The ways in which the symptoms of obsessive-compulsive disorder (OCD) are experienced vary widely from one person to another. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) offers a comprehensive definition of OCD that includes the presence of obsessions and/or compulsions that lead to major distress or disruption in the daily living of an individual. Clinicians and researchers suggest that OCD can be divided into different types based on the nature of the symptoms one experiences.
5 symptom subtypes of OCD
Although specific types of symptoms appear to be relatively stable over time, it is possible to experience a change in the nature and focus of one’s symptoms. Additionally, although most of the symptoms might be consistent with a particular symptom subtype, it is also possible to experience symptoms associated with other types at the same time.
- Contamination obsessions with cleaning/washing compulsions– Usually, if one is affected by this symptom subtype, then they will focus on the feelings of discomfort associated with contamination and may wash or clean excessively in order to reduce the distressed feelings. For example, an individual suffering from this symptom subtype might feel that their hands are dirty or contaminated after they touch a doorknob or worry that they will contaminate others with their germs. To overcome these feelings, they might wash their hands repeatedly for hours at a time.
- Harm obsessions with checking compulsions– When one experiences this symptom subtype, they will often have intense thoughts associated with possible harm to themselves or others and use checking rituals to relieve their distress. For example, one might imagine that their house is burning down and then continually drive by their house to ensure that there is no fire. Or, one might feel that merely thinking about a disastrous event increases the likelihood of it actually happening.
- Obsessions without any visible compulsions– Often, this symptom subtype relates to unwanted obsessions surrounding sexual, aggressive, or religious themes. For example, an individual suffering from this symptom subtype might experience intrusive thoughts about being a rapist or that they will attack someone. When the individual has these involuntary thoughts, they may often use mental rituals, such as reciting particular words, praying, or counting in their head, to overcome the anxiety they experience. Usually, the triggers associated with the obsessions are avoided at all costs.
- Symmetry obsessions with ordering, counting, and arranging compulsions– When experiencing this subtype, one feels a strong need to arrange and rearrange objects until they are “just right”. For example, one might feel the need to constantly arrange their shirts so that they are ordered precisely by color. This symptom subtype may also involve thinking or saying sentences or words repeatedly until the task is perfectly accomplished. Sometimes, these ordering, counting, and arranging obsessions are performed in order to ward off potential danger. For example, one might feel that if they arrange their desk perfectly their husband won’t fight with them. However, this is not the case always.
- Hoarding– Now, hoarding is recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items, which are judged to be of limited value by others, such as old magazines, containers, clothes, notes, receipts, or junk mail. Often, the living space of individuals suffering from this symptom subtype becomes so consumed with clutter that it becomes impossible to live in. Hoarding is often accompanied by obsessional fears of losing the items or possessions, which one might need someday and an excessive emotional attachment to objects. Individuals affected by this symptom subtype will tend to experience higher levels of anxiety and depression than individuals with other subtypes, and they are often unable to maintain steady employment. Notably, compulsive hoarding may occur independently of OCD.