• Jan 14, 2025

Understanding OCD

Subtypes, Symptoms, and Effective Treatments with ERP and ACT

Obsessive-compulsive disorder (OCD) is a complex mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). These obsessions and compulsions can be distressing, time-consuming, and disruptive to daily life. However, understanding OCD and its many subtypes can empower individuals to seek effective treatment and begin their journey toward healing. In this post, we’ll explore different subtypes of OCD, including lesser-known types like sensorimotor/hyperawareness OCD and perinatal OCD. We’ll also discuss two evidence-based treatments: Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT).

What is OCD?

At its core, OCD involves:

• Obsessions: Unwanted, intrusive thoughts, images, or urges that cause significant anxiety or distress.
• Compulsions: Repetitive actions, behaviors, or mental rituals performed to neutralize anxiety or prevent a feared outcome.

While OCD is often portrayed as simply “being neat or organized,” it is much more than that. OCD can cause debilitating fear, doubt, and distress—impacting relationships, work, and overall quality of life. OCD can take many different forms. While some individuals may fit neatly into one subtype, others may experience overlapping symptoms.

Common Subtypes of OCD

Contamination OCD

• Obsessions: Fear of germs, illness, or environmental toxins.
• Compulsions: Excessive handwashing, cleaning, or avoiding “contaminated” spaces, objects, or people.
• Impact: Individuals may isolate themselves to avoid contamination, leading to strained relationships and difficulty participating in daily activities.

Checking OCD

• Obsessions: Fear of causing harm or failing to prevent a catastrophe (e.g., a fire or break-in).
• Compulsions: Repeatedly checking locks, appliances, or other safety measures.
• Impact: Individuals may spend hours checking and feel unable to trust their memory or judgment.

Harm OCD

• Obsessions: Fear of harming oneself or others, accidentally or intentionally.
• Compulsions: Avoiding sharp objects, reassurance-seeking, mentally reviewing past actions, or avoiding certain situations.
• Impact: Individuals with harm OCD are often distressed because these thoughts contradict their values.

Symmetry/ “Just Right” OCD

• Obsessions: Intense discomfort when things feel “out of place” or “off balance.”
• Compulsions: Arranging, repeating actions, or counting until things feel “right.”
• Impact: Can significantly disrupt routines, with individuals repeating actions for hours.

Religious/Moral OCD (Scrupulosity)

• Obsessions: Fear of being immoral, sinful, or offending a higher power.
• Compulsions: Excessive praying, confessing, reassurance-seeking, or avoiding “wrong” situations.
• Impact: Can create intense guilt and anxiety, especially for those with strong beliefs.

Relationship OCD (ROCD)

• Obsessions: Persistent doubts about the “rightness” of a romantic relationship.
• Compulsions: Reassurance-seeking from a partner, comparing relationships, or mentally reviewing interactions.
• Impact: Often strains relationships and causes emotional exhaustion.

Sexual Orientation OCD (SO-OCD)

• Obsessions: Intrusive doubts about one’s sexual orientation.
• Compulsions: Mental reviews of past attractions, reassurance-seeking, and avoidance of triggers.
• Impact: Reflects obsessive doubt, not genuine orientation changes.

Pure Obsessional OCD (“Pure O”)

• Obsessions: Intrusive thoughts related to harm, sex, or morality, without visible compulsions.
• Compulsions: Mental rituals such as analysis, rumination, reassurance-seeking, or avoidance.
• Impact: Internal struggle can be as exhausting as visible compulsions.

Lesser-Known Subtypes of OCD

Sensorimotor / Hyperawareness OCD

• Obsessions: Heightened awareness of automatic bodily processes (e.g., breathing, blinking, swallowing) or sensory experiences.
• Compulsions: Hyper-focusing, attempts to control/avoid sensations, or mental reviewing.
• Impact: Feeling “trapped” in awareness of body, mind, or surroundings.

Perinatal/Postpartum OCD

• Obsessions: Intrusive thoughts about harm coming to one’s baby.
• Compulsions: Avoidance, reassurance-seeking, or excessive checking on the baby.
• Impact: Driven by anxiety and fear (distinct from postpartum depression).

Effective Treatments for OCD

Exposure and Response Prevention (ERP)

ERP is a form of Cognitive-Behavioral Therapy (CBT) that involves:

• Exposure: Gradually facing feared situations, thoughts, or sensations.
• Response Prevention: Resisting the urge to perform compulsions.

Example:

• For contamination OCD, ERP may involve touching a “dirty” surface without immediate handwashing—learning to tolerate anxiety without rituals.

Why ERP Works

ERP retrains the brain to tolerate uncertainty and discomfort. By resisting compulsions, individuals learn feared outcomes are unlikely or manageable—breaking the OCD cycle.

Acceptance and Commitment Therapy (ACT)

ACT helps individuals accept intrusive thoughts rather than fight or control them. Key components include:

• Cognitive Defusion: Observing thoughts without becoming “fused” with them.
• Mindfulness: Present-moment, non-judgmental awareness—even with uncomfortable feelings.
• Values-Based Action: Taking steps aligned with personal values despite anxiety.

Example:

• Instead of mental rituals to “prove” goodness, someone with harm OCD commits to living their values of kindness and compassion, even when thoughts arise.

ERP vs. ACT

ERP focuses on behavioral change by confronting fears, while ACT focuses on psychological flexibility—learning to accept distress and live meaningfully despite it. Combined, they build resilience and help individuals regain control.

When to Seek Help

If you or someone you know is experiencing symptoms of OCD, reaching out to a licensed therapist trained in ERP and ACT can be life-changing. These evidence-based approaches have helped countless individuals break free from obsessions and compulsions and live fulfilling, meaningful lives.

You don’t have to navigate OCD alone—healing begins with that first step toward support.