What other mental disorders come with OCD?
Disorders That May Co-exist with OCD
When two diagnoses occur in the same individual, they’re referred to as “comorbid” disorders. According to the most recent, large-scale community study of mental health in adults across the United States, 90% of the adults who reported OCD at some point in their lives also had at least one other comorbid condition, including anxiety, mood, AD/HD, oppositional-defiant, and substance use disorders. A trained mental health professional can diagnose and provide appropriate treatment for these conditions as well as OCD.
Following are some of the disorders that are frequently comorbid with OCD (descriptions of the disorders are based upon information provided in the DSM-5):
ANXIETY DISORDERS. Anxiety disorders that may occur with OCD include Separation Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder (panic attacks), Social Anxiety Disorder and Specific Phobias, such as fear of snakes or heights. All of these disorders share features of excessive fear and anxiety as well as related behavioral disturbances. But because each disorder is different, symptoms can be quite varied.
MAJOR DEPRESSIVE DISORDER. Symptoms of depression may include a persistent, sad, empty or hopeless mood, loss of interest in usually pleasurable activities (such as sports, hobbies, or sex), decreased energy, difficulty concentrating, insomnia or oversleeping, irritability, weight gain or loss, and thoughts of death or suicide. Symptoms must be present for at least a 2-week period and represent a change from previous functioning.
BIPOLAR DISORDERS. Bipolar disorders are marked by extreme changes in mood, thought, energy and behavior. Bipolar I Disorder is characterized by the presence of a manic episode (abnormally elevated or irritable mood and increased energy lasting for at least 1 week). Bipolar II Disorder involves the presence of both a hypomanic episode (elevated mood and energy lasting for 4 consecutive days; episode is not severe enough to cause marked impairment in functioning) and a major depressive episode.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (AD/HD). There are three types of AD/HD: (1) Predominantly inattentive presentation; (2) Predominantly hyperactive/impulsive presentation; and (3) Combined presentation. Criteria for AD/HD require that some symptoms of AD/HD be present before the age of 12 and that several symptoms be present in two or more settings (e.g. home, school, work).
FEEDING/EATING DISORDERS. These disorders involve serious disturbances in eating or eating-related behaviors. They include anorexia nervosa: a persistent limiting of food intake that leads to significantly low body weight, fear of gaining weight (or behavior that interferes with weight gain), and a disturbance in self-perceived weight or shape; bulimia nervosa: binge eating with compensatory behavior such as self-induced vomiting, misuse of laxatives, excessive exercising, and self-evaluation overly influenced by body shape and weight; and binge-eating disorder: recurrent overeating that is not accompanied by compensatory behavior.
AUTISM SPECTRUM DISORDER (ASD). People with ASD have difficulties with social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities; these symptoms cause significant impairment in functioning. Although symptoms must be present in the early developmental period, they may not become fully manifest until later in life. ASD is categorized by severity levels, based upon the amount of support needed due to challenges with social communication and restricted interests and repetitive behaviors.
TIC DISORDERS/TOURETTE SYNDROME (TS). Tics are sudden, rapid, recurrent, nonrhythmic motor movements (such as blinking, shrugging shoulders) or vocalizations (such as sniffing or grunting). Persistent (Chronic) Motor or Vocal Tic Disorder involves either motor or vocal tics only. TS involves both motor and vocal tics that have been present for more than a year. Symptoms occur prior to 18 years of age in tic disorders and TS.
Several disorders that tend to co-exist with OCD share many similarities with OCD and are listed in same DSM-5 category as OCD: OCD and Related Disorders. These conditions should also be treated by a qualified mental health therapist. They include:
BODY DYSMORPHIC DISORDER (BDD). People with BDD are preoccupied with one or more perceived flaws or defects in various areas of the body (e.g., skin, hair, nose). Although these flaws are not visible or appear only slight to others, individuals with BDD may think of themselves as ugly and are often obsessed with the perceived defect. Excessive, repetitive behaviors or mental acts are performed in response to these preoccupations (e.g., excessively grooming, skin picking, repeatedly checking perceived deficits in mirrors).
