Characterized by fears of contamination with dirt or germs, fears of harming and intrusive distressing thoughts. Compulsive behavior involves rituals or avoidance:

  • Excessive hand washing, cleaning
  • Avoiding touching things, (e.g., covering hands with sleeves to touch doorknobs)
  • Checking (e.g., checking stoves, light switches, or door locks; checking the road or car due to “hit and run” OCD)
  • Counting, repeating (e.g., having to repeat behavior 4 times or multiples of 4)
  • Ordering – arranging things, or having to create symmetrical a arrangements, having to do things that create even feelings on left and ride sides
  • Compulsive telling or confessing
  • Checking for reassurance with family members, doctors, or on websites


Primarily Obsessional OCD

Characterized by disturbing, inappropriate or horrific intrusive thoughts or images:

  • Relationship OCD: Fear that one is in the wrong relationship, in an otherwise good relationship, leading to checking for evidence to confirm one’s doubts
  • Aggressive thoughts: Thoughts of harming self or others, e.g., thoughts of stabbing loved one, when one has no desire to do so
  • Sexual thoughts: Fears of being gay, or fears of being straight, if one is gay; fears of molesting children, etc.
  • Scrupulosity, i.e., religious or moral obsessions: Fears of doing something bad or wrong, or fears of blaspheming God, or fears of being unfaithful, with compulsions to confess minor behavior (among Catholics), excessive praying, checking with clergy for reassurance, etc.
  • Indecisiveness: Fear of making the wrong decision, leading to reviewing all options, and avoiding making decisions


Postpartum OCD

May involve horrific intrusive thoughts or images of harming the baby, leading to fear of being alone with baby or fear of bathing baby, or may involve increased contamination fears.



Excessive accumulation of things that most people would consider useless and difficulty getting rid of them, leading to cluttering home, or causing parts of the home to be unusable, unsanitary, or unsafe.



(Pediatric Autoimmune Neurological Disorders Associated with Streptococcal Infections): Onset or exacerbation of OCD due to having a strep infection


Hypochondriasis and health anxiety

Fear that a minor symptom is indicative of a deadly disease leading to excessive checking for reassurance with family members, doctors, or medical websites


Body Focused Repetitive Behaviors (BFRB’s):

  • Trichotillomania (Hair Pulling)
  • Skin Picking
  • Nail Biting
  • Mouth or lip chewing, picking, etc.
  • Treatment involves CBT, including Habit Reversal Training, Relaxation Training, and the use of strategies, e.g., use of barriers or incompatible behaviors


Tourettic OCD:

Needing to repeatedly do physical behaviors (swallowing, sniffing, turning head, etc.,) in a way that brings about “just right” feeling