Obsessive compulsive disorder (OCD) involves the triggering of unwanted thoughts, images, or impulses (i.e., obsessions) that provoke feelings of distress in the form of anxiety, disgust, or other negative emotions. In response, people then engage in compulsions in an attempt to reduce or eliminate the distress. This cycle of trigger-obsession-distress-compulsion is reinforced by the temporary relief the person achieves by doing the compulsion. Once the obsession is triggered again, the cycle is even more likely to be repeated. OCD is the fourth most common mental health disorder. Despite how common OCD is, most people still have difficulty getting proper treatment. Many therapists are not trained in Exposure and Response Prevention (ERP) yet still claim to treat OCD. To complicate things further, OCD is not always easy to identify. Most people can recognize excessive hand washing or checking locks as OCD, but there are so many other ways OCD can present that are harder to identify. Harm obsessions Harm obsessions can take the form of harming loved ones or anyone perceived as vulnerable, so people often have fears of harming partners, parents, siblings, children, and pets. It is also common to have fears of harming oneself (e.g., thoughts of driving off the road or jumping from a high balcony). Often, these thoughts are accompanied by a fear of losing control. For example, “what if I lose control and stab my partner while preparing dinner?” These thoughts differ from genuine suicidal or homicidal thoughts in that they are unwanted thoughts and the person has no real desire to act on these thoughts. A very common time for these thoughts to manifest is during pregnancy or after childbirth. Many parents develop obsessions around harming their child during this time. People may also fear causing inadvertent harm to others if they were to cause a fire (by failing to check the stove), burglary (by failing to check the door locks), or car accident (by failing to pay proper attention or check their periphery). Instead of obsessing about losing control, the thoughts here may be more focused on making a mistake that leads to catastrophic consequences. Sometimes harm obsessions manifest as a fear of emotionally harming others. For example, someone may obsess over whether they’ve hurt someone’s feelings and experience intense guilt and anxiety. Or perhaps they obsess about losing control and blurting out something offensive. Regardless of the form of harm obsessions, a common thread is a sense of overresponsibility. Individuals with harm obsessions have core fears involving being a “bad” person, going to prison, ruining lives, and ruining relationships. Common compulsions include checking, mentally reviewing situations or trying to “figure it out,” thought suppression or distraction, internet research (e.g., reading about serial killers or psychopaths), seeking reassurance from others, confessing, apologizing, and avoidance of people or objects. Sexual obsessions OCD can present as intrusive sexual thoughts about someone inappropriate – often family members, friends, children (Pedophile OCD or POCD), and even pets. People may experience sexual images or impulses to act on sexual thoughts. These thoughts are experienced as disgusting and repulsive to the person and, therefore, elicit anxiety and shame. Sometimes these thoughts take the form of “Did I just touch that person inappropriately?” Other times the thoughts could be more like “What if I lose control and do something inappropriate?” There may also be some overlap with harm obsessions as well – for example, obsessions about whether they sexually assaulted someone they walked by on the street. It’s also very common for someone with OCD to question whether they are experiencing pleasure by having the thoughts (although on some level they know these thoughts are not pleasurable and they would do anything to get rid of the thoughts) and to even monitor arousal. Typically, the core fears underlying these types of sexual obsessions are fear of being a “bad” person, fear of going to prison, fear of ruining someone else’s or one’s own life, and fear of ruining relationships. Another subset of sexual obsessions involves doubting one’s sexual orientation. This could manifest in a number of ways. Someone who is heterosexual could have doubts that they might be gay. Someone who is gay might have doubts that they are secretly straight. The important thing here is that there is a need to know with absolute certainty what one’s sexual orientation is, whether it be gay, straight, bisexual, asexual, pansexual, etc. This goes far beyond normal questioning of one’s orientation. Core fears around sexual orientation are sometimes based on fear of losing important romantic relationships if one discovers they’re not the sexual orientation they thought they were. Sometimes the main concern is devastating their partner. Sometimes they worry about their entire life having to change. The core fear could also be about not knowing oneself, or simply the fear of never feeling sure about one’s sexual orientation. Common