Exploring the Types of OCD: A Guide to Obsessive-Compulsive Variations

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a challenging mental health condition characterized by the presence of obsessions and/or compulsions, which can significantly impact an individual’s life. Obsessions refer to repetitive and intrusive thoughts, images, impulses, or urges that cause distress and anxiety [7]. In contrast, compulsions entail repetitive behaviors or mental acts performed in response to these obsessions, often rigidly to achieve a sense of completeness [7]. In this article, we will discuss the intricacies of obsessive compulsive disorder and break down the different types of OCD that individuals may suffer from.

Common OCD Symptoms

OCD presents with two primary features: obsessions and compulsions. Obsessions are persistent and distressing thoughts that can be irrational and unwanted, leading to heightened anxiety. These OCD obsessions commonly revolve around themes such as:

• Contamination Obsessions: Fear of germs, dirt, or contamination, often resulting in contamination symptoms such as excessive handwashing or avoidance of certain objects or places [7]. 
• Harm Obsessions: Concerns about unintentionally causing harm to oneself or others, leading to repetitive checking behaviors [7].
• Symmetry and Order Obsessions: An obsession with exactness and the need for things to be arranged in a specific way [7].
• Forbidden Thoughts or Taboos: Intrusive thoughts about morally or socially unacceptable themes, such as violence, sex, or religion [7].

Compulsions, on the other hand, are repetitive actions or mental rituals that individuals feel compelled to perform in response to their unwanted obsessions. Common compulsions include:

• Checking: Repeatedly checking locks, appliances, or switches to ensure safety or prevent harm [7.
• Cleaning and Washing: Excessive handwashing and cleaning rituals aimed at reducing contamination fears [7].
• Counting: Repeatedly counting or engaging in numerical rituals linked to obsessions [7].
• Repeating: Engaging in repetitive behaviors to neutralize obsessions or prevent harm [7].
• Mental Compulsions: Engaging in mental rituals, such as counting silently or repeating phrases, to alleviate anxiety associated with obsessions [7].

Additionally, individuals with OCD often avoid situations, objects, or places that trigger their obsessive thoughts or compulsions. This avoidance can severely impact daily functioning and overall quality of life [7].

OCD symptoms are time-consuming, consuming a significant portion of a person’s day, and can interfere with work, relationships, and daily activities. Despite recognizing the irrationality of their obsessions and compulsions, individuals with OCD still feel compelled to perform them, further contributing to emotional distress and impairment [7].

OCD Subtypes

OCD is a complex mental illness with various subtypes that manifest differently in individuals. These subtypes of OCD include:

• Contamination OCD and Cleaning Subtype: This subtype involves obsessions related to contamination fears, leading to compulsive cleaning and handwashing behaviors [6-7].
• Symmetry and Ordering Subtype: Individuals with this subtype obsessively seek symmetry and order, often engaging in repetitive arranging and organizing behaviors [6-7].
• Hoarding Disorder Subtype: Hoarding OCD is characterized by obsessions related to acquiring and saving items, leading to excessive accumulation and difficulty discarding possessions [6-7].
• Pure Obsessional Subtype: In this subtype, individuals experience obsessions without visible compulsions, which may involve taboo thoughts, aggressive impulses, or sexual content [8].
• Postpartum OCD (ppOCD) Subtype: Although debated as a subtype, ppOCD manifests during the postpartum period and exhibits unique symptomatology and course [4).
• Over responsibility for Harm OCD: This subtype involves obsessions related to the fear of causing harm to oneself or others, often leading to compulsive checking behaviors [5].
• Taboo Subtype: Taboo OCD consists of obsessions related to aggressive, sexual, or religious themes, with varying compulsions to cope with these distressing obsessions [5].
• Relationship OCD: In this subtype, individuals experience distressing and obsessive thoughts surrounding their romantic relationships which are accompanied by compulsive behaviors. Relationship OCD symptoms affect relationships negatively and are usually driven by an anxiety disorder.

