Obsessive-Compulsive Disorder (OCD) is a chronic, neurobehavioral condition characterized by unwanted intrusive thoughts, images, urges, or sensations (obsessions) and repetitive mental or behavioral actions (compulsions) performed to reduce distress or prevent a feared outcome. OCD affects people across all ages, backgrounds, and identities, and it often goes untreated for years due to misunderstanding, shame, or misdiagnosis. 

OCD is maintained by a cycle of:
Obsessions → Anxiety/Discomfort → Compulsions → Brief Relief → Stronger Obsessions Next Time

This cycle reinforces the brain’s false alarm system, making symptoms more persistent over time.

Exposure and Response Prevention (ERP) is the gold-standard treatment.

Obsessions are:

• Unwanted intrusive thoughts, images, urges, or sensations
• Disturbing or ego-dystonic
• Repetitive and difficult to ignore
• Accompanied by anxiety, guilt, disgust, or self-doubt
   

Examples include fears of harming others, contamination fears, taboo intrusive thoughts, or a sense that something is “not right.”

Compulsions are behaviors or mental actions performed to reduce distress or prevent a feared outcome. They may be visible or completely internal.

Common compulsions include:

• Checking
• Avoidance
• Reassurance-seeking
• Mental reviewing or analysis
• Repeating actions until they feel “right”
• Cleaning or washing
• Neutralizing thoughts with “good thoughts”
   

Compulsions provide temporary relief but reinforce the OCD cycle.

The Four Main themes of OCD 

Although OCD can show up in thousands of ways, most symptoms fall into one of four core themes. These categories help guide treatment planning and exposure design.

The intrusive thoughts theme includes unwanted, distressing thoughts, images, or urges that go against a person’s values or identity. Themes often include:

• Violent intrusive thoughts
• Sexual intrusive thoughts
• Blasphemous or morally unacceptable thoughts
• Identity-based doubts (sexual orientation, gender, morality)
• Relationship doubts
   

Key feature: The distress comes from the shock of the intrusive thought or image and/or the meaning assigned to the thought.

The harm and responsibility theme involves fears of causing harm, being responsible for something going wrong, or failing to prevent danger. Themes include:

• Fear of accidentally hurting others
• Fear of intentionally hurting others (Harm OCD)
• Fear of causing fires, accidents, or contamination
• Excessive guilt and fear of moral wrongdoing
• Hyper-responsibility for others’ safety
   

Key feature: Heightened responsibility + fear of catastrophic consequences.

The symmetry theme is driven by an internal sense of wrongness, imbalance, or incompleteness—not fear of danger. Themes include:

• Need for symmetry, alignment, or perfection
• Repeating actions until they feel “finished”
• Rewriting, re-reading, or retyping until “even”
• Balancing touches or steps
• Arranging items to achieve a sense of order
   

Key feature: Compulsions aim to relieve internal discomfort, not prevent harm.

The contamination theme involves an exaggerated sense of threat from germs, chemicals, bodily fluids, or environmental contaminants. Themes include:

• Fear of illness or spreading illness
• Fear of dirt, waste, or bodily fluids
• Fear of chemicals, mold, toxins
• Fear of objects being “contaminated” and spreading contamination
• Excessive cleaning, washing, and avoidance rituals
   

Key feature: Fear of danger or responsibility linked to contamination and/or distress about the idea of spreading contamination .

Common OCD Subtypes

OCD can take many forms, but most presentations fall into recognizable patterns. Below are some of the most common subtypes, based on clinical research and real-world symptom clusters. Many individuals experience more than one subtype at a time or shift between themes over the lifespan.

Formerly known as HOCD.
Features:

• Intrusive doubts about sexual orientation
• Checking for arousal, reactions, or attraction
• Avoiding triggers like certain people or media
• Mental reviewing or self-testing
   

Features:

• Doubts about partner, attraction, compatibility
• Overanalyzing interactions
• Checking feelings constantly
• Comparing relationship to others
   

Features:

• Unwanted intrusive sexual thoughts
• Fears about inappropriate or taboo scenarios
• Checking for signs of desire or arousal
• Avoiding people, places, or triggers
   

Features:

• Fear of sinning, offending God, or violating doctrine
• Excessive confession or prayer
• Fear of being morally “bad”
• Over analysis of intent, purity, or motive
   

Features:

• Obsessions about meaning, identity, or reality
• Rumination about philosophical or metaphysical questions
• Fear of “never knowing the answer”
• Mental spiraling and analysis
   