HOARDING DISORDER. Hoarding Disorder involves a persistent difficulty parting with or discarding one’s possessions (e.g., newspapers, clothing, books) due to a belief that the items are useful or have aesthetic value, even though many individuals would deem them useless or of limited value. Individuals with Hoarding Disorder may also have a strong sentimental attachment to their possessions. The need to save these possessions and the distress associated with discarding them results in an accumulation of items that clutter and obstruct living areas, preventing them from being used as intended. Difficulties discarding items and/or clutter causes impairment in functioning, including maintaining a safe environment for self and others.
TRICHOTILLOMANIA (HAIR-PULLING DISORDER). Trichotillomania is characterized by the recurrent pulling out of one’s own hair from any region of the body in which hair grows, resulting in hair loss, as well as repeated attempts to reduce or stop hair pulling. Common areas of pulling include the eyebrows, scalp, and eyelids. Hair pulling may be preceded or accompanied by feelings of anxiety or boredom; it may also be preceded by an increasing sense of tension or lead to gratification or a sense of relief when the hair is pulled out.
EXCORIATION (SKIN-PICKING) DISORDER . Excoriation disorder is characterized by recurrent skin picking that results in noticeable (or hidden) damage to the skin (e.g., scabs, sores). As with Trichotillomania, (1) the individual with Excoriation Disorder has made repeated attempts to reduce or stop skin picking, and (2) skin picking may be triggered by feelings of anxiety or boredom; it may also be preceded by an increasing sense of tension or lead to gratification or a sense of relief when the skin or a scab has been picked.
OTHER SPECIFIED OBSESSIVE-COMPULSIVE AND RELATED DISORDERS. Examples of these disorders include obsessional jealousy, which is characterized by a nondelusional preoccupation with a partner’s infidelity and repetitive behaviors or mental acts performed in response to these infidelity concerns; and body-focused repetitive behavior disorders such as nail biting, lip biting, and cheek chewing, which are accompanied by attempts to decrease or stop the behavior.
The History of OCD
To truly understand obsessive-compulsive disorder , we need to learn about how our concept of it has changed and evolved through the years.
What is OCD?
Obsessive-compulsive disorder is an anxiety-based mental health disorder that combines distressing thoughts with repetitive behaviors.
OCD obsessions can vary widely, but most often revolve around one or more of the following themes:
- Cleanliness and contamination concern.
- Worry over the possibility of a catastrophic event.
- “Just right” thinking that overly focuses on symmetry and organization.
- Preoccupation with taboo thoughts over socially unacceptable content.
OCD compulsions are initially carried out as a calming mechanism, via a repeated action that is initially meant to assuage the anxiety raised by OCD-related thoughts. This can be anything from turning the lights on and off, to an idiosyncratic hand gesture, to repeatedly organizing one’s cabinets. Though at first calming, these ritualistic behavior patterns eventually become compulsive, as with each new enactment they contribute more stress and frustration to the individual who feels compelled to perform them.
It is also worth stressing that it is OCD-induced anxiety, which results from the unyielding thought obsessions and repeated actions, that weighs heaviest on those battling this condition. For this reason, the existence of anxiety is considered a key feature in the definition of this disorder.
OCD Throughout History: A Part of Many Different Disorders
Before the mid-1800s, OCD was a little understood condition. Its high levels of anxiety, worrying thoughts and repetitive behavior were explained as symptoms of a number of possible illnesses. Back then, OCD-related symptoms such as obsessive thoughts and compulsive actions were considered part of a number of possible diagnoses, among them: a break from reality, poor blood flow, an intellectual disability or emotional instability.
