The unexpected symptoms of OCD beyond hand-washing and light-switch rituals

CNA

30-05-2025

When most people think of obsessive-compulsive disorder, they may picture behaviours they've seen on TV – like repetitive hand-washing, flicking light switches on and off and meticulously arranging small items over and over.
But the disorder manifests in many other ways. Some patients obsess over thoughts that they might hurt someone, while others fixate on certain aspects of their personal relationships.
The comedian Maria Bamford, for example, has called her OCD 'unwanted thoughts syndrome.' On The Late Show With Stephen Colbert, she shared a story about how she couldn't stop thinking horrific thoughts about her family members.
On social media, people describe many types of obsessions and compulsions: ' Relationship OCD,' 'sexual orientation OCD' or 'emotional contamination OCD'. These aren't separate diagnoses, but rather they are different expressions of the same disorder – much like how people with phobias can suffer from different fears, said Dr Carolyn Rodriguez, an OCD expert and a professor of psychiatry and behavioural sciences at Stanford Medicine.
Understanding these distinctions can help clinicians tailor a precise treatment plan, she added. And they're important for the public to grasp as well. Otherwise, people who experience the disorder might not even recognise they have it, Dr Rodriguez said.
People who are fearful of harming others might think, 'Maybe I am a murderer,' she added. 'If I tell anybody these things, I'm going to be put in jail.'
Here's what to know about the diverse ways that OCD shows up.
FIRST, WHAT IS OCD?
OCD involves a set of obsessions and compulsions that cause great distress and affect people's quality of life.
Obsessions can include unwanted intrusive thoughts, images or urges that dominate the mind.
Compulsions are the repetitive actions that people take in response to their obsessions to try to help themselves feel better.
These OCD symptoms can be time consuming, lasting for at least an hour a day, according to the diagnostic manual used by mental health practitioners.
If someone worries excessively that they will set the house on fire by accidentally leaving the stove on, for instance, they might check again and again to make sure the knobs are in the off position.
About 2.3 per cent of American adults are estimated to have had OCD at some point in their lifetime, according to the National Institute of Mental Health. Women are more likely to receive a diagnosis than men are.
More research is needed to further understand the origins of OCD, which is thought to have genetic and environmental causes.
WHAT ARE THE DIFFERENT TYPES OF OCD?
While all of those with the disorder have obsessions and compulsions, 'OCD across patients is almost never exactly the same,' said Jeremy Tyler, co-chief of ambulatory psychiatry at the Perelman School of Medicine at the University of Pennsylvania.
People with OCD can differ in many ways, including whether or not they have tics (involuntary, repetitive movements or vocalisations). Patients also vary in their degree of 'insight,' which is their level of awareness of being ill, as well as in how they feel when their symptoms are triggered.
Another way patients differ is in the content of their obsessions and compulsions.
Concerns about contamination, a need for symmetry or order, forbidden or taboo thoughts and a fear of harming others or yourself are common themes, said Dr Helen Blair Simpson, a psychiatry professor and OCD researcher at Columbia University.
The International OCD Foundation lists other themes as well, including sexual thoughts; fixations on relationships; worries that tie into responsibility, like being responsible for something terrible happening; or fears related to perfectionism, like showing excessive worry over making mistakes.
Patients and therapists have labelled some of these themes in online forums, coining terms like 'symmetry and order OCD' and 'perfectionism OCD'. Creating names for different expressions of OCD may help sufferers feel less alone, Dr Rodriguez said.
Often, more than one theme can be present at the same time, and the content of a person's obsession or compulsion can change over the course of the illness, the experts said.
HOW IS OCD TREATED?
OCD is typically treated with an antidepressant, exposure and response prevention therapy, or both. Therapy involves asking patients to experience their stress and anxiety without performing a compulsion in response. Therapists will also encourage patients to allow their obsessions to surface rather than continually try to push them away.
It's particularly important for therapists to know someone's 'type' when carrying out exposure and response prevention therapy, because clinicians can then ensure that their patients are being exposed to the precise types of situations that typically stir up their obsessions, Dr Tyler noted.
'I eat food off the ground with people; I hold knives with people,' he said. It may sound 'wild,' he added, but in the process, patients learn that the thing they fear the most isn't likely to happen.