Hyper-awareness of automatic bodily processes.
Features:

• Obsessive noticing of staring, breathing, blinking, swallowing
• Fear of never being able to stop noticing
• Compulsive attempts to distract or suppress awareness
   

Not contamination-based—this subtype focuses on disease interpretation, not germs.
Features:

• Fear of having a serious illness
• Constant body-checking
• Reassurance from doctors, test results, online research
• Misinterpretation of normal physical sensations
   

Where the compulsions are all mental.
Features:

• Rumination
• Neutralizing thoughts
• Mental checking
• Covert reassurance
• No obvious physical rituals
   

Features:

• Fear of losing touch with reality
• Monitoring thoughts for signs of psychosis
• Comparing oneself to stories of severe mental illness
• Reassurance-seeking about sanity
   

Different from harm OCD—it centers on impulsivity.
Features:

• “What if I snap?”
• “What if I jump off this balcony?”
• “What if I scream something offensive?”
• Avoiding situations where impulsive actions feel possible
   

Features:

• Fear of anxiety sensations
• Avoidance of places where panic might occur
• Internal scanning for symptoms
• Compulsions to prevent anxiety spikes
   

Often blends responsibility, harm, and checking.
Features:

• Fear of hitting someone
• Repeatedly circling back
• Checking mirrors compulsively
• Avoidance of highways or busy streets
   

• Fear you may have hit a pedestrian or car
• Driving back over and over
• Checking news or police reports
• Reassurance-seeking from others
   

Features:

• Fear that you did something immoral, dangerous, or illegal
• Rumination about past events
• “What if I can’t remember?”
• Avoiding reminders of the event
• Seeking certainty about what “really happened”
   

Different from false memory OCD because something did happen—but OCD distorts meaning.
Features:

• Overanalyzing past events that were benign
• Excessive guilt
• Fear that a normal mistake proves you’re dangerous, immoral, or bad
  
   

Features:

• Belief that thoughts can influence outcomes
• Superstitious behaviors
• Repetitive rituals to prevent imagined harm
• Thought-action fusion patterns
   

Features:

• Avoidance of “bad” numbers
• Repeating rituals with “safe” numbers
• Counting compulsions
• Fear that wrong numbers cause harm
   

Different from germ-based contamination.
Features:

• Fear of being “contaminated” by people, memories, moods
• Avoiding objects associated with certain people
• Fear of absorbing traits or “bad energy”
   

A form of scrupulosity focused on ethics, not religion.
Features:

• Fear of being dishonest, mean, unethical, or harmful
• Overanalyzing tone and intentions
• Excessive apologizing
• Compulsions to “make things right”
   

Critical to list separately for SEO.
Features:

• Intrusive thoughts about harming the baby
• Fear of making a catastrophic parenting mistake
• Avoidance of childcare tasks
• Hyper-responsibility rituals
   

Connected to symmetry but distinct.
Features:

• Need to touch things repeatedly
• Need for sensations to feel balanced
• Repeating actions to fix “wrongness”
   

Separate from symmetry; more rule-bound.
Features:

• Rigid numerical patterns
• Alphabetizing
• Doing things in exact sequences
• Rules that feel mandatory
   

A variant of harm OCD, but focused specifically on imagery.
Features:

• Graphic intrusive images
• Fear of meaning behind disturbing mental pictures
• Avoidance of triggers

People with POCD commonly experience:

• Unwanted sexual thoughts or images involving minors
• Fear of being attracted to a child
• Fear of acting inappropriately or impulsively
• Hyperawareness around feelings, bodily sensations, or physical proximity
• Fear of having “hidden intentions”
• Concern about normal interactions being misinterpreted
   

The person’s distress comes from the fear of what the thoughts might mean, not from desire.

Exposure and Response Prevention (ERP) is the gold-standard treatment for all OCD subtypes. ERP helps by:

• Reducing avoidance
• Interrupting compulsive behaviors
• Teaching the brain to reinterpret intrusive thoughts
• Building tolerance for uncertainty
• Weakening the OCD cycle over time
   

ERP is structured, collaborative, and customized to match specific triggers, values, and fear patterns.

Whatif provides ERP therapy via telehealth across California, including:
Los Angeles • San Francisco • San Diego • Orange County • Sacramento • Long Beach • Riverside • Oakland • San Jose • Fresno • Bakersfield • and statewide.