But while there is an almost unlimited number of themes to which OCD can attach, the ultimate presentation of the disorder tends to be the same. “Someone is worried about specific unwanted or intrusive thoughts, and then they may engage in behaviors, many of which we don’t see, in order to tolerate or neutralize the discomfort or uncertainty,” Joanna Hardis, MSSA, a licensed clinical social worker and OCD specialist in Cleveland, tells SELF.
Despite the similar manner in which all OCD themes function, it can still be helpful to understand what the different subtypes might look like. According to the International OCD Foundation (IOCDF), here are some of the common obsessions that can appear in OCD:
Contamination OCD involves the fear of contamination, whether that’s becoming contaminated or contaminating someone else. Generally, contamination OCD is associated with things like dirt, bacteria, or viruses, but any substance can become the focus of contamination fears—including bodily fluids, chemicals, or other environmental contaminants. Some people also experience obsessions involving mental contamination from thoughts, feelings, words, images, or even superstitious beliefs. For example, if certain words trigger an obsession, such as the word accident, then the person might avoid saying or writing these words, and eventually stop reading the newspaper for fear that it could contain that word.
Practically, this is where those hand-washing stereotypes come into play. Yes, some people with OCD do wash their hands repeatedly, but again, it’s not a preference for being clean. They feel compelled to do it to allay the underlying anxiety they are feeling.
As the name suggests, this type of OCD surrounds the fear of losing control, usually in the context of doing things that a person doesn’t, or shouldn’t, want to do. Sometimes these obsessions can involve the fear of feeling (or acting) on a thought or impulse about hurting themselves or others. But loss-of-control obsessions can also involve other behaviors, such as worrying about saying something rude, doing something illegal, or simply losing control of one’s mind or body in some way.
To understand this obsession, it’s important to recognize that this fear is about losing your sense of identity and doing something on impulse that changes you from “good” to “bad,” or causes you to lose the comforts of your life. For example, if you lose control and yell obscenities at your boss, you might get fired and lose your paycheck. Therefore, people with loss-of-control OCD obsess over this idea and often look for constant reassurance that they will not act out in violence or lose control.
Harm OCD involves the fear of harming oneself or others, whether purposely or inadvertently. If you have harm OCD, you might experience violent thoughts, images, or impulses—things like hitting, stabbing, or otherwise injuring a loved one, a stranger, or even yourself, according to the IOCDF. Or you may fear doing something that can inadvertently hurt another person, such as something neglectful that could result in an accident, like leaving your flatiron on and causing your house to burn down.