OCD is substantially misdiagnosed and can lead to improper treatment, worsening of symptoms, and suicidality. Many providers are not trained on the intricacies of OCD and therefore usually misdiagnose clients with another type of anxiety disorder, depression, or psychosis. Too many clients spend years feeling even more distant or disgusted by themselves because they do not know why their obsessions and compulsions won’t leave, even with consistent therapy. It’s important for both providers and clients to understand how OCD can present itself so they can catch it in its tracks and start OCD-specific treatment like Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP).
This part of the series will focus on both the common and lesser-known types of OCD and how they most often present in people. Some of these descriptions may be activating and difficult to read about, especially if you suffer with OCD or are just learning about it. Please take your time to read slowly, stop at any time, and take a break if needed.
Types of OCD
Each type of OCD below is briefly described and then demonstrated through examples. These examples are not exhaustive, but may fit some of your experiences. Resources will be listed at the end of the blog for those wanting to learn more about these types.
Contamination: Most commonly recognized subtype. You may be concerned about getting sick, touching dirty or contaminated objects, and cleaning.
Health/Somatic: Feeling very focused on physical symptoms. You may fear a significant health problem, vomiting, and your body not being “right”.
Symmetry: Not feeling “right” until something is corrected. You may fear something bad will happen or just feel uncomfortable until you “fix” it.
Magical Thinking: Can often be a part of other subtypes. You may worry something will happen, that doesn’t often make rational sense, if you do or do not do something.
Scrupulosity: Obsessions attached to moral or religious worries. You may fear offending God, being a bad person, or doing something that makes you “wrong”.
Sexual: An often misunderstood and shamed subtype, even by seasoned clinicians. You may have unwanted thoughts, impulses, and images about aggressive sexual behavior or content involving your opposite sexuality.
Harm: Also a misunderstood subtype that is often misdiagnosed as suicidal ideation, homicidal ideation, or psychosis.
Relationship: Often surround your partner or other important relationships. You may be concerned that you do not love your partner enough, that they are cheating on you, or that they aren’t “the one”.
Sensorimotor: Hyperawareness of external stimuli or automatic bodily processes. You may feel overwhelmed by these noises or sensations and not be able to “get rid” of it or shut it out.
Existential: Intrusive thoughts about questions that can’t be answered. You may worry about finding the real meaning and purpose of life and become activated when you are not able to.
What These Symptoms May Mean for You
As mentioned in the first part of this series, you must have the four main components of the OCD cycle to fit the diagnosis: 1) Obsession, 2) Anxiety from Obsession, 3) Compulsive Behavior, and 4) Temporary Relief from Compulsive Behavior.
However, even if you experience some of these obsessions and compulsions, it does not always mean that you have Obsessive Compulsive Disorder. For one, OCD is often co-occurring with other diagnoses, like C-PTSD. Other conditions can also include OCD-like symptoms but not fully meet OCD criteria, like anxiety, depression, PTSD, autism, schizophrenia, and more.
Someone experiencing psychosis may experience intrusive thoughts and images, but the difference between them and someone with OCD is their level of insight. Many people with OCD can tell that these obsessions and compulsions are due to mental illness and are not reality; people in psychosis cannot tell the difference between reality and imagination.
In the same way, someone with PTSD may experience intrusive thoughts and images, but the difference here is in the “ego-dystonic” nature of OCD, meaning the content is against their core values and beliefs. A person with Harm OCD may stay away from knives (compulsion) to make sure they stay a good person (ego-driven value), while a person with PTSD may stay away from knives to avoid flashbacks to a real, harmful event that happened in their life. To put it simply, OCD is dysregulation from going against values; PTSD is dysregulation from re-experiencing a traumatic memory.
Accessing Support for OCD
It’s important that you do not self-diagnose or try to independently treat your OCD symptoms. Psychotherapists who specialize in OCD disorders will be able to provide the appropriate assessments, like the Yale Brown Obsessive Compulsive Scale (Y-BOCS), to set you up with the most helpful treatment.
If any of these examples resonate and you want support with OCD, please reach out to us to connect with Mac or another therapist specializing in Cognitive Behavior Therapy (CBT) and Exposure and Response Prevention (ERP) therapies to break the OCD cycle. In the next part of this series, there will be more information about ERP and how to help quell the anxiety of obsessions in and out of the therapy office.
Additional Resources
Article
Journal of Affective Disorders Reports, A systematic review of misdiagnosis in those with obsessive-compulsive disorder
Websites
Books
Educational
Brain Lock by Jeffrey M. Schwartz
“Pure O” OCD by Chad LeJeune
The Imp of the Mind by Lee Baer
The Mindfulness Workbook for OCD by Tom Corboy and Jon Hershfield
Fiction/Non-Fiction
The Man Who Couldn’t Stop by David Adam
Obsessed by Allison Britz
Turtles All the Way Down by John Green