OCD is characterized by recurrent, unwanted intrusive thoughts, followed by compulsions.
Compulsions can be physical, mental or avoidance based. This means the stereotypical ‘Hollywood’ picture of OCD is very misleading. We grow up thinking OCD is handwashing and a love for cleaning. While sometimes symptoms can manifest as hand washing and cleaning; the person never loves it. The person feels compelled to do it, in fear that something terrible will happen if they don’t. There is no love inside OCD. There is fear, anxiety and dread. OCD has different subtypes, meaning symptoms present in different ways for different people. Common subtypes include:
Harm OCD (HOCD)– fear of harming someone including kids, partner, friends, family members, fear of hit and run, fear of shoving someone in the train, fear of blurting out obscenities
Sexual obsessions– including fear of molesting children (POCD), incest, sex with animals, anything taboo you can think of.
Religious/moral obsessions– feeling compelled to follow religion/morals perfectly out of fear of going to hell if you do one thing wrong.
Just right/perfectionism obsessions– needing things to feel ‘just right’ or perfect, or something bad will happen.
Contamination obsessions -f ear of getting sick or getting someone else sick, includes emotional contamination fears (i.e. if I talk about this illness I will get it).
Symmetry obsessions – intrusive thoughts about organization and symmetry
Real Event OCD– obsessions about past events and what people are thinking
Relationship OCD– “Am I with the right person?” “I’m not attracted to them.”
Existential OCD– “What is the meaning to life? Why am I here?”
Perinatal OCD– common during pregnancy, often manifests as obsessions about harming the baby
Sexual orientation obsessions– “What if I am actually gay/lesbian/hetero?”
As you read this list, you might be thinking: “wait so if I have had these thoughts, does that mean I have OCD?” Not quite. Everyone gets these thoughts – they are completely normal and mean nothing about you or your values. The difference is for people with OCD, these thoughts become ‘sticky’ and repetitive, and the person develops intense anxiety and fear of the thoughts. Because of that fear and anxiety, the person then develops compulsions in an attempt to make them go away or ease the anxiety. This becomes a vicious cycle and keeps the thoughts coming non-stop. The paradox is, the harder you try not to think about it, the more your brain will fire them! Thought stopping techniques do not work with OCD.