The most common obsession in OCD is fear of contamination. It accounts for over a quarter of all obsessive predisposition in the US and is the leading OCD type worldwide. Contamination worry is derived from fear of a certain disease (could also be death or fear of being disabled). For example, a person who is afraid of developing cancer or other serious diseases may feel extremely threatened by asbestos, x-ray, air pollution, and other carcinogens. People may take their fear to the extreme that they create scenarios in their heads. One may insist on overcooking their meat to avoid parasite infestation. Although properly cooked, they would may imagine bacteria attached to the meat that they refuse to eat it. An average person knows that it is possible for meat to be infected by tapeworm, but freezing and cooking the meat properly kills eggs and larvae. People with OCD will insist that their food is contaminated even though their fears are unfounded. How extreme these obsessions can manifest depends on where the contamination worry lies in a patient's hierarchy or the severity of the symptoms. It may come to the point when a person with contamination fear will treat every place as contaminated except a small, self-chosen space. Because the obsession is about a dreaded disease, the person with OCD often feels a strong sense of responsibility to protect others from being contaminated. Situations like this create tension and trouble to those close to an OCD patient as they will force their family and friends to avoid the imagined contaminants for fear of spreading the germs to their protected places. The fear of illness or disease is the root cause of almost all contamination obsessions, but there are exceptions to the rule. For example, a person can feel agitated by gooey or sticky substances. The reason behind this agitation can be no more than a discomfort, and not by fear of catching a disease. Since OCD sufferers are often obsessed with symmetry or orderliness, it may explain why sticky substances can cause one a great discomfort.
A person with contamination worry might be worried about getting a disease (AIDS, flu, and other infectious diseases) by touching public objects like door handles, toilet seats, and handling money or shaking hands.
Ironically, cleaning supplies like bleach and detergent that other OCD sufferers can’t live without, can be a source of distress for other OCD individuals. They think of pesticides, hair dye, and other household items as potential sources of carcinogens. Those with cancer fears will scrutinize every small print on hardware products, looking for ingredients that can cause cancer. We live in a world where contaminants can be found everywhere, and our own homes and the very food we eat may contain traces of pesticides – an average person, who also avoids prolonged exposure to harmful chemicals, knows that just washing fruits and vegetables are enough. OCD individuals will continue to feel distressed over things that might happen, such as “what if there’s still traces of toxic materials left?”
May include pesticides, toxic wastes, asbestos, radiation, mold, etc. A person with contamination worry of sickness and/or death doesn’t respond to these things like typical people do. Even though they see other healthy people accepting the fact that we live in a world full of health risks, they are still nagged by unwelcome thoughts of getting sickness from these substances.
Some OCD sufferers fear getting in contact with saliva, blood, semen and other body excretions. Let’s say a person has a fear of getting AIDS – a small spot of red in a public space is enough for that person to imagine “what if” scenarios, such as a person with AIDS has cut his finger and left a drop of contaminated blood there (though it can be a red ink or tomato sauce). To relieve the anxiety, one will clean that area just to be safe or avoid it at all cost.
This can be any of the following: glue, butter, stickers, cooking oil or bubble gum, shampoo, soap suds, creams and pastes etc.
Most people with contamination OCD feel uncomfortable with animals and see them as dirty. So, a large dog running toward a person with OCD to play and lick their face, while other people may find endearing, could be plain disgusting for one with OCD. They might also find flies revolting, especially because they often land on dirty surfaces. It is also different from phobia because people with a specific phobia are just simply afraid of the animal and not of contamination.
The extreme need for symmetry and orderliness depicted in movies and television doesn’t hold a candle to the real thoughts and compulsions that OCD sufferers experience day by day. In fact, it is far from amusing. Just like all “just right” obsessions (thoughts or feelings that something is not quite right), an individual may feel very uncomfortable or annoyed seeing objects in disarray. In most cases, everything that doesn’t fit their idea of “perfectness” must be arranged or altered. Ordering and arranging are the compulsive corrections they employ to relieve their anxiety. Even though their action may seem random, just like what is often depicted in the media, there is always a reason behind these actions in real OCD patients, albeit irrational and magical.
A person with issues on symmetry is more likely to have obsessive-compulsive personality disorder (OCPD) or other anxiety-related disorder. Symmetry OCD has an early onset and evidence suggests that it can also run in the family. OCPD symptoms are similar to OCD symptoms but OCPD patients are less distressed by their thoughts, therefore their symptoms cannot be called true obsessions. OCD patients with symmetry concerns are greatly stressed and often debilitated by their condition. Their thoughts are referred to as ego-dystonic. Ego-dystonic – unwelcome thoughts or obsessions that are considered illogical or unreasonable Ego-syntonic – thoughts that are part of oneself and are considered reasonable
Magical thinking is a thought pattern deemed illogical, foreign or superstitious. OCD patients with symmetry obsessions may also have magical thinking. Such people often link unrelated actions or events. They may be preoccupied with lucky or unlucky colors and numbers, words and sayings, and link them to potentially catastrophic events. They know these things are ridiculous, but “what if” thinking is the hallmark of OCD, so this person may accumulate what-if thoughts and the associated compulsive behavior that takes so much of their time.
