Five Common OCD Themes

In Greek mythology, the Hydra was a serpent-like creature with nine heads and poisonous breath. The hero Hercules was tasked with killing this monster, only to encounter a major problem – every time he cut off one of the Hydra’s heads, two more grew back in its place.

Battling obsessive-compulsive disorder (OCD) can be a little bit like fighting the Hydra. Just like the Hydra’s nine heads, OCD can manifest differently in different people, making it confusing to identify and understand. However, learning more about the ways OCD manifests is a great first step to conquering this monster. Below, you’ll learn more about five common OCD themes that people frequently struggle with.

Contamination

Imagine you’re washing your hands in a public restroom. As you reach for a paper towel, you see someone who just used the toilet make a beeline for the exit without even glancing at the sink. Most people would agree that this is gross behavior, but how anxious would you feel about touching the door handle our dirty-handed friend just used?

For someone with contamination OCD, this scenario would feel like a real-life nightmare.

Often portrayed as simple discomfort with dirt, contamination OCD can make living in our sometimes-unhygienic world almost impossible. People with this type of OCD experience significant distress when exposed to something they perceive as unclean. Germs, dirt, bodily fluids, spoiled food – these all pose the threat of “contaminating” an otherwise clean surface, something that feels intolerable to someone with contamination OCD.

People with this subset of OCD tend to overestimate the reach a germ or spoiled object has. For example, in 2004, researchers asked people with OCD to identify a “contaminated” object. Then researchers touched this object using a pencil and asked participants to rate how “dirty” the pencil was as a result. They then touched this pencil to another pencil, asking for another rating. They continued this process with 12 pencils.

Participants with contamination OCD rated the twelfth pencil as contaminated as the first pencil. In contrast, participants without OCD quickly determined that the early pencils were not contaminated, showing how people with contamination OCD believe that germs can affect more surfaces than what is possible.

In response to encountering a contaminated object, people with this type of OCD will often engage in compulsive behaviors to “decontaminate” their environment. These compulsions often include showering, handwashing, changing clothes, and excessive cleaning. A person with contamination OCD may not even be able to identify why they perceive an object as dirty – it may just “feel unclean,” leading them to engage in a compulsion until the object is decontaminated.

Perfectionism

Have you ever had an itch on a part of your body that you couldn’t reach? It can be infuriating that, no matter how hard you try, the itch is just out of grasp, driving you crazy as you fail to scratch it.

Having an itch that’s just out of reach is like living with perfectionism OCD. Also called “just right” OCD, this theme deals with completeness and correctness.

For someone with perfectionism OCD, things that feel incorrect or incomplete can create a good amount of distress. If you’ve ever tried washing your windshield at a gas station, you know how impossible it is to get every bug scraped off. For most people, having a few spots on their windshield isn’t a big deal, but for someone with perfectionism OCD, it may feel incredibly uncomfortable until it’s spotless.

In other instances, there may be no apparent reason why something is “off.” Instead, it’s an internal feeling that something is incorrect or incomplete, even if it looks perfect.

In response to their distress, people with perfectionism OCD may repeat the same task over and over until it “feels right.” While striving to perform tasks well isn’t necessarily a bad thing, it can become problematic when it interferes with daily living. Someone with this type of OCD may spend hours trying to accomplish a task that should take minutes to complete, limiting the amount of time they’re able to spend with family or doing enjoyable activities.

One important note to make is that people with perfectionism OCD don’t get pleasure out of working until something feels correct. For many, it feels like being trapped in a loop they can’t get out of.

Harm

While every type of OCD is difficult to live with, harm OCD can feel exceptionally distressing and disturbing.

Harm OCD is a type of OCD where the sufferer fears that they, or someone they love, may experience harm. While this is distressing in and of itself, harm OCD becomes exceptionally difficult when the sufferer begins to fear that they will become the source of harm.

Let’s look at a common example. Imagine that you’re a parent holding your newborn child. Suddenly, the mental picture of you tossing your baby down the stairs slams into your mind.

While this is a disturbing thought, it’s likely no indication of your love for your child, nor does it suggest you want to throw you child down the stairs. Instead, it’s a completely random thought that your brain created. Most people can notice this thought and simply dismiss it. However, someone with harm OCD will begin to question if this thought was a sign that they want to harm their child. What follows is a terrible cycle of worrying about harming their loved ones and wondering if they are somehow a violent person.

In addition to physical injury, someone with harm OCD may worry about harming someone emotionally, mentally, or sexually. Because it’s important to take thoughts of harm seriously, it can be difficult for someone with this type of OCD to accept that their thoughts are benign.

As a result of their distress, someone with harm OCD may isolate themselves from their loved ones out of fear that they will hurt them. They may also ask other people for reassurance about their character, seeking reminders that they aren’t a violent person.

Relationship

Take a moment and imagine a person whom you care deeply about. Now, imagine questioning if you actually love this person. You know that they’re important to you, but you keep wondering if maybe you despise them deep down. Or maybe you question if you’ll ever be capable of truly loving them, or that you secretly find them too annoying handle, or that someone else might be “the one.”

It’s normal to have relationship concerns at times, but these are fundamentally different from relationship OCD. While normal relationship concerns can be worked through, relationship OCD is an endless cycle of worry, leading to a good deal of distress.

According to the International OCD Foundation, relationship OCD takes two different forms – partner-focused or relationship-centered. As the name suggests, partner-focused concerns are focused on the sufferer’s partner, like their looks, personality, and education.

In contrast, relationship-centered concerns are about the actual relationship. Questions like “How do I know he’s the right one?” or “What if I actually don’t love her?” are common presentations of these concerns.

So, how do you distinguish between normal relationship concerns and relationship OCD? It can be challenging to do, but a good place to start is to monitor the frequency and intensity of these concerns. Do they feel all-consuming, intense, and frequent, or do they come and go as you spend more time with your partner? If it’s the former, it’s likely that you’re struggling with relationship OCD. This podcast episode from Clearly Clinical is also a good place to start if you think you may be struggling with relationship OCD.

Scrupulosity

On October 31st, 1517, German professor of theology Martin Luther nailed his 95 Theses to the door of Wittenberg’s Castle Church, initiating the Protestant Reformation. Whether or not you agree with Luther’s stance on theology, there’s no denying the impact of his actions on Christianity. One lesser-known fact about Luther, however, is that he likely struggled with scrupulosity.

Scrupulosity is a form of OCD that attacks one’s religious beliefs and morality. People who struggle with scrupulosity may experience blasphemous thoughts about God, question the quality of their personal faith, or have intrusive images of devilish creatures in their mind’s eye. According to OCD UK,  Luther even wrote about experiencing intrusive images of “the Devil’s behind” when he prayed.

In response to these intrusive thoughts, people with scrupulosity often spend copious amounts of time “repenting” of their thoughts of examining their faith. Luther reportedly spent hours talking to priests to ensure that he hadn’t left any sin unconfessed

Because of the high level of importance many people put on faith, scrupulosity can be an especially distressing form of OCD. It’s normal and good to examine one’s faith, but scrupulosity goes beyond normal concerns about faith, creating a great deal of distress for the sufferer.

The Final Theme

Despite their differences, there is one theme that unites these OCD sub-types – they’re each very treatable. Exposure and response prevention (ERP) has been shown to be an effective treatment for OCD over and over again, so don’t lose hope if you’re struggling with OCD.

Just like the Hydra, OCD can be a terrible beast to fight alone, and I’d love to fight it alongside you. You can click here to contact me and learn more about how ERP could help you overcome your OCD.