Obsessive Compulsive Disorder (OCD): Meaning & Types

What Is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder, commonly called OCD, is a chronic mental health condition characterised by recurring, intrusive thoughts (obsessions) and repetitive behaviours or mental actions (compulsions).  

According to the National Library of Medicine, around 2% of the general population worldwide has this condition.  

A person with OCD may think of their condition as something that’s irrational. However, OCD makes them powerless to cope independently.  

Some people with an official diagnosis and the right mental health support may learn to cope with the symptoms. Change is possible but might require consistent therapy and social support.  

Usually, common misrepresentations of OCD in media may confuse people. Does constantly washing your hands mean you have OCD? Or does thinking about one specific thought, like dying your hair orange, mean you have intrusive thoughts? It is all a bit confusing.  

Hence, we expand on the misconceptions about OCD by learning about the OCD symptoms, causes, types, and treatment options.  

Symptoms of OCD

Research shows that the onset of OCD occurs during late adolescence or early adulthood. The severity and duration of OCD could also vary.

The symptoms of OCD may present in two ways: obsessions and compulsions.  

The two primary signs are usually the most observable. Needless to say, OCD is complex and may not look the same for different people.  

Hence, the symptoms below should only be used as an initial way to assess the condition. A psychologist is the right professional to conduct diagnostic tests for OCD. 

a) Obsessions

Obsessions may refer to intrusive thoughts, images, or urges. Intrusiveness is anything that could be disturbing or frightening to an individual.  

Rather than worrying about daily life issues such as cleaning or finishing laundry, intrusive thoughts could be more specific.  

Some examples include:

• Fears of dirt, germs, chemicals
• Fears of harming oneself or others
• Fears of making a mistake, being imperfect or forgetting something
• A need to have everything in symmetry or perfect order
• Excessively focusing on religious or moral ideas
• Intrusive thoughts about aggression, sexual, or violent subjects
• Fear of a parents hating them
• Fears of dying or falling sick
• Fears of uttering offensive or obscene opinions

When a person has aggressive impulses, they may not trust themselves and may fear the safety of their loved ones.

However, the thoughts are like lies that OCD tells the brain. A person with OCD is not their thoughts.  

As it may be difficult to create an identity outside of OCD, the person may villainise themself and enter a cycle of self-blame and hatred.  

Hence, early intervention and support are paramount. Support can make the person improve their self-esteem and image.  

b) Compulsions

Compulsions are repetitive behaviours performed in response to an obsessive thought.

A person may have compulsions as a coping mechanism. For example, a person may check the stove multiple times, fearing that they may burn the entire house.  

Compulsions can either be observable actions or mental rituals like counting or chanting.

Common symptoms include:

• Arranging items in precise order or symmetry
• Re-reading or re-writing sentences multiple times to ensure accuracy
• Touching objects a certain number of times before leaving a room
• Washing hands for a specific duration or until they feel "just right."
• Avoiding cracks on the pavement while walking
• Silently repeating a word or phrase to counteract a negative thought
• Discarding items due to an irrational fear they're contaminated
• Rechecking messages or emails multiple times before sending
• Counting steps while walking or taking only a specific number of sips when drinking
• Insisting on performing everyday tasks in a set routine or sequence

Over time, these compulsive acts can become habitual, leading to an increased cycle of anxiety and repetition. 

What Causes OCD?

Scientists have come up with different theories to determine why someone develops OCD.

As for any other psychological condition, OCD does not have a single cause. It is impossible for any theory to completely explain the experiences of every person.

However, the empirical data researchers have gathered seem to indicate that the below factors may be involved in the onset of OCD:

• Psychological causes
• Experiences
• Biological causes 

Even though we may not understand what causes OCD, the condition can still be successfully managed through OCD tests and personalised treatment.   

a) Psychological

Have you ever seen a spider web? That’s how deep and ravelled psychological triggers and cognitive processes can be.  

How a person’s cognition works may have an impact on triggering the symptoms of OCD.  

A person with cognitive distortions (ie irrational thought patterns) may believe that thinking of something can increase the likelihood of the thought becoming true.  

For example, a case study showed that a woman with OCD gave birth to a child in 2014 and strongly believed that something was wrong with the baby (obsessive thought).  

As she believed that it was ‘wrong’ to give birth to an ‘imperfect’ child, she had overwhelming urges to kill the baby (compulsions).  

In contrast, some people may struggle with ‘mental neutralising’. They may engage in an opposite mental ritual to counteract the perceived threat if they have an intrusive thought.  

For example, after thinking they might fail an exam, students might repeatedly visualise themselves succeeding to counterbalance the negative thought. 

b) Experiences

Personal experiences may also cause OCD. These could include upbringing, academic life, social life, cultural influence etc.  

