Specific themes or dimensions are common in obsessive-compulsive disorder (OCD). Some people may call these, subtypes or types of OCD. For example, contamination OCD or harm OCD.

A diagnosis of OCD means you experience obsessions, compulsions, or both. Obsessions are intrusive and distressing thoughts that are difficult to manage at will. Compulsions are repetitive behaviors or rituals you engage in to relieve the anxiety that obsessions cause.

OCD types are typically named based on the theme of the obsessions.

Most U.S. mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to diagnose mental health disorders. The DSM-5-TR doesn’t specify any types of OCD, but it does recognize obsessions and compulsions may vary between people and could focus on different themes.

While there are no official classifications or subtypes of OCD, the DSM-5-TR and research suggest people experience OCD symptoms around these main categories:

  • cleaning and contamination
  • symmetry, incompleteness, and ordering
  • harm (to self and others), shame, and guilt (this is sometimes categorized under taboo thoughts)
  • taboo thoughts around violence, religion, and sexual behaviors

Some people with OCD may also have obsessions and compulsions around hoarding or the need to collect and keep items.

This list isn’t all inclusive. It is possible to have obsessions that center around other themes or fears.

Not every person with OCD experiences obsessions and compulsions the same way, even if the theme is similar. Also, some people may have symptoms around different dimensions or themes at the same time.

Cleaning and contamination OCD

Contamination OCD usually focuses on the persistent fear of being exposed to germs and toxins.

Symptoms may involve:

  • persistent worry about germs or sickness
  • intrusive thoughts about feeling dirty or unclean (physically or mentally)
  • ongoing concern about exposure to blood, toxic substances, viruses, or other sources of contamination
  • intense avoidance of possible sources of contamination, real or perceived
  • constant urges to get rid of items that could be contaminated or dirty (even if they aren’t)
  • recurrent cleaning rituals
  • frequent cleaning or washing rituals, such as handwashing or scrubbing

Symmetry and ordering

Symmetry OCD may involve:

  • intense urge for items or belongings to be aligned in a certain way
  • extreme need for symmetry or organization around you
  • need for symmetry in your body, clothing, or actions (e.g., if you scratch your left knee, you also must scratch your right knee)
  • repetitive efforts to arrange your belongings or other items in certain ways until they feel “just right”
  • severe distress when items aren’t completely symmetric or aligned
  • need to repeat counting rituals, such as counting to a specific number a certain number of times
  • persistent magical thinking, or believing something bad will happen if you don’t arrange or organize things in the right way

Taboo thoughts

Taboo OCD may center around different themes.

For example:

  • Scrupulosity OCD focuses on religious or moral thoughts. In some instances, people refer to scrupulosity OCD with obsessions but no compulsions as pure O.
  • Harm OCD centers on fears of harming others or yourself, or it could also involve unwanted images of violence and aggression.
  • Sexual OCD may involve distressing thoughts, images, or urges regarding sexual activity.

Common symptoms of taboo OCD vary per theme and between people, but may involve:

  • intense fear of harming others, intentionally or unintentionally
  • magical thinking around the fear your thoughts may cause a natural disaster or accident
  • guilt, shame, and other distress about your obsessions
  • persistent questioning of your sexual orientation, desires, or sexual interests
  • persistent worry that you’ll act on your intrusive thoughts or that having them makes you a bad person
  • intense concern about behaving in a way you consider blasphemous or wrong
  • urges to avoid or hide things you feel you could use as a weapon
  • a need to seek reassurance that you won’t act on intrusive thoughts
  • frequent reviewing of daily activities to make sure you haven’t hurt anyone, whether mentally or physically retracing your steps

As with other types of OCD, taboo OCD involves unwanted thoughts and images, and a need to engage in rituals to minimize the distress you feel for having those thoughts and images.

Taboo OCD doesn’t mean you want to hurt someone or that you need to engage in certain behaviors. On the contrary, it is fueled by fear and guilt that you do so, because that is not what you really want to do.

Hoarding OCD

Hoarding OCD may sometimes be a component of harm or contamination OCD. Symptoms of this OCD subtype may involve:

  • persistent worry that throwing something away could bring harm to you or someone else
  • need to collect a certain number of items to protect yourself or someone else from harm
  • extreme fear of throwing away an important or essential item by accident (such as mail with sensitive or needed information)
  • urges to buy multiples of the same item, even when you don’t need that many
  • difficulty throwing away things because touching them could cause contamination
  • feeling incomplete if you can’t find a possession or accidentally lost or threw it away
  • intense needs to check or review your possessions

Hoarding in the context of OCD differs from hoarding disorder, a separate mental health condition. The main difference between the two is the severe distress involved with hoarding-related OCD.

If you have OCD, you don’t want all of the things you collect, but you might feel compelled to save them because of your obsessions.

No. Types refer to the themes of your obsessions and compulsions, while specifier is a technical term in the DSM-5-TR to refer to additional notes related to your diagnosis.

Although the DSM-5-TR mentions themes in OCD, it doesn’t list official types. A diagnosis of OCD will not specify the themes of your symptoms, but it may include one or more specifiers.

OCD specifiers include:

  • With good or fair insight: When this specifier is added to an OCD diagnosis, it means the healthcare professional has determined that you recognize your obsessions are probably not true, even if they cause you distress. For example, you know you won’t get sick or die if you don’t wash your hands every 10 minutes.
  • With poor insight: This specifier means that you aren’t sure if your obsessions may become true and you believe they probably will. For example, you feel there’s a high chance you will get sick if you don’t wash your hands often.
  • With absent insight or delusions: The specifier notes that you may be completely convinced your obsessions are true and you may not change your mind despite evidence to the contrary. For example, you know you will get sick if you don’t wash your hands; even if when you cannot wash them, you do not get sick.
  • Tic-related: This specifier notes that you have a history of a tic disorder.

No formal OCD types exist, but clinicians may categorize themes of OCD into four main dimensions depending on the focus of your obsessions and compulsions: cleaning and contamination, symmetry and order, taboo thoughts, and hoarding.

OCD may also be distinguished based on the level of insight you have. You could be completely convinced your obsessions are true (absent insight), believe your obsessions could be true (poor insight), or know your obsessions aren’t true even if they are distressing (fair insight).