What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorders (OCD) is described in the DSM V (book clinicians refer to for diagnosing) as the :
“Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. (Meaning. I direct evidence, OCD has its own unique logic process often relying on possibilities, abstract stories, and doubt in oneself).
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
3 Core Fears according to Exposure and Response Prevention Therapy (ERP):
Catastrophe (something bad will happen if I don't do my compulsions)
Uncertainty (I can't handle not knowing and need to figure this out)
Disgust (the feeling associated with this is repulsive and I don't feel like I can handle it)
OCD Themes
There are so many different themes and as someone who has specialized in working with OCD since 2018 and seen hundreds of clients navigating this diagnosis there are still times where I see new flavors of OCD and themes present in different ways. So while this list includes a lot of themes/flavors of OCD, it is not comprehensive! Flavors and themes often shift and even the same theme can change over time which is why I like to refer to them as flavors.
Some OCD Themes categories and examples:
Moral OCD: worried about being good
Scrupulosity: wanting to know they are good for religious reasons (examples: worried not following religious rules exactly like they should, worries they may one day leave religion which causes distress, worries they aren't worthy, etc).
Perfectionism can fall under this category and can feel like they need to do things perfectly in order to be good. (Examples: worrying about being perfectly honest, worrying about not having followed rules such as work, school rules or laws, etc).
Harm obsessions: worried about harm coming to themselves or others due to their actions or lack of actions
Contamination: in some way them being contaminated or spreading contamination could harm themselves or others (examples: worried about spreading an allergen such as peanuts to someone who might be allergic to it, worried about bodily fluids spreading because of germs, worried about catching a virus and getting seriously sick, etc)
Worries related to neglect (examples: what if I forgot to lock the front door and a murderer comes in during the night?, what if I don't realize that I'm subconsciously wanting to hurt myself or others?, what if I accidentally dropped a pill when I was taking my meds and my dog ate it? what if I don't watch my kids closely enough and something bad happens?, etc)
Worries about intentions and harm (examples: what if I was aroused when I saw that kid and that means that I might want to be a pedophile? What if that thought about driving into oncoming traffic means I want to hurt myself? What if the image of my partner bleeding I got in my mind while cutting vegetables means I want to hurt them? Etc).
Relationship OCD: worries related to relationships
What if I'm in the wrong relationship?
What if they are a bad person?
What if I'm a bad person?
What if I'm not attracted to my partner or they aren't attracted to me (can be related to sexual identity)
What if my partner doesn't love me anymore?
What if I’m not likable?
What if I did something that caused me to be estranged from my family?
What if my boss is angry at me?
Just right OCD: this one is feelings based and about things feeling “just right” can have a threat associated, but often doesn't (examples: needing to turn off the stove multiple times until it feels just right or really any compulsion until it feels “just right” such as asking for reassurance until it feels “just right”)
Disgust based: often has excessive repulsion that lead to avoidance and rituals
Contamination can fall under this category too and is often related to fears of some contaminant being spread Examples:
Fear of bodily fluids or feces that leads to avoidance of others or special rules
Fear related to meat that leads to avoidance and special rituals
Some Phobias fall under this category such as emetophobia (fear of vomit), fear of spiders, and fear of needles when disgust is the fear etc.
Health obsessions
Worries about yourself or someone else having an illness can be a specific disease or more general worries related to physical experiences meaning something more serious (examples: what if I have a brain tumor and don’t know it?, What if I have an STD and am going to pass it to others and not know it?, What if my child has an illness? etc)
This can also be related to avoiding getting an illness or disease and may include excessive avoidances and rituals to try to avoid getting sick (examples: worried about lung cancer and so doesn’t go outside and has multiple air purifiers, worried about carcinogens and avoids using any products with them etc)
Can be fear of bodily functions (examples: what if I were to pee myself in public?, What if someone got blood on this item I am buying at the store? etc)
Magical Thinking: worrying certain thoughts, words, behaviors etc could impact unrelated outcomes (examples: If I wear blue than I will feel sad today, I need to flip the light switch an odd number of times so nothing bad happens, I can’t wear the jacket I was wearing the last time something bad happened etc)
This can sometimes include order and symmetry based compulsions, although other times they fall under different categories. Examples: if I don’t line my toys up just right than something bad is going to happen to my mom, if anything is out of place than it is going to cause something bad to happen to me, etc.
What are your themes? What core fear(s) does your OCD go back to (disgust, catastrophe, or uncertainty)?
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