OCD as a Distinct, Anxiety-Based Disorder
It was German psychiatrist Carl Westphal who, in 1877, presented the world with a separate definition for OCD-related symptoms. Made even more accurate by his student Robert Thomsen in 1895, Westphal’s definition outlined OCD’s two central features — obsessive thoughts and compulsive behaviors —and highlighted how their presence causes patients increased anxiety . Their efforts resonate to this day, through the way OCD is currently defined and diagnosed.
Freud’s Obsession: OCD as a Focus on Forbidden Desires
The father of psychoanalysis, Sigmund Freud saw compulsive OCD behavior as the result of internal conflict. He first referred to OCD as “zwangsneurose,” or “anxiety neurosis,” in 1895, within a paper focusing on anxiety.
According to Freud, some individuals struggle to settle secret, taboo desires within the limitations of social norms and of external reality. These desires are internalized into the unconscious, with its pent-up, frustration eventually manifesting in the uncontrollable urge to carry out illogical actions.
Freud postulated that though these actions offered the patient temporary relief, they also incurred embarrassment, since the patient understood them to be incongruent with normative behavior. Freud’s school of psychoanalysis was the most common form of treatment for OCD well into the mid-20th Century, at which point other forms of treatment became more widely used with this condition.
Interestingly, it was Freud’s choice of words that led to the term we use today: In the UK, “zwangsneurose” was translated as “obsessive neurosis,” while in the US it was translated as “compulsive neurosis.” A compromise between the two was eventually struck, with the term “obsessive-compulsive disorder” emerging as a result.
Following both Westphal’s emphasis on obsessions and compulsions, as well as Freud’s more psychodynamic approach to OCD as a manifestation of taboo desires, official mental health organizations began to take notice of this condition. Specifically, both the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) and the World Health Organization’s International Classification of Diseases and Illnesses (ICD) included OCD among their recognized mental health disorders, though the condition’s position in relation to other anxiety disorders remained an open debate.
OCD as Part of the Anxiety Family
Earlier iterations of the DSM manual featured OCD as part of the anxiety disorders family. And in the current ICD-10, OCD is still featured as part of the “neurotic, stress-related and somatoform disorders” family.
Categorizing OCD under these disorder families made sense, due to its high comorbidity rates with other anxiety-based disorders, as well as the significant damage both OCD and anxiety can cause to one’s life. And so, OCD was seen as another in a row of anxiety disorders, until the publication of the DSM-V.
The Case for Separating OCD from Anxiety
The DSM’s fifth edition, which was published in 2013, ushered in several new stances in the field of mental health. the manual as a whole moved toward a more developmental approach, detailing which disorders tended to appear before other disorders became apparent; transgender identity was removed and no longer considered a mental disorder; and OCD was given a section of its own, outside of the anxiety disorders family.
There were several reasons that contributed to the extra focus now granted to OCD. First, OCD research has uncovered unique familial, genetic, and neural commonalities among OCD and other OCD-related disorders. In particular, a strong association was found between OCD and abnormalities in brain structures found to be connected to impulse and motor control, as well as self-regulation.
A second contributing factor was the emerging Executive Functioning Hypothesis, which convincingly asserts that OCD evolves out of a disturbance in one’s self-regulatory abilities — while other anxiety-based disorders are more associated with emotional processing.
Together, conclusions from cutting edge research and the Executive Functioning Hypothesis act to reaffirm one another, building the case for increased focus on OCD in light of these developments, as opposed to other disorders that are not yet as well understood.
Current Treatments for OCD
At present, several treatments have been shown to offer significant symptomatic relief for OCD: Deep TMS, cognitive behavioral therapy (CBT), and SSRI medication.
Deep Transcranial Magnetic Stimulation (or Deep TMS) works by utilizing magnetic fields that regulate the neural activity of brain structures such as the anterior cingulate cortex, which has been shown to be associated with OCD. A non-invasive treatment, Deep TMS does not cause any significant or long-lasting side effects or recovery period, and can be combined with any other form of therapy. Due to its safety and efficacy, Deep TMS is the only non-invasive medical device to be FDA-cleared with clinically proven outcome data to treat OCD.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (or CBT) is a form of psychotherapy considered to be a first-line treatment for OCD. This treatment helps the patient identify the thoughts, feelings, behaviors, and physical sensations they associate with their condition. As they learn to acknowledge and respond to triggering stimuli in a way that dismantles their automatic and compulsive OCD responses, patients undergoing CBT gain a better understanding of their condition and solidify their sense of control of it.