One study set out to uncover the distinct OCD subtypes based on differences in brain structure and function using brain scans and found that there are at least two other OCD subtypes that have specific patterns in the brain, even though they look very similar in terms of symptoms and demographics [2]. This finding suggests that treating these types of OCD might require different approaches, which could ultimately lead to more effective treatments for OCD [2]. However, further research is needed to confirm and expand upon these findings [2].

Obsessive-Compulsive Related Disorders (OCRDs)

Obsessive-Compulsive and Related Disorders (OCRDs) share some features with OCD, including intrusive thoughts and repetitive behaviors. These disorders include:

1. Body Dysmorphic Disorder (BDD): BDD involves an obsession with perceived flaws in physical appearance, leading to repetitive grooming or checking behaviors related to one’s appearance [5].
2. Trichotillomania (Hair-Pulling Disorder): Trichotillomania is characterized by compulsive hair-pulling, resulting in hair loss and distress[5].
3. Excoriation (Skin-Picking) Disorder: Excoriation disorder involves compulsive picking at one’s skin, leading to skin damage and potential infections [5].

Treatment Options

Individuals with Obsessive-Compulsive Disorder (OCD) can benefit from various treatment options, including psychotherapy and medication. It’s essential to customize the treatment approach based on the person’s unique symptoms and circumstances, and consulting with a mental health professional is crucial in making the right decision.

Psychotherapies

Cognitive Behavioral Therapy (CBT)

• Exposure and Response Prevention (ERP):ERP, a subset of CBT, is the gold standard for OCD treatment. It involves systematic exposure to obsessions while resisting compulsions, ultimately empowering individuals to confront their fears and compulsions, leading to long-lasting improvements [3,7].
• Acceptance and Commitment Therapy (ACT): ACT helps individuals observe and accept negative thoughts without reacting to them, emphasizing values-focused activities [3]
• Habit Reversal Training: This approach is effective for conditions like trichotillomania and skin-picking disorder, focusing on awareness training, self-monitoring, and alternative responses to compulsive behaviors [3].

Other Treatment Options

Deep Brain Stimulation (DBS): DBS is a surgical intervention for severe, treatment-resistant OCD involving the implantation of electrodes into specific brain regions. It carries surgical risks and requires ongoing research to evaluate long-term impact [3].

Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive technique that stimulates targeted brain regions. Recent research suggests its effectiveness, particularly when TMS therapy targets specific OCD-related brain areas [3,8].

Medications

Currently, there is an array of psychiatric medications which have been used to treat different types of OCD. The type of medication that ends up being prescribed usually depends on the specific circumstances and symptoms of the person struggling with OCD.

Selective Serotonin Reuptake Inhibitors (SSRIs): Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used to treat Obsessive-Compulsive Disorder (OCD). Doctors often begin treatment with SSRIs such as Zoloft (sertraline), Celexa (citalopram), and Lexapro (escitalopram) due to their perceived safety and effectiveness [1]. These medications increase serotonin levels in the brain, which can alleviate both obsessive and compulsive symptoms. However, caution must be exercised while using high-dose citalopram as it may increase the risk of arrhythmia. [3].

Selective Norepinephrine Reuptake Inhibitors (SNRIs): Effexor (venlafaxine), an SNRI, can be effective for OCD, particularly when SSRIs are not successful [8]].

Anafranil (clomipramine): Although not an SSRI, clomipramine is recommended for OCD treatment, with comparable efficacy to SSRIs but potentially more side effects. It can be considered as an add-on treatment in cases of resistance to SSRIs [8]].

Antipsychotic Medications as Augmentation: In some challenging cases of OCD, doctors may suggest adding antipsychotic medications to the treatment plan. [1]. Risperdal (risperidone) is generally considered safer. [1].Haldol (haloperidol) and quetiapine are options, though not as safe as risperidone. Zyprexa (olanzapine) should be used cautiously due to potential side effects. [1].