This type of OCD drives people to engage in compulsions in response to their obsessions to protect themselves and the people close to them. They don’t mind that their actions seem ridiculous if it relieves the “incompleteness” they see around them. Arranging something perfectly to prevent diseases like cancer is too far-fetched but they would rather carry out the task than feel regret when it happens. They might even think catastrophic events can befall them or their loved ones if they are lazy to arrange things in certain order or as a negative karma for not caring enough.
The need for symmetry or arranging things in order may not present with magical thinking. The OCD sufferer wants to fill the nagging sense of incompleteness that gives them discomfort and stress. They are always bound to seek relief through their compulsions because it provides temporary relief. People with these symptoms may have other co-morbid conditions such as tic disorders or skin picking.
Checking rituals can be a result of different types of obsessions, including fears of harming others accidentally, fears of harming willfully, or sexual thoughts. Compulsive checking is done to prevent an error that could impact someone or their loved ones' well-being. It also provides some sort of relief for the doer although only temporary. These rituals often involve an impulse to check light switches, door locks, stove, and faucets etc. In some cases, checking is cued by specific situations like leaving the house or going to bed at night, but it may also be a response to random thoughts that just come suddenly and deemed dangerous by the person with OCD. It also makes such person believe that a bad event that just pops in their head is more likely to happen if they are not careful.
Many OCD patients are known to check locks repeatedly to make sure they are securely bolted. That person knows that they have previously checked the lock, but their mind creates doubts that they probably didn’t check it properly or that they must check again just to be sure. The usual fear is that a thief may break in and steal or harm the people in the house and the person with OCD would be responsible for failing to check the lock.
Repeatedly checking stoves and other hot appliances are done to make sure they have not left anything that could cause a fire. The OCD patient may need to check and re-check if the appliance is unplugged just to feel safe. In most cases, these people worry about electrical outlets, light switches, and light sockets as well.
The fear of harming or killing others or oneself is also common with OCD patients. These people feel overly responsible for causing harm that they must repeatedly check if they have accidentally caused harm to others. OCD also confuses some individuals that cause them to think that if their harming thought is a memory. So much so that when a person hits a bump in the road while driving, they will be so convinced that it was the body of a person or a child. In response, they may stop the car and or drive around the block to compulsively check if no one was harmed.
A person with OCD who is worried that they may have accidentally harmed themselves will be constantly checking for bruises or cuts in their bodies, even though there is no previous recollection of harm being done.
Some OCD patients will go to great lengths to ensure that no negative occurrences have been impacted by their actions. One example would be relentlessly checking the news for information about plane crashes, deaths, and other disasters.
Having made a mistake that will result in horrible consequences also plague the minds of OCD sufferers. To relieve their fear and anxiety, they may repeatedly check filled-out forms. They may also review emails several times before and after sending or open sealed letters just to make sure that everything has been completed correctly.
Other OCD patients may fear they are developing a serious illness in return, they may repeatedly check their body for signs of medical conditions. They may compulsively check their skin for rashes and blisters; check their temperature or buy a blood pressure apparatus to make sure their BP is not elevated.
Among OCD symptoms, washing and cleaning are the most well-recognized and well-documented. This type of OCD can make a person perpetually engage in compulsive acts of avoiding contamination. Washing and cleaning compulsion is divided into two groups:
Those who belong to the first group are worried about contracting a disease through contamination or spreading it to others. The washing compulsions are done to prevent the perceived danger. Those who belong to the second group have fewer recognized obsessions and only engage in washing or cleaning compulsions to relieve the discomfort of feeling dirty. They have stronger intolerance reactions than those in the first group.
A person with contamination obsession will often engage in excessive washing to remove perceived dirt and germs. It could involve repeated handwashing done in a ritualized manner, such as cleaning each finger and under each fingernail. Their hands may end up red and chapped and may even bleed because of excessive hand washing. When their hands are all clean, they may turn off the tap with a towel to avoid re contaminating their hands. They may also use hand sanitizers excessively in between washing. Other manifestations of washing compulsion include excessive brushing of teeth, grooming, ritualized showering or bathroom routine. They may use gloves to prevent contact with contaminants.
People with contamination fears are known to spend a lot of time cleaning household objects and other items that do not normally require washing, such as cellphones and credit cards that encounter something dirty.
Because these people will go to great lengths to avoid being contaminated, they may use a tissue paper to open a toilet door knob. They may avoid touching their own shoes and remove them by pushing the heel of one shoe with the other shoe.
