“That’s OCD?” Part 2

3 More Types of OCD You Haven’t Heard Of

By Taylor Newendorp, M.A., LCPC

Previously I wrote about 3 OCD subtypes that most people are not familiar with: Harm OCD, Pedophile OCD, and Sexual Orientation OCD. In the interest of continuing to try and break through stereotypes of what OCD is and help people better understand the complex ways in which OCD may manifest itself, here are 3 more types of OCD that most people haven’t heard of:

1. Relationship OCD: Remember that one of the tricks of OCD is that it causes an excessive amount of doubt within an individual. Relationship OCD (ROCD) is characterized by ongoing, extreme doubts about the relationship one is in. Sometimes it is easier to notice, for example, someone with OCD has been in a long-lasting, committed intimate relationship when all of a sudden he or she is overwhelmed by an onset of intrusive thoughts such as “What if I do something to ruin this relationship?” or “Maybe I don’t love my partner enough!” Other times, ROCD can be sneakier and more insidious, and what tend to be natural or “normal” concerns in many relationships gradually develop into full-blown obsessions that the person with OCD can’t stop thinking about (“What if there’s someone better out there for them?” “What if there’s someone better out there for me?” “My partner doesn’t really know the real me!”). People with ROCD may then compulsively seek reassurance from their partner that “everything is okay.” Other compulsions include constantly looking for evidence and/or “signs” that the relationship is good or bad, mentally reviewing essentially anything and everything related to the relationship, and even avoiding the partner due to the high levels of distress the person with ROCD starts to experience when his or her partner is around. For people with ROCD, their partners, and even for many professionals, it can be difficult to distinguish ROCD from other types of relationship issues. One of the keys to look out for is that the person with ROCD is truly struggling with anxiety related to uncertainty, and their OCD-driven doubts about the relationship usually become all-consuming. This is different from someone who knows they are not in love with their partner or knows the relationship is not going well and they need to end it. Because this is a lesser-known and frequently unidentified form of OCD, if you suspect this applies to you or someone you know, it is best to consult with a therapist who specializes in OCD and has experience treating ROCD specifically.

2. Hyperawareness OCD: This form of OCD can involve an intense, near-constant focus on sensations and stimuli that people without OCD tend not to notice much. It is common that people with Hyperawareness OCD experience what are known as”somatic” or “sensorimotor” obsessions where they are overly attentive to automatic bodily processes such as blinking, breathing, swallowing, or even the beating of their own heart. People may also be acutely aware of external sensory stimuli such as sounds in their environment (airplanes flying overhead, dogs barking, birds chirping, cars driving by, the sound of them chewing their own food, etc.), smells, and even tactile sensations (sticky, slimy, or gritty substances, for example). Hyperawareness OCD has a two-fold obsessive process: First, the person cannot stop focusing on the sensation itself; Second, they are aware of the fact that they are hyperaware of that sensation, and they then have difficulty not obsessing about the fact that they are hyperaware of it. People may try to avoid any environments where they may be exposed to outward sensory stimuli that trigger their obsessions, and they may compulsively try to “figure out” why they’re so focused on these sensations and analyze what it”means” that they have this heightened awareness. (Hint: All it “means” is that they have this type of OCD!)

3. Existential OCD: “Why am I here?” “Why is anyone here?” “What does it all mean?” These are questions that many thoughtful people experience at some point in their lives. These kinds of questions have driven some of the greatest philosophers, scholars, scientists, and leaders throughout history. They are natural curiosities many of us have. However, for the person with Existential OCD, these very questions can be torture. These ideas turn into non-stop obsessions that can fill the individual with confusion, fear, and dread. Since people with OCD tend to have difficulty tolerating uncertainty, this form of OCD can be highly distressing as many of the intrusive thoughts that come along with it are ultimately unanswerable questions. People with Existential OCD may even experience extreme, disconcerting thoughts like, “Do I even really exist?” These kinds of obsessions are often confused for delusions, and people may receive incorrect diagnoses and treatment that can just exacerbate the OCD symptoms. As with many other types of OCD, it is common for people with Existential OCD to engage in mental rituals and compulsions such as continual analysis of their own thoughts, constantly trying to “figure it all out,” and scrutinizing what it means about them as a person to even have such thoughts. One of the keys to working on this kind of OCD is acceptance. Rather than attempting to suppress these thoughts, push them out of one’s mind, or answer them, people have to learn to accept that these thoughts may continue to run through their minds indefinitely but they don’t have to “do” anything about them. A combination of Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Mindfulness techniques can help people reach that place of acceptance necessary to overcome the OCD.