What is it? 

The theme of these intrusions is about harming yourself or others as either a direct or indirect result of your actions.

Aggressive obsessions can involve fears of self-harm or of causing harm to others either by lethal forms of harm (e.g., stabbing, suffocating, strangling, shooting, poisoning oneself or another) or because of carelessness (e.g. “if I don’t pay attention, they may fall down on the stairs” or “If I trip when holding a knife, I may stab them”).

People dealing with aggressive or harm obsessions usually hold on to the thoughts of “Because I think so, it makes me so” or “If I don’t do anything, if I don’t prevent it, it’s the same as me causing it.” It’s as if having these violent images or thoughts makes them a violent person, or reveals their true aggressive persona; and, if they don’t pay attention to them, they believe that they may act on them or accidentally harm others.

Avoidant behaviors may include the avoidance of people who could cause harm, of tools that could be used to harm, and of news, books, movies, or any other material related to harm.

Aggressive or harm compulsions may include checking that someone is okay; asking others if they did anything weird; checking your own intentions (“Did I really want to hurt my kid?”); anticipating future scenarios in case of causing potential harm to yourself or others; analysis of past scenarios or reviewing past scenarios to make sure that nothing has happened and, therefore, your innocent.

What is it? 

This is, perhaps, one of the best-known forms of OCD, since it has been disseminated through social media quite often.

People with fears of contamination get hooked into the fear of “being contaminated” due to direct contact with different substances, such as toxic chemicals, dirt, germs, garbage, sticky substances, bodily fluids (saliva, semen, feces, etc.), and objects that are infected by any of the contaminants.

Everyday compulsive behaviors may include excessive handwashing, excessively long showers, wearing gloves, sanitizing different areas, changing clothing that has been exposed to the street environment before letting it come into contact with furniture in the house, asking others if it’s safe to go to a particular place, or asking if a stain or contaminant that a person stepped in is safe.

Avoidant behaviors usually include staying away from contaminated places such as hospitals, public bathrooms, people who have a particular illness, shaking hands with people who could potentially contaminate them, and so on.

In the past, the literature has included emotional contamination within the subtype of contamination obsessions. However, in recent years, the literature has mentioned a new theme of OCD, metaphysical OCD, that includes obsessions about emotional contamination. Metaphysical OCD is described further in this table.

What is it? 

This theme of obsessions involves philosophical thoughts, existential matters, and reflections about life issues. While they seem like natural reflections that every person has at one time or another, at some point these thoughts arise alongside extreme distress that is hard to let go of.

Most well-known existential obsessions are about death, life after death, feeling love after death, making the best of life, whether emotions are the right ones in a given situation, immortality, life-after-death experiences, and other similar matters.

Compulsive behaviors may include scanning memories about life events in which a person experienced particular feelings, replaying emotional experiences (such as falling in love, being excited about life, etc.;), dissecting past encounters when having a particular feeling to make sure it was the right one, discussing existential topics or life issues as a form of “figuring them out” and hoping to find the “right response,” searching online about existential matters, and reading books about philosophical matters.

What is it? 

This form of OCD is also known as somatic OCD or somatosensory OCD.

This group of fears relates to concerns about the quality of specific involuntary bodily reactions or bodily functions, such as breathing, swallowing, amount of saliva, itching, ringing in the ears, blinking, body smell, just to name a few. 

Compulsive behaviors typically include contacting doctors, searching online, and checking the quality and intensity of bodily functions (for example, “Am I breathing the same amount of air as this morning?” or “Is this tingling sensation moving from one finger to another?”).

Because the focus of these obsessions is on functions that happen automatically in a person’s body, people with this form of OCD fear not being able to stop being aware of them (eg “what if I cannot stop paying attention to them and it ruins my life?”) or not being able to distract themselves from them because they’re present at all times.

People struggling with hyperawareness obsessions usually engage in massive dosages of body checking and body scanning. Some carry on with regular day-to-day activities like work and school, and so on; on the surface, they appear fine, because they’re not avoiding any situations or activities. Yet, they’re internally preoccupied and hyperfocused on their bodily sensations.