Glutamate Modulators: Medications like Merative (riluzole), Namenda (memantine), N-acetylcysteine (NAC), and Lamictal (lamotrigine) target glutamatergic dysfunction, potentially involved in OCD. Research is ongoing to determine their efficacy [3,8].

5-HT-3 Receptor Antagonists: Medications like Zofran (ondansetron) and Kytril (granisetron) have been investigated for OCD treatment, but their effectiveness is not firmly established. They are often considered after glutamate modulators if necessary [3].

Medications Stimulating the Cingulate Cortex: Psychostimulants, Provigil (modafinil), and cholinesterase inhibitors may be options for managing compulsive hoarding [3].

Antibiotics: In cases where OCD in childhood is associated with streptococcal infections (PANDAS), antibiotics can be effective if administered early in the course of the disease [3].

Get the Help you Need

Overall, OCD is a complex medical condition with obsessions and compulsions that can significantly impact an individual’s daily life. It is essential to recognize the signs and symptoms of OCD and seek professional help. While OCD is a challenging disorder to manage, with the proper treatment and support, individuals with OCD can lead fulfilling and productive lives. It is crucial to continue research efforts to better understand the underlying mechanisms of OCD types and develop more effective treatments to relieve the common symptoms people with OCD suffer from.

If you or a loved one is suffering from one of these types of OCD, reaching out to a healthcare professional is the first step towards healing. The psychiatrists at Neuro Wellness Spa who specialize in treating OCD and other mental health conditions will walk you through your treatment options. Don’t let unwanted thoughts and repetitive behaviors control you any longer. Call us today to begin your journey towards mental wellness.

References:

1. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Current neuropharmacology, 17(8), 710–736. https://doi.org/10.2174/1570159X16666180813155017
2. Han, S., Xu, Y., Guo, H. R., Fang, K., Wei, Y., Liu, L., Cheng, J., Zhang, Y., & Cheng, J. (2022). Two distinct subtypes of obsessive-compulsive disorder revealed by a framework integrating multimodal neuroimaging information. Human brain mapping, 43(14), 4254–4265. https://doi.org/10.1002/hbm.25951
3. Krzyszkowiak, W., Kuleta-Krzyszkowiak, M., & Krzanowska, E. (2019). Treatment of obsessive-compulsive disorders (OCD) and obsessive-compulsive-related disorders (OCRD). Leczenie zaburzeń obsesyjno-kompulsyjnych (OCD) i zaburzeń powiązanych (OCRD). Psychiatria polska, 53(4), 825–843. https://doi.org/10.12740/PP/105130
4. McGuinness, M., Blissett, J., & Jones, C. (2011). OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioral and cognitive psychotherapy, 39(3), 285–310. https://doi.org/10.1017/S1352465810000718
5. Schwartzman, C. M., Boisseau, C. L., Sibrava, N. J., Mancebo, M. C., Eisen, J. L., & Rasmussen, S. A. (2017). Symptom subtype and quality of life in obsessive-compulsive disorder. Psychiatry Research, 249, 307–310. https://doi.org/10.1016/j.psychres.2017.01.025
6. Starcevic, V., & Brakoulias, V. (2008). Symptom subtypes of obsessive-compulsive disorder: are they relevant for treatment? The Australian and New Zealand journal of psychiatry, 42(8), 651–661. https://doi.org/10.1080/00048670802203442
7. Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive-compulsive disorder. Nature reviews. Disease primers, 5(1), 52. https://doi.org/10.1038/s41572-019-0102-3
8. Swierkosz-Lenart, K., Dos Santos, J. F. A., Elowe, J., Clair, A. H., Bally, J. F., Riquier, F., Bloch, J., Draganski, B., Clerc, M. T., Pozuelo Moyano, B., von Gunten, A., & Mallet, L. (2023). Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Frontiers in psychiatry, 14, 1065812. https://doi.org/10.3389/fpsyt.2023.1065812