Selective serotonin reuptake inhibitor (or SSRI) medication is also considered a first-line treatment for OCD. This group of medications keeps the neurotransmitter serotonin active for a longer period of time, resulting in an elevated mood and a decrease in both anxiety and depression. SSRIs are considered an effective treatment that causes significant OCD symptom relief. That said, it can cause a number of side effects that some patients find to be too adverse to continue treatment. Weight gain, sexual dysfunction and nausea are among SSRIs’ more common side effects.
Facing Our Most Persistent Fears
Perhaps more than anything else, OCD is a lesson in perseverance. Initially a misunderstood condition, it is the unrelenting anxiety that comes with OCD that eventually caused mental health researchers, theorists, and practitioners to pay attention to the suffering experienced by those battling this condition, leading to a more in-depth and comprehensive understanding of it. And as we continue to learn more about OCD, we are able to offer greater care and hope for the individuals who contend with its presence.
4 Different Types of OCD
Obsessive-compulsive disorder (OCD) is a mental health condition that affects just about 1% of the population. There are several types of OCD that all overlap in symptoms but vary in how each person is affected.
Whether you, a family member, or a loved one has obsessive-compulsive disorder, it’s important to understand the condition to know what makes it better and what causes OCD to get worse. When someone has OCD, they’re consumed with intrusive thoughts and common obsessions that can interfere with their life — sometimes to the point of significant distress and disruption of daily functioning. Despite the fact that there’s a wide variation in how OCD affects individual people, some of the subtypes (or categories) tend to be more common.
What Are the Different Types of OCD?
All forms of OCD are similar in that a trigger occurs, causing intrusive thoughts, which then cause distress and anxiety and ultimately lead to compulsive behavior. Both OCD obsessions and mental compulsions can have either physical or emotional symptoms.
Lesser known types of OCD that are not listed in this article include:
- Relationship OCD
- Responsibility OCD
- Retroactive Jealousy OCD
- Just Right OCD
- ‘Pure O’ OCD
- Existential OCD
- Pedophilia OCD
- Sexual Orientation OCD
The following four stand out as they’re some of the more commonly seen types of OCD:
- Cleaning/contamination OCD
- Order/symmetry or counting compulsions OCD
- Harm OCD
- Hoarding OCD.
We will take a deep dive and discuss these types of obsessive-compulsive disorder.
People who have a cleaning or contamination OCD tend to focus on fear or intense feelings of discomfort that results from contamination or uncleanliness. Washing excessively is normal and is done in an attempt to relieve the feelings of distress.
A good example of contamination OCD is touching a light switch and convincing yourself that it was dirty and that you’re now contaminated. You may fear that you’ll contaminate others which may lead to the repetitive behavior of frequently washing your hands to try and cleanse yourself.
Order/symmetry or counting compulsions OCD
Order and symmetry and counting compulsions OCD creates a very intense urge to arrange and rearrange things until they’re just right — or at least exactly how you think they should be. In some cases, this compulsive behavior could look like a need to constantly rearrange the socks in your drawer to be organized by color or by type.
Order and symmetry OCD might also make you count or say phrases or words over and over again until you feel something is done perfectly. Sometimes the need to order, count, or repeat can be an attempt to stave off danger or bad luck. You may feel like if you get something perfectly arranged, or if you say a certain phrase so many times, perhaps someone won’t die, or they won’t leave you.
Harm OCD involves extreme feelings or worry that you’ll harm yourself or others. In order to relieve these unwanted thoughts, you might use what’s known as checking rituals.