Despite doctors ruling out medical conditions, people with hyperawareness obsessions get hooked on thoughts about something being wrong with their health, feel a strong need to prevent that potential medical condition from occurring, and continue to engage in checking behaviors and mental compulsions.

What is it? 

This classification of OCD usually refers to obsessions about a sensation or feeling that is interpreted as weird, uncomfortable, distressing, or off. Because these obsessions are so sticky – meaning they’re extremely difficult to let go of – a person engages in compulsions related to symmetry, ordering, arranging their physical environment, or any other form of compulsive behavior until the “weird” situation “feels right.” Because of these organizing behaviors, this form of OCD is also known as perfectionistic OCD.

Just-right OCD also includes mental compulsions characterized by a person repeating sayings, making lists, counting words, praying, or the like until the person or their situation feels right.

A popular misconception is that people dealing with these types of obsessions or compulsive behaviors are, in general, very organized, neat, and like perfection, but this is an assumption that is usually very far from the truth.

Yes, some people dealing with this form of obsession may prefer and like to keep things organized, but not everyone who has an obsession or any form of OCD will automatically inherit those preferences.

And, just to make it crystal clear, the compulsions (organizing behaviors) are driven by the wish to avoid the discomfort that comes with the uncomfortable feelings that “something is wrong and off” about any environment or situation. These compulsive behaviors are not necessarily meant to prevent something bad from happening—they’re meant to neutralize, get rid of, or minimize the distress they feel.

What is it? 

This is a fairly new topographical description about obsessions about obsessions and related matters; in other words, the theme of Meta OCD is about OCD itself.  Meta OCD may involve issues related to (a) making obsessions worse, (b) doubting about the diagnosis, (c) fears about your character or who you are because of obsessions, or (d) concerns about the appropriateness of treatment. As you can see, this is another example of how the brain can latch onto anything and everything as an obsession and as compulsion.

Some examples of obsessions involve questions like: what if I actually don’t get better? Do I have OCD? Am I faking OCD? How do I know I’m in a good place to leave treatment and not go back to where I was before?  Am I lying about having OCD?

Some examples of compulsions could be asking for reassurance from others or searching for all types of mental health resources (self-help books, forums, OCD tests, etc).

What is it? 

This form of OCD has been recently mentioned in the literature, so there is not much written about it, although quite likely, it has affected the lives of many before now.

When dealing with this theme of obsessions, people get triggered with particular feelings, vibes, or energies as if those internal experiences are symbols, cues, or omens that could cause harm to themselves or others. Some past literature has referred to this theme of obsession as emotional contamination OCD.

Strong beliefs in metaphysical or alternative energies are common in some cultures; and just to clarify, I’m not saying that holding these beliefs is inherently problematic. What is problematic is when an over reactive brain gets hooked on obsessions and compulsions triggered by energies, feelings or vibes and this cycle gets socially reinforced because of cultural messages. For instance, in the area where I live, doing “manifestations or creating manifestos” is a very popular practice; when creating a manifesto you are asked to visualize your future in any area of your life and you’re encouraged to ask the universe for that future to become a reality; creating a manifesto assumes that by imagining your future, you will make it happen which reinforces the idea that you have control over your thoughts and that all those feelings, sensations you experience have a particular meaning.

In other words, there is a difference between practicing some activities flexibly (e.g, doing a visualization exercise of your future) versus rigidly attaching meaning to them -(“if say this, it always means this” or “I cannot say this, because it a manifesto and it may happen.) A reactive brain can easily get hooked onto thoughts such as “because I think so, it makes me so”; “I feel it, therefore it’s true”; “thinking about it, makes it happen” or “feeling this, means this…” As with many forms of OCD, a person with a metaphysical obsession can easily end up attributing power and meaning to every single word, sentence, or feeling, thus establishing a problematic cause-and-effect relationship.

What is it? 

See Scrupulosity OCD.

What is it? 

Pedophile OCD encompasses thoughts about molesting children, feeling sexually attracted to children, and committing incest. Unfortunately, this may be one of the most misunderstood forms of OCD, even by some clinicians.