compulsions include checking for sexual arousal (groinal response), mentally reviewing situations or trying to “figure it out,” thought suppression or distraction, internet research, seeking reassurance from others, and avoidance of people. Relationship obsessions Relationship OCD (ROCD) involves extreme doubt about one’s relationship. These doubts can center around how one feels about their partner or the relationship itself – “Am I attracted enough to my partner?” or “Is this the right relationship for me?” Alternatively, one can struggle with doubts and fears about how their partner feels about them. Sometimes relationship OCD leads to obsessing about a partner’s relationship history – for example, obsessing over the number of sexual partners their partner has had, or feeling the need to know details about their partner’s previous relationships. Core fears with ROCD include fear of being hurt or betrayed, fear of missing out on “the one,” and fear of causing irreparable harm to another person. People with ROCD tend to seek reassurance from their partner that everything is okay. They also may seek reassurance from others about what is “normal” in a relationship or engage in comparing their relationship to others’ relationships. They may monitor their sexual arousal to confirm they are still attracted to their partner. They may also check for sexual arousal around other people. Other compulsions may include mentally reviewing situations or trying to “figure it out,” thought suppression or distraction, confessing, and avoiding their partner or other attractive people who are not their partner. Religious obsessions (also known as Scrupulosity) Religious obsessions or Scrupulosity involves the fear of sinning or doing something morally wrong, including blasphemy. Often people fear sinning or offending God, but sometimes the fears are unrelated to religion or faith and focus simply on a need to do the “right” thing. It’s important to understand that being religious, even deeply religious, does not cause OCD. However, because OCD often attacks the things we care about the most, people who are deeply religious or scrupulous and have OCD may develop obsessions of a religious nature or involving morality. Further, scrupulosity can develop within any set of religious beliefs, whether they be Christian, Muslim, Jewish, or any faith. Core fears may involve being punished, going to Hell, and being a “bad” person. Common compulsions include praying for forgiveness, mentally reviewing situations or trying to “figure it out,” thought suppression or distraction, seeking reassurance from religious leaders, confessing, apologizing, and avoidance of people or objects. Many people who struggle with religious scrupulosity find it difficult to attend religious services or practice many aspects of their faith. Contamination obsessions People with contamination obsessions may have fears of dirt, germs, bodily fluids, chemicals, and diseases. Sometimes these things are feared because they are linked with illness, and other times they may trigger a feeling of disgust. Some may also experience a fear of emotional contamination, which is a fear of taking on or spreading someone’s or something’s essence. For example, they may fear taking on characteristics of selfishness simply by being around someone they perceive as selfish, or they may fear going to a particular place where something negative or traumatic happened due to a magical belief that they will cause something bad to happen. Contamination obsessions can focus on oneself, other people, or both, and this would be reflected in the core fears present. Core fears could include a fear of contracting an illness and dying, or possibly suffering. Perhaps they fear being in a vulnerable state and not believing anyone would take care of them. Or perhaps they fear leaving their family behind and not being able to take care of them. Individuals who mostly fear spreading contamination, much like those with inadvertent harm obsessions, feel overly responsible. Often their core fears center on causing significant illness or death to someone they love. Common compulsions would include excessive hand washing, showering, using barriers like gloves or towels, cleaning/decontaminating items, and avoidance of people and places that are considered contaminated. Symmetry/Order obsessions Lastly, obsessions with symmetry, order or exactness are common. People may have concerns about how items on their desk are arranged, or they may feel unsettled if they experience a sensation only on one side of their body (e.g., bumping their left elbow and feeling an urge to even things out by bumping their right elbow). These can be linked to a magical fear that something bad will happen if an item is left out of order, but often they trigger an uncomfortable feeling of things not feeling “just right.” Compulsions could include ordering and arranging items in a particular way, repeating tasks until they feel “just right,” and “evening out” bodily sensations (e.g., needing shoelaces to be even tensions on both feet). Return to top of page