What do you mean OCD has subtypes?: Subtypes you may have never heard of before
When most people hear the words Obsessive-Compulsive Disorder (OCD), they probably
picture someone washing their hands over and over, checking the door ten times before leaving
the house, or needing everything to be perfectly organized. Y es, those can absolutely be part of
OCD; however, there are many different themes OCD can take on, and some of them are
surprisingly hard to recognize. In fact, someone can struggle with OCD for years without
realizing that what they're experiencing is OCD because their symptoms don't look like the
stereotypical version we usually see portrayed in media.
At its core, OCD is about getting stuck in a cycle of intrusive thoughts, doubts, fears,
sensations, and compulsions; those thoughts can attach themselves too almost anything. Some of the more commonly discussed forms include contamination, checking, "just right", relationship, scrupulosity, and sexual orientation OCD. But there are other presentations as well. Another three that are important to remember are Sensorimotor or Somatic, Existential or Philosophical, and False Memory OCD.
Of note, these "subtypes" are not official diagnoses. The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5) describes OCD as a single disorder that
shows up across a handful of symptom dimensions. These theme-based names (popularized by
organizations like the International OCD Foundation) are useful for describing what OCD is
latching onto, pointing back to the same underlying disorder. They can look very different from
one another, but their commonality includes the the mind getting stuck trying to find certainty
about something that doesn't seem to have a satisfying answer.
Sensorimotor OCD
Have you ever suddenly become aware of your breathing? Normally, we don't think about
it. We just breathe. But imagine becoming so aware of your breathing that you can't seem to stop paying attention to it. You may start thinking: Am I breathing normally? Why am I thinking about breathing? What if I have to consciously control my breathing forever?
Now you're monitoring every breath. The same thing can happen with blinking,
swallowing, your tongue, your heartbeat, eye contact, or even the way your eyes move. This is
sometimes referred to as Sensorimotor OCD or Somatic OCD. A person becomes intensely
aware of something that normally happens automatically. Once you notice it, it can feel almost
impossible to un-notice it. You might try to make your breathing feel "normal" again. You might
test whether you can stop thinking about blinking. You might repeatedly swallow to see if it feels
right. You might monitor your tongue to make sure it's sitting in the "correct" position. The
problem is that the more you check, the more aware you become. Uncomfortable sensations and
urges that drive compulsions, sometimes called "sensory phenomena", are reported by a large
share of people with OCD.
Existential OCD
Most people have had an existential thought at some point. Those are normal human
questions. Some people find them fascinating. They might read philosophy, watch
documentaries, have conversations with friends, or simply think about them every now and then.
Why are we here? What happens after we die? What is consciousness? Why does anything exist at all? Is reality actually real?
With Existential OCD, these questions can become much more than interesting thoughts.
They can become urgent. You feel as if you need to know for sure. You might spend hours
researching consciousness online. Y ou might debate yourself in your head. You might ask other
people what they believe. You might try to prove to yourself that you're real, that other people
are conscious, or that life has meaning. And even after all that thinking, you still don't feel
satisfied. So you go back and think about it some more. There isn't a Google search that can
finally prove, beyond all doubt, why the universe exists. There isn't an argument that will make
every possible uncertainty disappear. And suddenly something that started as a philosophical
question becomes something that consumes hours of your day.
False Memory OCD
This one can be particularly distressing. False Memory OCD involves intense doubt
about whether something happened in the past, even when there doesn't seem to be any evidence that it actually happened. For example, someone might suddenly think:
"What if I hit someone with my car five years ago and completely forgot?" "What if I did something horrible, and I've somehow blocked it out?" The person may have no actual memory of doing it. There may be no evidence that it happened. Nobody may have ever mentioned anything. But OCD doesn't necessarily care about the lack of evidence. Instead, it asks: "but can you prove it didn't happen?” And that's a very different question. So the person starts looking for proof. They replay the memory. Then they replay it again. They look at old photos. They search news stories. They ask friends or family members what they remember. They may even try to reconstruct an entire day from years ago. And for a little while, they might feel better. Then the doubt comes back: "but what if I missed something?" So they check again. Our memories aren't perfect recordings. They change, become less detailed, and can be influenced by all sorts of things. But OCD can turn that normal uncertainty into a terrifying problem that needs to be solved.
The Content of OCD Doesn't Define You
Having a less well-known OCD theme doesn't make you unusual or broken. OCD often attaches itself to whatever matters most, or whatever a person’s brain finds hardest to leave unresolved. The good news is that “unusual” OCD themes aren't untreatable. The best-established psychotherapy for OCD is Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), and most people who complete it experience meaningful change. Medication is also a well-established, first-line option. Selective serotonin reuptake inhibitors (SSRIs) can be used on their own or alongside ERP . Most importantly, having an intrusive thought doesn't define who you are. A thought is just a thought. Even when OCD tells you it has to mean something more.
Candace Telford, MA, LPC
Panacea Therapy Group
405-855-9246
Disclaimer
The information provided in this blog is for educational and informational purposes only and is
not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or mental health issue. The content of this blog reflects the
author's perspective and opinions. Individual experiences and treatment outcomes may vary. If you or someone you know is struggling with psychological disorder, it is important to seek
professional help from a qualified mental health professional or medical provider.
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