There is a variable that makes this complicated, but not unworkable, when dealing with pedophile obsessions: groinal responses. Everyone experiences groinal responses – tingling, itching, scratchy reactions – and everyone experiences arousal reactions that vary in intensity from moment to moment. These responses are dynamic instead of ecstatic experiences. They are triggered when we’re with our romantic partners, or without them, and when hanging out with people of all ages, including children.

The challenge is that these uncontrollable reactions are quickly interpreted by a reactive brain, eager to prove that something is wrong with the person that has them: it is as if they have those groinal reactions, it means the person wants to act on them.

A person dealing with pedophilia obsessions can easily spend significant amounts of time compulsively replaying past scenarios when dealing with triggering situations, checking their bodily reactions for potential signs of sexual attraction, or anticipating and preventing how they would handle future situations if they were to have them.

But the primary difference is that those with this type of OCD do not want to hurt children; their obsession is with their unwanted thoughts about what could happen.

What is it? 

See “Just right OCD.”

What is it? 

This class of obsessions includes intrusive thoughts about either intentionally or accidentally harming one’s own baby (e.g. contaminating the baby with toxic products, doing something inappropriate, transferring bad energies, so on).

It’s extremely distressing and panicky for a parent to experience and acknowledge these intrusive thoughts when they are expected to be happy and bubbly about becoming a parent; and, because of this social pressure, there is much secrecy around this type of obsession.

While most of the literature has suggested that only mothers are affected by postpartum obsessions, there is preliminary research that suggests that fathers experience this form of obsessions as well (Abramowitz, 2001). This, of course, makes sense given that the brain could latch into anything as an obsession and as a compulsion; there is no reason why the overreactive brain of a father cannot latch onto fears of harming a baby, doing something inappropriate, and so on. Obsessions at the end, are not a matter of gender but a matter of a brain perceiving danger when bizarre and non-bizarre thoughts, images, and urges pop up

Compulsions may include: repeatedly checking that the baby’s blankets are not close to his face when he is sleeping, so he doesn’t suffocate; checking multiple times that there are no other objects in the crib; holding a mirror to check if the baby is breathing; checking with sitters to see if the baby is okay; asking people to come over, so that the parent isn’t alone with the baby, and so on.

Avoidant behaviors usually include resisting the following: being alone with the baby, changing the baby’s diapers, being around sharp objects, giving the baby a bath, holding the baby, walking while holding the baby, feeding the baby, and the like.

What is it? 

“Pure OCD” is a term that has created controversy among clinicians, researchers, and OCD sufferers. Because of the way it’s written, it conveys the message that a person dealing with pure OCD only has obsessions, with no compulsions.

Here is my take: there is no need to argue about this label but to understand it within its context,

If you look at the literature on OCD, most of it was focused on public compulsions that are visible to the eyes of everyone and while, there were some writings about people that have mental compulsions, no much was written about it. In fact, we don’t know how many people got undiagnosed because of the lack of awareness of mental compulsions and not knowing they were suffering with OCD.

With the premise, let’s briefly clarify that pure OCD or mental OCD is a myth given that all OCD episodes include both obsessions and compulsions. Even if a compulsion is private, not visible to others, it’s still a compulsion.

These obsessions can be prompted by all types of triggers like fears of getting contaminated, existential themes, doing things right, and everything in between. The key characteristic is that once triggered, the compulsions are private, no one sees them, and even the sufferer doesn’t know that they are engaging in a mental compulsion, because all they’re focused on is getting rid of the distress that comes along with these wacky obsessions.

To make it crystal clear, obsessions may show up as thoughts like “did I? could I? would I? do I want to do x, what if I do …?” And then, the response to those thoughts is more thinking, dwelling, repeating sentences, dissecting, figuring out, and so on.

Table 9.1 in Chapter 9 charts the different forms that mental compulsions have, so you will read more about them there. As an example of what you will read in that chart, some mental compulsions look low-key, like saying sentences, repeating words or counting numbers, but they can also be very complex, like replaying past scenarios over and over until they feel right, because your brain is holding on to a memory that feels safe, right, and blocks the disturbing obsessions.