An example of harm OCD is you may believe that you accidentally hit someone with your car. You can feel so strongly about this that you’ll be compelled to drive back to the place where you thought the accident occurred to prove to yourself nothing happened. You’ll likely do this repeatedly in an attempt to be absolutely sure.
Hoarding OCD is now actually recognized as its own diagnosis in the DSM-5. When someone hoards, they collect items that typically don’t have much value. Magazines, notes, clothing, games, containers — a hoarder may keep so many of these items, their home becomes virtually unlivable as it’s so filled with clutter.
An obsessive thought surrounding not having something you might one day need is common with hoarding. This OCD subtype has a higher rate of co-existing depression and anxiety than others.
Note that hoarding OCD is a separate condition from compulsive hoarding and can occur on its own without a distinct OCD diagnosis.
“The three most common types of OCD include cleaning/contamination, order/symmetry, and harmful, intrusive thought patterns. Cleaning/contamination involves washing everything excessively to ward off contamination. Order/symmetry involves organizing items by color, shape, or category to the point where other areas of our life are impaired. Harmful, intrusive thought patterns can be described as being forced to think about things without having control over the topics.”
In addition to these main subtypes, there are also obsessive-compulsive-related disorders that can occur.
- Hair-pulling disorder (trichotillomania) — Hair pulling disorder causes a strong urge to pull hair from the head, eyelashes, eyebrows, or anywhere else on your body. Habit reversal training or cognitive behavioral therapy (CBT) are often successful treatment options.
- Skin picking disorder (excoriation) — Excoriation disorder causes persistent picking of the skin. It can cause infections, lesions, and extreme distress.
- Body dysmorphic disorder — Body dysmorphic disorder involves a preoccupation with what you may perceive as a flaw in your own appearance. Most often, the imperfections you see either aren’t observable at all, or they’re only very slightly observed to others. Body dysmorphic disorder causes repetitive behavior to check your appearance or groom yourself. It also typically involves comparing yourself to others.
How to Treat Different OCD Types
Different types of OCD can have slightly different OCD symptoms, which can make treatment options more tricky since it’s not a one-size-fits-all method. You’ll have to consider what your symptoms are, how severe they are, and which forms of treatment will best work to help you.
Most mental health experts agree that OCD therapy, medication, or a combination of the two show the most promising benefits for OCD treatments.
Two types of therapies that seem to work better for OCD than others are cognitive behavioral therapy (CBT) and exposure therapy.
Remember that since OCD symptoms vary by individuals and subtypes, not all therapy techniques will be effective in all forms of OCD. For example, in some research, ERP doesn’t appear as effective for treating obsessive thoughts. However, other CBT techniques like mindfulness-based CBT might be better for an intrusive or obsessive thought.
Prescription medication might be another option, and it’s often suggested solely in the beginning as you learn additional coping techniques in therapy for OCD. Some of the drugs that have proven effective in treating OCD include antidepressants, anti-psychotics, and selective serotonin reuptake inhibitors (SSRIs).
Note that, again, OCD medication will be dependent on symptoms. Some studies have shown that certain subtypes of OCD (like cleaning and contamination OCD) may not respond as well to SSRIs.
“Treating different OCD types is quite complex. Typically the best rhythm is by incorporating medications before therapeutically diving into both exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT). Focusing on the thoughts that typically drive the compulsions in the specific form that they come out. Challenge dysfunctional belief systems, perspectives, and ideas that have been reinforcing the pattern to continue”
Which Type of OCD Do I Have?
Since there are so many forms of OCD, figuring out which type of OCD you have will be the first step in finding a way to live with your condition. Start with our OCD test to learn more. Then, through either in-person or online therapy, reach out to a therapist or doctor for a full diagnosis and develop a treatment plan that can help you manage your mental health condition so you can live life to the fullest.
You do not have to let your OCD control you, but you can definitely learn how to deal with OCD. Treatment may not ‘cure’ your OCD, but it can help lessen the symptoms and give you the tools you need to make them manageable.