The Doubting Disorder
OCD is a complex mental illness, however, most of us have come to understand it as the “germaphobe” or the “perfectionist” illness. Here, I will do my best to not only add to these representations, but also hopefully shatter some common misconceptions that are strung along with this disorder.
With that, please note that this illness is not limited to the information I have posted here. Additionally, the links to the sources that I used to help me in this explanation will be listed at the end of the article.
Alright, so how do we define OCD? Let’s start with a simple Google search definition. A couple definitions pop up initially. The first, from Oxford languages defines OCD as, “having a tendency towards excessive orderliness, perfectionism, and great attention to detail”. Right off the bat, we get a definition that only defines one way that OCD may manifest. Unfortunately, this definition reinforces the common stereotype of OCD that presents the notion that one cannot have OCD unless their compulsions are visible. Sadly, this is the definition of OCD that many of us are most familiar with. It’s the definition that the media often utilizes to portray people with OCD and it’s the definition that caused me to dismiss my own diagnosis for years.
Of course, with a little more scrolling on the internet, we get another definition from the Mayo Clinic that defines it as “Excessive thoughts (obsessions) that lead to repetitive behaviors (compulsions)”. Surely, there’s no simple single-sentence that perfectly sums up OCD. So, though still a surface level definition, the latter, in my opinion, is far better than the former since the first definition entirely dismisses the possibility of mental manifestations. Moreover, to add to this second one, the compulsions that follow these excessive, unwanted thoughts are caused by a strong desire to carry out an act repeatedly to ease the intrusions. And yes, these compulsions can be that of performing a physical act, but they can also be acts or rituals performed mentally.
Certainly, even just a slightly more in depth search on the internet gives us more detailed information, but these surface-level descriptions in conjunction with the media’s portrayal of the disorder provides us with the OCD stereotype that we all know, making it more confusing for people trying to understand OCD sufferers that do not fit into this box.
Furthermore, another thing that makes this illness more difficult to understand can be in part due to the fact that it seems that many sources define their list of “main types of OCD” a bit differently. Some sources only include 4 main types of OCD, others 7 or 15. Next, you may have slight variations in the names of some of the types and then you have some sources that will refer to OCD types as subtypes or themes. Initially, my head was spinning trying to understand the meaning behind all of these differences. Are these things all separate parts of the illness? Are they the same thing? What. does. it. mean. Basically, types, subtypes, and themes are essentially the same thing. They’re all meant to represent the differing thoughts and ideas that OCD may attach itself onto. And sure, there are certain themes that are more prevalent than others, but like I said, the grouping of the “main types” of OCD varies from source to source. Ultimately, what I’ve come to learn is that none of these differences in the grouping and naming actually matters. The truth is that a person’s OCD can surround any theme or idea. Essentially, OCD operates under the same conditions regardless of the “type” and is often treated in the same ways. That said, going over some main types and ways it manifests hopefully provides a clearer depiction of the very basis of what this illness can look like. An individual can have a combination of differing types of OCD which could change over the course of one’s life. Basically, things could be mixed and matched in a multitude of different OCD cocktails.
Before getting into some common themes, it’s really important to preface that the subject matter of one’s intrusions does not align with the person’s values. Intrusive thoughts are ego-dystonic, meaning that they are incompatible with one’s identity and morals. So, it’s very common that OCD targets ideas or subject matters that are most important and dear to the sufferer. In other words, OCD targets what you love most.
Moreover, though it is completely normal for all of us to have intrusive thoughts from time to time, for a person with OCD, these thoughts cannot be brushed off easily. A person can ruminate on an intrusive thought for minutes or even hours at a time and will often have to keep repeating a compulsion until it feels “good enough” to move on.
Now, without further adieu, let’s briefly go over a few common themes in OCD:
Let’s start with the one that we know best,
Contamination OCD
A person with contamination OCD holds the fear of being dirty. This can be a fear of germs and contracting diseases or it can be the fear of dirt and being dirty in and of itself. This may also manifest as metaphysical contamination which comes with the fear and anxiety of catching or passing on contamination by the means of an idea, concept, memory, or thought that is triggering to the sufferer. That said, for some people, hurting a loved one by getting them sick may be the main fear, or obsession, with this theme. A few common compulsions may be to clean, wash certain body parts repeatedly, and/or avoid certain triggers altogether.
