The 5 major types of OCD and how to recognize key symptoms – Insider

  • The most common types of OCD include contamination and cleaning, forbidden thoughts, symmetry, harm-focused, and hoarding.
  • People with OCD characterized by forbidden thoughts may feel shame around persistent, intrusive thoughts that are often violent or sexual in nature. 
  • Another way OCD can manifest is through hoarding, which may make you hold onto items such as junk mail, old clothes, and receipts.
  • This article was medically reviewed by Alisa Ruby Bash, PsyD, LMFT, of Cure by Benya Medical Spa in Malibu, California. 
  • Visit Insider’s Health Reference library for more advice.

Obsessive-compulsive disorder (OCD) is a mental health condition that causes uncontrollable reoccurring thoughts and repetitive behaviors. It is a relatively common mental disorder and affects about 2% of adults in the US. 

Obsessions and compulsions are the two main components of  OCD. “Obsessions are unwanted and intrusive thoughts which cause significant anxiety and distress. Compulsions are behaviors a person engages in to reduce distress and anxiety and to suppress unwanted thoughts,” says Jeffrey Cohen, PsyD, a clinical psychologist at Columbia University Medical Center. 

These obsessions and compulsions manifest themselves in various ways for different people with OCD. For example, some people may feel compelled to constantly disinfect their surroundings for fear of germs, whereas others may fill their home with clutter that they cannot bear throwing away.  

Here’s how to recognize the most common types of OCD and how to treat the condition. 

1. Contamination and cleaning 

This type of OCD occurs when a person has an intense and persistent feeling of being contaminated by germs. People with it often fear getting sick. They also fear infecting people close to them, which causes them to self-isolate and avoid social interaction. 

People with this condition have a compulsion to clean themselves and their surroundings to an unhealthy degree. The cleaning process can last for hours at a time and often affects their physical health, as they can sometimes clean themselves until they bleed. 

To recognize this type of OCD, look for behaviors like:

  • Fear of contracting a fatal illness or infection through exposure to bacteria and germs
  • Excessive hand washing
  • Self-isolation and avoiding touching things or people

2. Forbidden thoughts 

Forbidden or intrusive thoughts are thoughts that enter your consciousness without warning. They are often graphic and offensive. We all experience these thoughts; however, it becomes an OCD when we are unable to control them. 

“Forbidden thoughts OCD involves intrusive thoughts that lead the sufferer to feel shame or a similar negative emotion, usually followed by an illogical action to stop the thought,” like avoiding certain places or people, says Patricia Celan, MD, a Psychiatry Resident at Dalhousie University in Canada.

Some examples of these thoughts are:

  • Perverse sexual thoughts 
  • Fixation on religious issues
  • Violent thoughts

People with this type of OCD instinctively try to suppress their forbidden thoughts. However, a better coping mechanism is allowing them to surface, and resisting the compulsion to engage in an illogical action because of it. 

3. Symmetry 

People with this form of OCD have an obsessive fear of certain objects lacking perfect symmetry. They spend a lot of time trying to ensure that activities like folding clothes, putting photos on a wall, or stacking cans in a cupboard are done ‘just right.’

In some cases, they hardly socialize to avoid interacting with even the smallest forms of disarray. “If someone with this disorder gets one hand wet, they will feel an overwhelming urge to get the other hand wet, as well, and cannot focus on other things until this is achieved,” Celan says. 

Some examples of behaviors that people with symmetry OCD may engage in are:

  • Rewriting words and letters until they are perfectly symmetrical 
  • Engaging in obsessive counting rituals, like counting their steps when they walk or counting the ceiling tiles in every building they walk into 
  • Arranging and rearranging objects until they are perfectly spaced or even 

As a coping mechanism, Celan advises people with this form of OCD to practice mindfulness meditation. “Mindfulness meditation can be especially helpful for people with symmetry OCD, helping them become accustomed to an uncomfortable sensation and letting it go,” she explains. 

4. Harm-focused 

People with harm-focused OCD have intense intrusive thoughts about self-harm and harm to others. They often worry that having these violent thoughts means that they will carry them out intentionally or accidentally.  

“It includes intense anxiety about making mistakes that would result in harm to other people or not doing enough to prevent something bad from happening,” says Cohen. 

For example, people may have thoughts of hitting someone with a car or jumping in front of a train — and as a result, they are unable to drive or refuse to go near train tracks. People with this type of OCD rarely ever act on these violent urges. 

Some other examples of thoughts or behaviors that people may exhibit are:

  • An irrational fear of accidentally causing harm to someone because of a negligent action
  • Having sudden impulses to self-harm
  • Involuntary thoughts of violence
  • Performing physical or mental rituals they believe will stop bad things from happening 
  • Obsessively reviewing their actions to make sure they haven’t caused harm to others

If you experience these harm-focused thoughts, it’s important to recognize that it doesn’t mean you will do it. Having unwanted violent thoughts can be normal, as long as they don’t take over your life, and people without OCD may even have these thoughts occasionally.  

5. Hoarding 

Hoarding is the inability to discard useless and worn out possessions such as junk mail, old clothes, containers, and receipts. A person with this type of OCD will often allow their living space to become so consumed with clutter it’s almost impossible to live in. 

Some characteristics of hoarding are:

  • Being unable to let go of things that aren’t useful anymore
  • Forming strong emotional attachments with inanimate objects
  • Refusing to let people into their homes due to shame or embarrassment 
  • Difficulty making simple decisions 

How to treat OCD

OCD has gone from being an almost untreatable disorder to a highly manageable one. Today, medical experts make use of a combination of psychotherapy and medication for optimal results. 

The two most effective psychotherapy treatments for OCD are:

  • Cognitive Behavioral Therapy (CBT): CBT is a type of psychological treatment which focuses on how thoughts affect behavior. The goal of CBT is to replace negative thoughts with positive and productive ones. “CBT teaches people with OCD how to more effectively manage intrusive thoughts, reduce rituals and avoidance behaviors, and improve the overall quality of life,” says Cohen.
  • Exposure and Response treatment: This involves exposure to conditions which trigger OCD, and preventing the person from acting on the compulsions that usually follow.

“Antidepressants are used in OCD, as they can improve the neurotransmitter deficiency in the brain,” Celan says. These include selective serotonin reuptake inhibitor (SSRI) medications, like Zoloft. 

“A person diagnosed with OCD has about a 50% chance of responding to medication,” says Cohen. “Of those people who do respond, a 20% to 40% reduction in obsessions and rituals can be expected. Medication is less effective overall compared to behavioral therapy.”

Treatment is also often dependent on the specific needs of each person and the type of OCD. “Those with contamination and cleaning OCD may do better with ERP (exposure response prevention),  while someone with symmetry OCD may be better treated with mindfulness-based cognitive therapy,” says Celan. 


Most forms of OCD follow the same vicious cycle: an obsessive thought leads to compulsive behavior, then temporary relief, before the thought pops up again. OCD can’t be ignored or controlled, but it is manageable, with the right combination of therapy and medication. 

Accepting that a problem exists and visiting a doctor is the first step towards OCD recovery. If someone you love may have OCD, they need your support. Encourage them to speak with a doctor about their condition and seek professional help.

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