Repetition is part of most compulsions in OCD and what creates rituals. Repetitive and all-consuming thoughts cause disruptions to a person’s life and normal routine. Repeating can be in many forms such as:
Compulsive counting is a common OCD symptom, which may involve counting to a certain number (which the person feels significant), counting tiles on the ceiling or counting steps while walking. The counting may be in their heads or talk aloud. If, say, a person feels the number 5 is significant, they will do things in sets of five. They will finish a glass of water by gulping 5 times; clean a mirror in 5 strokes, and so on. Others have obsessive thoughts that if they stop counting or doing things in sets of 5, certain catastrophic events may happen, or harm will befall upon their family.
Those without a special number, may still count objects and anything on their surroundings.
is a word that refers to obsessions with counting and numbers; it is a common expression of obsessive-compulsive disorder. These people may not have a reason for counting, in contrast to those with contamination fears which are somewhat based on reality. Those with counting compulsion just feel the need to count, sometimes because it relieves their anxiety or to prevent an imagined bad thing from happening. If compulsive counting is just secondary to a primary subtype such as sexual obsession, it may not be as severe and disruptive.
The person knows that their fear is illogical, but their minds continue to create thoughts that seem very reasonable to the person with OCD. Their number fears are often ridiculous even to themselves, but they just can’t stop submitting to it. Someone with arithmomania may need to lock the door 7 times to feel safe. They may look at a clock and wait for an even number or a specific number before they can look away or their family will die of a dreaded disease.
They know it’s their OCD that makes them that way, but they don’t stop counting because of the temporary relief it gives (it must really be working because it makes them comfortable) or simply out of fear of tempting karma. These counting rituals may progress into more compulsions and consume the person’s life.
People who are preoccupied with this type of obsession often engage in compulsive rituals that may include rearranging, reorganizing or lining up objects until it feels “just right.” These individuals are often called perfectionists by their peers because of their strong sense of keeping things in order with such precision and exactness.
An OCD sufferer may feel a discomfort seeing things not set up in the proper or correct way. When things like books on the shelf or magazines in a rack are not symmetrically aligned or arranged in terms of color or height, the feeling of “incompleteness” nags the person. In return, they will have to arrange and rearrange objects a certain number of times until they are satisfied. They may have specific patterns that they incorporate into their routine while arranging. They may also do these compulsions mentally.
Ordering and arranging compulsions affect a person’s life and disrupt their normal routine. Because these individuals have special ways of arranging things, it takes time for them to do simple tasks. They may also feel annoyed or get enraged when other people move their belongings.
It’s common for people with this type of compulsion to engage in counting and touching behaviors. They may write notes repeatedly until they look just right or arrange silverware in the cupboard so that they are evenly spaced.
People with this type of OCD have beliefs about the importance of thoughts and the need to prevent them. The distressing thoughts can be unacceptable or taboo, including blasphemous thoughts against a religion, sexual, harming or violent thoughts.
Rather than engage in an overt ritual, the person may perform mental neutralizing or mental compulsions. This could mean repeating certain words and prayers silently and replacing unwanted thoughts with good thoughts. These mental compulsions only provide temporary relief and may cause more overt rituals.
Obsessive-compulsive disorder may present differently for each individual. Below are some common compulsions that do not fit into any category and have not been the focus of many research studies.
Compulsions and compulsive rituals are any behavior performed by an individual with OCD to allay their obsessions. These things do not work because the provided relief is only temporary and OCD sufferers do not know that their compulsions are unnecessary.
A person with OCD is constantly afraid of forgetting something important. They tend to make unnecessary and excessive lists as a form of reminder to do their normal daily routine, such as making breakfast or brushing their teeth. But according to various studies, most OCD patients do not have memory problems. The making of lists is considered a compulsion if it reassures the person and alleviates their worry, thus they never understand that the list is not required in remembering things. The list can be written or said aloud.
There are instances where a person with OCD may constantly wonder if they have committed inappropriate behavior or made a mistake. To cope, they let the other person know every detail of their actions. This is a difficult compulsion to address for couples in a relationship because a man may have an urge to tell his girlfriend every time he finds another woman attractive. The same way Catholics may feel the urge to confess their littlest sins to a priest. They also tend to disclose every little detail of their past mental issues to their therapist to make sure that they be given proper diagnosis and treatment. The person listening to an OCD patient may feel frustrated and weary because of their constant over-explaining. Their urge to confess is often connected to their need to get reassurance.
It’s common for OCD patients to seek reassurance from other to relieve their anxiety. Research has concluded that people with sex, religion and bodily issues type of obsession are most likely to seek reassurance to cope with their intrusive thoughts. A person may demand reassurance or ask for it subtly. In some cases, people with illness concerns may seek medical help repeatedly to ensure that they are not coming down with a disease. These people who use reassurance to cope can be very good in asking for reassurance feedback from other people – it may not even be obvious that the person is dealing with OCD. A lot of therapists also provide reassurance to their patients as part of their treatment program. But OCD sufferers should not be reassured to stop them from being trapped in the OCD cycle.