What is it? 

R-OCD, covers obsessions relating to relationships. While initially this category only included obsessions affecting romantic relationships, these days the academic literature also reports cases between parents and children, and even relationships with spiritual authorities.

While it’s natural for all of us to deliberate about the “fit” of a romantic relationship – whether our feelings for our partner are real or not – the high degree of panic, fear, and anguish that comes with these reflections is considered a form of OCD. Reflecting on life matters is one thing, but having obsessions about relationships that are hard to let go of, that are more like sticky thoughts, and that, when unresolved, stop a person from moving forward in their day-to-day activities, is quite another, and can be extremely painful.

Current writings recognize relationship OCD as having two variations: relationship-centered and partner-focused (Doron, G. & Derby, D., 2017). In plain language, these variations can be seen in three types of common obsessions and many variations or combinations of them:

(1) Is this the right relationship for me? (e.g., “Am I just settling down?”; “Would this relationship be a long-lasting one?”)

(2) “Do I really love this person?” (romantic partner, parent, child, religious figure).

(3) “Does this person really love me?”

People struggling with this type of obsession can spend years not fully committing to a partner in a relationship, and it may even appear as if they have “commitment phobia,” whereas they may well be struggling with intrusive thoughts about relationships.

Frequent compulsions may include a person testing their feelings when spending time with their partner (e.g., “Am I in love?”; “Do I feel love?”); searching for that “Aha!” moment, or for warm feelings inside; checking their sense of attraction or their romantic memories; or comparing current feelings with feelings they had with previous partners.

Common public compulsions may include asking for reassurance about being loved, asking others if they observed cues that their partner loves them, discussing the quality of the relationships with their partners.

Avoidant behaviors may include steering clear of the following: saying “I love you” to a partner; responding to compliments about the relationship; or having intimate relationships with romantic partners.

The challenge with these obsessions is that they can go unrecognized for years because they can appear as natural reflections that any thoughtful person has. However, in the day-to-day life of a person suffering with OCD, they’re painful, take them into agony, and keeps them in an analysis-paralysis state. Usually, sufferers cannot make sense of what’s happening to them, because they’re fighting thinking with more thinking.

What is it? 

See Scrupulosity OCD.

What is it? 

This category of OCD refers to the unsettling fear of being irresponsible and causing harm or potential harm, whether intentionally or by accident. It is very similar to harm OCD.

The academic literature has highlighted that these OCD sufferers present with an extreme sense of hyper-responsibility about their behaviors and the impact of them on others.

Other authors have tagged obsessions about responsibility as a theme, and that’s how the name of responsibility OCD emerged.

Obsessions about being responsible for causing harm to others can vary from causing death, emotional harm, or other types of harm (such as environmental harm or moral harm). See Harm OCD above for a more elaborate explanation of this.

A subtle difference that some authors note is that, at the core, clients with this form of OCD are engaging in compulsions to prevent not only harm but also to prevent feeling guilty, remorseful, or regretful.

What is it? 

Scrupulosity OCD refers to obsessions related to the fear of intentionally or accidentally committing immoral acts, being an immoral person, saying or doing things wrong, or engaging in any form of behavior that goes against a person’s morals, standards, or religious beliefs.

The specifics of an obsession that is incongruent with a person’s religious beliefs varies from person to person, given their religious background. For instance, within the Jewish community some examples of obsessions are fears of violating dietary restrictions or disrespecting the Shabath (Sabbath). For a person from a Christian background, some obsessions involve offending God, going to hell, or disrespecting religious authorities (Huppert & Siev, 2010).

Most common efforts to neutralize those obsessions may include compulsions like: excessive praying, asking for reassurance, figuring out or replaying a religious practice, asking God for forgiveness, confessing sin, repeatedly checking to see if a sin was committed, avoiding spiritual contamination, or avoiding spiritual services or figures that may be triggering.