“Just Right” OCD
With this type, there usually is not a specific fear attached to it. “Just right” OCD more-so refers to a feeling. You close the door, but it just didn’t “feel right” so you go and do it again. Oh, but that didn’t feel right either so go on and do it 5 more times, then 3, then 2, and 1 okay you’re good. Keep it shut now and move on. It can attach itself onto really any action - physical, verbal, or mental.
Obsession: A person gets an intense feeling that something just is not right.
Compulsions: Performing certain actions over and over, mentally reciting phrases repeatedly, organizing or rearranging things.
This is the OCD theme that often gets labeled as the “perfectionist” type. What’s so important to understand with this is that, yes, some people who struggle with this particular form of OCD, on the surface, MAY appear to be neat and organized perfectionists; however, being a perfectionist does not mean you have OCD and having this type of OCD does not necessarily mean you are a perfectionist from society’s viewpoint of what a perfectionist is. Refusing to accept anything short of perfection on an assignment, a piece of work, or the way that your closet is organized is not the same as having an illness that does not seem to allow your mind to move on from a task as simple as setting down a glass of water until it feels “good enough”.
These next few themes follow similar trends of obsessional thoughts accompanied by ruminating, reviewing, checking, and avoidance behaviors that act as the compulsions. Not to say that these are the only ways one may act on these particular intrusions, however, when the compulsions are purely mental, this is considered a form of “Pure OCD” or Pure-O. The OCD themes detailed below, typically fall under this category.
Harm OCD
The intrusive thoughts that come with harm OCD are often common intrusive thoughts that everyone experiences from time to time. That scary thought of, “What if I just rammed my car into the person in front of me?” Of course, for people with harm OCD, these thoughts cannot be brushed off without ruminating excessively and/or performing some type of compulsion. People who struggle with this theme have intrusive thoughts of performing violent acts onto others or themselves.
Pedophilia OCD - POCD
POCD sufferers obsess over the fear that they may accidentally act like a pedophile and/or that their intrusive thoughts will turn them into one. They may obsess and wonder if they were appropriate in a situation with a child or obsess over future events: “What if I accidentally touch a child in an inappropriate way?”, “What if I think a child is pretty, am I a pedophile?”. For people with POCD, the thought of harming a child in any way is atrocious and the need to engross oneself in compulsive behaviors is painstakingly overwhelming.
It comes to no surprise that this OCD theme usually carries the most amount of shame and is the most stigmatized, but POCD is not equivalent to pedophilia. Pedophiles indulge in sexual thoughts about children, while people with POCD fear the thoughts themselves.
Sexual Orientation OCD - SO-OCD
SO-OCD involves obsessions about one’s sexuality. This is not the same as actually questioning one’s sexuality or being in denial of one’s sexuality. It may seem confusing to non-OCD people why someone may obsess and have such distress over such thoughts, but the fear stems from losing a part of one’s identity and living in a lie, being trapped.
Pure-O is exhibited through these and many other OCD themes such as relationship OCD, religious/scrupulosity OCD, death, hyperawareness, existentialism, etc. Overall, I only detailed a handful of themes just to give an idea that it really can surround or attack any theme and that it is so much more of a mental war than what is visible to others. It is not a disorder that is black and white, easily defined.
One thing that all types of OCD do have in common is that the intrusive thoughts are 100% lying to the sufferer. OCD tells you that you can find the answer to your obsessions, that your compulsions will ensure the safety of your loved ones and of yourself. That you’re f*cked in the head for even having such thoughts. That you must compulse, check, ritualize, seek reassurance, avoid, etc. if you want to prohibit that bad thing from happening.
OCD is often called the “doubting disorder” for a reason. Because behind every theme, there lies doubt. When it comes to the crux of it, people with OCD cannot bear to live with this doubt. Though it is something that is all around us and we obviously cannot escape it, sufferers have developed these maladaptive ways of coping with the doubt, taking it upon themselves to try to eliminate it. Of course, those of us that struggle with this illness know that we can’t play god. We know we can’t actually control the future and that the thoughts are lies and the compulsions don’t actually do anything, but OCD makes it feel like we have no choice. It’s not worth the risk when all we want is to just break up the fight going on in our heads.
This can be a very difficult and frustrating disorder to understand. If you know someone with OCD remember to have patience. It’s challenging to explain and it’s challenging to understand, but patience and empathy on both ends goes a long way. And finally, if you struggle with OCD yourself, you are not alone. As terrifying and stressful as they may be, thoughts are just that - thoughts. We have the power to take away their power, not the other way around. Remember that you are not your diagnosis.
