the purpose of life?” or “Do we have free will?” or “What happens after we die?”. These thoughts can become intrusive and all-consuming, leading to significant distress and impairment in daily functioning. The person might engage in mental rituals to try to answer these questions or seek constant reassurance from others or the internet. OCD treatment can help us redirect our attention to the quality of our life in the here and now.
Health OCD
Health OCD involves obsessive fears about having a serious illness. Individuals might frequently check their bodies for signs of illness, seek reassurance from doctors, or avoid medical information that could trigger their fears. Despite negative test results or reassurances, the anxiety persists, leading to a cycle of checking and reassurance-seeking that can be very disruptive. OCD treatment can help someone regain their ability to distinguish between reality-based health alarms and their OCD, tolerate uncertainty with minimal stress, and engage in value-based life activities that promote their overall health.
Magical Thinking OCD
Magical thinking OCD involves believing that certain thoughts, words, or actions can influence unrelated outcomes. For instance, someone might believe that thinking about a loved one’s death could cause it to happen or that performing a specific ritual can prevent bad things from occurring. This intrusive thinking can lead to compulsive behaviors aimed at preventing something bad from happening, even though they are not logically connected. Because the two events are unrelated, ERP treatment helps someone learn how to reduce and eventually eliminate the time consuming rituals and thus develop increased trust that compulsion engagement is unrelated to the feared outcome.
The Importance of Understanding and Awareness
These lesser-known OCD themes highlight the diversity and complexity of the disorder. They also underscore the importance of understanding and awareness. People with OCD often suffer in silence, fearing judgment or misunderstanding. It’s important to break the stigma because our feared self is OPPOSITE to our true character and person.
Our OCD and anxiety specialists understand this and will not negatively react to your fears. In fact, people often express feeling immense relief from meeting a professional who understands and knows how to help.
If you or someone you know is struggling with OCD, remember that help is available. Cognitive Behavior Therapy (CBT), particularly exposure and response prevention (ERP), is highly effective in treating OCD. An alternative treatment method is Inference-Based CBT (I-CBT). Please understand that if a therapist practices Cognitive Behavioral Therapy and/or Acceptance and Commitment Therapy, they are not a good fit for someone with OCD. ERP or ICBT must be offered to be considered effective OCD treatment. Alongside effective therapy treatments, those with OCD often benefit from adding an SSRI, a class of medication proven to be effective for OCD. The first step is reaching out for help. You are not alone.