Unfortunately, those who struggle with this form of obsessions, find it difficult to distinguish religious behavior from compulsive responses to an obsessive fear of not living according to their religious beliefs. In fact, they may see a compulsion as a commendable behavior, even though it’s exhausting, stressful, and hard to handle in their lives.

What is it? 

This is another form of OCD that is usually misconstrued and underdiagnosed. Common obsessions are about sexual orientation, infidelity, sexual deviations, and, at times, sexual thoughts related to religious authority figures or religious figures (Gordon, 2002).

These forms of obsessions have nothing to do with a person’s view of homosexuality but with intrusive thoughts, worries, fears about feeling attracted to or wanting to be with someone of a different sexual orientation than they’re usually attracted to. This applies to people of all genders and sexual orientations. For instance, a homosexual person could have intrusive thoughts about being straight, and so on.

And, just to make it crystal clear, a core difference between sexual orientation obsessions versus being confused about sexual orientation or having sexual fluidity is that obsessions are extremely upsetting, stressful, pop up out of the blue, and are inconsistent with a person’s history of sexual preferences. Sexual obsessions are also different than sexual fantasies or horny thoughts, because these latter ones involve pleasure, fun, and are enjoyable.

People having sexual obsessions may have thoughts along the lines of “I notice I’m paying more attention to girls than guys – like, I like checking them out, and checking how cute they are. Is that because I’m gay?”

Sometimes people stressed with this form of obsessions are terrified that, somehow, they’re in denial of their real sexual orientation, and entertain thoughts such as “Maybe I’m just scared about coming out. Maybe one day I’ll wake up and I’ll have to come out of the closet.”

Compulsive behaviors may include checking whether a sufferer feels more attracted to people of a different sexual orientation than they’re usually attracted to; checking their desire to have sexual contact with the other person, (e.g., “Do I want to kiss her?”; “Do I want to have sex with them?”); testing their intentions when hanging out with others of a different sexual orientation; figuring out the physical sensations they experience; trying to find the meaning of having these thoughts; confessing their thoughts about their opposite sexual orientation as a way to validate and reassure themselves what they’re not.

Avoidant behaviors usually include minimizing contact with people who are triggers and cutting down on watching TV shows or any social media related to people of the sexual orientation that is a trigger for them.

What is it? 

See Hyper-awareness OCD.

What is it? 

Suicidal or parasuicidal behaviors are usually associated with mood disorders such as depression or bipolar disorder, and chronic emotion regulation problems.

However, because an overactive brain has the natural capacity to latch onto any thought, there are also people who experience intrusive thoughts about committing suicide or doing self-harm behaviors; these thoughts are very upsetting and stressful to them because they’re far removed from their intentions.

The variety of suicidal and self-harm obsessions may vary from feeling terrified about getting depressed and committing suicide, jumping off a bridge, slitting wrists, intentionally losing control and crashing a car when driving, or even a fear of overdosing with medications, just to name a few.

Suicidal obsessions may appear in any form, like images of a person committing suicide, or self-harm behaviors, or thoughts of “What if …?” or “Do I want to …?” Sometimes a person’s brain may link strong sensations in their body with wants or urges to engage in suicidal or para-suicidal behaviors. For instance, if a person is randomly walking in the street and feels a strong rush in their body, their brain may associate that strong rush with obsessions about wanting to die; then, the person may report this association like “It feels as if I want to run to the car and kill myself.”

Talking about death, suicide, or self-harm has been another taboo topic for years. It’s only recently that we’ve had more education and information about it. Yet, there is not much information about intrusive thoughts surrounding this theme, so it can be extremely distressful for the OCD sufferer, and also for a therapist who is not familiar with OCD. If a person reports suicidal thoughts, a clinician may conduct a risk assessment and even request hospitalization; this is necessary in some cases but can actually be counterproductive in others. When a person is dealing with obsessions focused on suicide, a risk assessment or exploring their feelings around it can inadvertently reinforce the OCD cycle because it leads to more compulsions and reassurance-seeking behaviors.

And just to clarify, this doesn’t mean that a person suffering with OCD cannot attempt suicide – they certainly can. The point is that when having a suicidal thought, we cannot automatically assume that a person wants to die.