Understanding the Lesser-Known OCD Subtypes
Author: Mokshvi Shah, BS Northeastern University Student
Published: May 2025
When most people think of Obsessive-Compulsive Disorder (OCD), images of excessive hand-washing, fear of germs, or needing things to be perfectly symmetrical often come to mind. While these are certainly valid experiences of OCD, they represent only a small fraction of how this condition can manifest. OCD is a complex and deeply misunderstood mental health disorder. It’s characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing the anxiety these thoughts cause. But what many people don't realize is that OCD can take on countless forms, some of which are much less recognized, but no less distressing.
1. Harm OCD
Harm OCD involves intrusive thoughts about causing harm to oneself or others, even if the person has no desire or intent to act on these thoughts. A person might fear stabbing a loved one with a kitchen knife or pushing someone into traffic, and may avoid certain situations or objects out of fear of "losing control." These thoughts are ego-dystonic, meaning they go against the person's values and desires. People with harm OCD are typically the least likely to ever act on these thoughts, they are horrified by them.
2. Sexual Orientation OCD (SO-OCD)
This subtype involves intrusive doubts and fears about one’s sexual orientation, regardless of their actual orientation. A straight person may suddenly obsess about being gay, or a gay person may fear they are actually straight. These obsessions are not reflective of real shifts in identity but are driven by anxiety and the need for certainty. Individuals may compulsively seek reassurance, avoid triggers, or mentally review their past relationships to "check" their orientation.
3. Relationship OCD (ROCD)
ROCD causes someone to obsess over their romantic relationship, often questioning if they truly love their partner or if their partner is "the one." These thoughts can lead to guilt, confusion, and repeated cycles of doubt and reassurance-seeking. Common compulsions include analyzing feelings, comparing the relationship to others’, or mentally checking for signs of compatibility.
4. Scrupulosity OCD
Scrupulosity involves obsessive concerns related to morality or religion. People with this subtype may worry excessively about sinning, being morally wrong, or offending a higher power. Compulsions can include excessive prayer, confessing, or avoiding anything that feels "wrong." These thoughts often cause deep shame and distress, particularly because they clash with personal beliefs or values.
5. Existential OCD
This subtype involves obsessive questioning about the nature of reality, existence, or the self. Thoughts like “What if none of this is real?” or “How can I be sure I even exist?” may arise, leading to compulsive rumination or reassurance-seeking. Because these questions have no definite answers, individuals can get stuck in never-ending mental loops trying to find certainty.
Why Awareness Matters
Understanding the full spectrum of OCD subtypes is vital, not only for those experiencing it but also for friends, family, and even professionals who may misinterpret the symptoms. Many people with these lesser-known subtypes suffer in silence, fearing judgment or misunderstanding. Worse, they may go undiagnosed or misdiagnosed for years. If you or someone you know resonates with any of these experiences, please know: you are not alone, and there is effective treatment available. Exposure and Response Prevention (ERP) therapy, a specialized form of Cognitive Behavioral Therapy (CBT), is the gold standard for OCD treatment, and can be tailored to address any subtypes.