Some examples include:

• Having experienced a painful and traumatic childhood. Trauma can include domestic abuse, sexual abuse, discrimination and bullying. The child copes with the trauma how they know best – and this could be through using obsessions and compulsions.  
• Living with family members who have anxiety or use compulsive behaviours to cope with their problems. A child may observe their parents and learn to adopt the same coping mechanisms.
• Other mental health conditions like generalised anxiety or addictions may trigger OCD.  
• In some rare cases, pregnancy or birth can cause perinatal OCD.  

c) Biological

Research suggests that biological factors in the brain or body may cause OCD.  

Lack of certain chemicals in the brain, such as serotonin, could potentially trigger OCD. However, whether chemical imbalance is a cause or a risk factor is unclear.  

Genetic factors may also cause OCD. Although research has not yet presented a precise element of genetics, a person is more likely to develop OCD if their twin, parents, or sibling also has the same condition.  

Types of OCD

Common Types of OCD

The DSM does not have a list of official types of OCD. However, for the sake of self-awareness and understanding, experts often segregate OCD based on the symptoms.  

1) Symmetry, Perfectionism, and Ordering 

People with this type of OCD may have obsessive thoughts related to organising and having objects in symmetry.  

The thoughts could make them believe that they will have a bad day or that something terrible might happen if they don’t organise everything in perfect order.  

The obsessive thought could then compel the person to repetitively arrange things in their desk, organise their to-do lists several times in a few minutes, and re-work on their task until it’s ‘perfect’.  

2) Contamination and Cleaning 

People with this type of OCD may have an intemperate worry about germs, dirt, and microorganisms.  

These obsessions could compel the person to wash their hands an unhealthy number of times, clean their surroundings every few minutes, and maybe even clean places outside their house.  

Excessive cleaning could cause blisters, and the preoccupation could lead them to lose focus in other important areas of life, such as work or relationships.  

3. Intrusive Thoughts 

People with this type of OCD may experience thoughts that are violent, disturbing, and sexual in nature.  

It is more so important here to understand that a person with OCD is not their thoughts. In other words, the obsessive thoughts do not represent the person.  

With that being said, people with this type may fear that they will act on their thoughts, even if it’s against their values and character.  

For example, the intrusive thoughts could be urges to kill their own child or burn their own house.  

4. Hoarding 

People with this type of OCD may hoard every item, even if it has no real value.  

The thought of discarding an item can make the person anxious and overwhelmed. For example, a person may hoard different types of knives, which may potentially cause safety issues. 

Lesser-Known Types of OCD

1) Relationship OCD [ROCD]

People with ROCD constantly doubt their romantic partners’ suitability or their feelings’ genuineness.  

For example, these people may often wonder if their partner is cheating or become preoccupied with thoughts such as ‘Does my partner really love me?”.  

People with ROCD may also frequently seek reassurance, obsessively analyse their partner’s behaviours, or even question their own feelings. They fear they might be with the wrong person or their feelings aren’t genuine.

ROCD could trigger an insecure and fearful attachment style and make it difficult to have a healthy and peaceful relationship.  

If you notice these signs in yourself or your partner, couples counselling can help you develop trust and improve your communication skills!   

2) Scrupulosity

People with this type of OCD may have an overwhelming preoccupation with moral or religious rightness.  

The fear that they may have sinned or offended their God could take control of their entire lives.  

For example, if a person forgets to reply to their partner’s time in, say – 5 minutes – the person may feel guilty and like they’ve sinned.

People with scrupulosity may excessively pray, confess, or seek reassurance. They fear divine retribution for perceived wrongdoings (ie things that they think are ‘wrong’ but, in reality, are normal and common habits). 

OCD Diagnosis

A single OCD test or one specific symptom cannot determine the presence of OCD. In fact, everyone with OCD may have completely unique experiences.  

Certain types of OCD are only the ones that are most commonly observed and easily identifiable.  

Hence, a psychologist may use personalised assessments to make an OCD diagnosis.  

The two determining factors of OCD are obsessions and compulsions. Firstly, the professional may clinically assess the peculiarity and intensity of these thoughts and behaviours.  

Secondly, the OCD tests may evaluate the presence of compulsions or repetitive behaviours performed to reduce the distress caused by the obsessions.

These behaviours are not realistically related to what they’re intended to prevent (eg cleaning the room every few hours to eliminate the thought, “I’ll die.”).

The psychologist may observe several other factors, such as:

• Personal upbringing
• Cognitive abilities
• Cognitive distortions
• Medical history  
• Duration of obsessions and compulsions
• Other psychological conditions with similar symptoms
• Impact of symptoms in daily life and relationships  

OCD Diagnostic Questions

During the diagnostic process, the psychologist may ask clinical questions to explore the nature of the condition.  

Some of these questions could include:

• Can you describe the thoughts or images that frequently intrude on your mind?
• How often do these thoughts or images occur?
• How disturbing do you find these thoughts?
• Do you feel compelled to behave a certain way to manage your emotions?  
• How much time do you spend daily on behaviours that you think are harmful?
• Have you ever tried to resist these thoughts or actions? What happens when you do?
• How have these thoughts and behaviours affected your daily life or relationships?
• Are there specific situations or places you avoid because of your symptoms?
• Are you currently taking any medication, or have you in the past for these symptoms?
• Do you have any family history of OCD or other mental health disorders? 

OCD Treatment

A Therapist in Singapore with a specialised focus on OCD can help clients explore the right treatment options.  

A therapeutic plan for OCD could include psychotherapy and medication. However, not everyone requires medications.  

It is best to consult your psychologist and your medical doctor to decide how you want to proceed with the OCD treatment.  

a) Psychotherapy

Cognitive behavioural therapy (CBT) is usually the most recommended type of psychotherapy for OCD.  

A psychologist may also use tools from CBT to develop a personalised approach. The two primary tools include:

1. Exposure and Response Prevention (ERP): This is a primary technique within CBT. Clients are:

• Gently exposed to their feared situations or thoughts (exposure)
• Taught to avoid or stop engaging in compulsive behaviours (response prevention

2. Cognitive Therapy: This primary tool could prevent negative or obsessive thoughts. Cognitive therapy helps the client:  

• Recognise irrational beliefs
• Challenge and modify these beliefs 

b) Medication

The below is a reference for what one can expect before using medications.  

The three common types of medications include:

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

• Fluoxetine (Prozac): This option is widely prescribed and is usually the first choice for OCD treatment. A typical dose is higher than when used for depression.
• Sertraline (Zoloft): These types of SSRIs may reduce OCD symptoms in both adults and children.  
• Paroxetine (Paxil, Pexeva): This medication is FDA-approved. However, it is not the first line of treatment due to the side effects. 

2. Tricyclic Antidepressants:

Clomipramine (Anafranil): This medication is approved to treat OCD. It is an effective option but with more potential side effects than SSRIs. 

3. Augmentation Strategies: 

In some cases, when SSRIs or clomipramine alone do not work, the doctor may add other medications, such as antipsychotics.  

Tips to Start Medications

Remember that only medical doctors (ie psychiatrists) can prescribe medications. Your doctor will advise you on how to start and cope with medications.  

You can consult your doctor and psychologist at the same time to adjust your treatment plan based on your needs and any changes in your life.  

If you have a physical or mental side effect of any medication, your doctor may change the dosage or type of medication accordingly.  

Below are some general tips you can follow to get started with medication:  

• Start slow and take your meds based on the suggested dosage
• Track the side effects you experience and analyse if they reduce or become worse after a few weeks  
• Take your medications regularly and as advised by your doctor
• Visit your doctor regularly to adjust the treatment plan 

Managing OCD

If you have OCD, you may struggle to perform daily activities or maintain important relationships in your life.  

However, you can manage OCD through professional help and effective self-care tools.  

Try to include some of the below tips in your lifestyle:

• Routine: Starting a routine can help you overcome some of the OCD triggers. For example, you can reduce unpredictability in your life. Try setting a daily schedule – your routine can involve sleep schedules, eating balanced meals, and allocating time to hang out with your loved ones.  
• Mindfulness and Meditation: Some effective mindfulness tools can help you replace obsessive thoughts with helpful ones. For example, try ‘stillness’. In this type of meditation, you should simply pause whatever you’re doing and breathe in and out slowly. Repeat this sudden meditation throughout the day or whenever you feel anxious.
• Limit Stimulants: Reduce your caffeine, alcohol, and sugar intake, as they might increase or trigger anxiety and OCD tendencies. Avoiding caffeine 6 hours before your sleep can be especially helpful in developing a good sleep-wake-cycle.  
• Join Support Groups: Talking about your struggles with others who are going through the same thing can provide social support and understanding. Consider joining a local or online OCD support group. Similarly, you can visit in-person groups if you have access to them.  
• Celebrate Small Victories: Try to appreciate even the slightest progress. Celebrating your efforts reinforces positive behaviour.  

The above tips can help you self-regulate and manage OCD. However, talking to a professional Therapist is important as you can work with a personalised therapeutic plan!  

Although your thoughts may be telling you otherwise, there is scientific proof that you can manage OCD. You are capable of change and reclaiming control of your life.