Obsessive Compulsive Disorders can be of many types, but usually they can fit into the following five categories:
Checking
This refers to a need to ‘check’ or ‘seek reassurance’ compulsion. This often stems from an obsessive fear to prevent harm, damage, fire etc. Some examples include checking door locks, car locks, stove, water taps, re-reading text excessively, emails/texts, and valuable items.
Checking is often carried out multiple times, sometimes hundreds of times and might last for an hour or even longer causing significant impact on the person’s life, being late for school, work, social occasions and other appointments. This can impact a person’s ability to hold down jobs and relationships , which is why the phrase ‘a little bit OCD’ is so inaccurate and offensive. Another consequence of checking compulsions is that they can often damage objects that are constantly being pulled and prodded or over tightened.
Dia asking her family and checking the locks was due to this type of compulsion.
Contamination/Mental Contamination
This refers to the excessive worry of being dirty or fear of being dirty. It is often a worry of dirt causing harm to self and other loved ones. The common compulsions might be to wash, clean or avoid. Some examples include: public toilets, chemicals, shaking hands, door handles, hospitals, public eateries, crowds, currency, clothes, brushing, outside air, specific places.
The cleaning or washing is often carried out multiple times, often accompanied by rituals of repetitive hand or body washing until the person ‘feels’ it is clean, rather than someone without OCD who will wash or clean once until they ‘see’ they are clean. The time this takes can have a serious impact on a person’s ability to hold down jobs and relationships and there is also a secondary physical health impact of the constant scrubbing and cleaning on the skin, especially the hands where people will scrub until the hands are bleeding.
Some people have also gone to the extremes of bathing in bleach. A person may also avoid entire places, people or objects if they experienced contamination fears previously. There is also a cost implication of the constant use and purchase of cleaning products, and also of items, especially electrical items like mobile phones, that are damaged through excessive liquid damage.
Sometimes Dia thinks she is dirty after touching a doorknob at her friend’s house, she has to take a shower after that no matter what.
Mental contamination is a more recent area that researchers have only just started to get an understanding of. Feelings of mental contamination can be evoked by times when a person perhaps felt badly treated, physically or mentally, through critical or verbally abusive remarks.
It is almost as if they are made to feel like dirt, which creates a feeling of internal uncleanliness — even in the absence of any physical contact with a dangerous/dirty object. A distinctive feature of mental contamination is that the source is almost always human, unlike the contact contamination that is caused by physical contact with inanimate objects.
The person will engage in repetitive and compulsive attempts to wash the dirt away by showering and washing which is where the similarities with traditional contamination OCD return, the key difference is the contaminated feeling does not need to come from a physical contact, often it is from feeling alone with mental contamination.
Dia was told by her teacher she is useless because she took way longer to finish her tasks. Every time after that class Liv has to wash her hands 5 times to get rid of these comments.
Symmetry and ordering
Also referred to as ‘just right’ OCD. This is characterized by a need to have everything lined up symmetrically (compulsion), the obsessive fear might be to ensure everything feels ‘just right’ to prevent discomfort or sometimes to prevent harm.
Those affected will spend a lot of time trying to get the symmetry ‘just right’ and this time consuming checking can result in them being extremely late for work and appointments. They may also become mentally and physically drained if the compulsions take a considerable amount of time. The sufferer may also avoid social contact at home to prevent the symmetry and order being disrupted which can have a negative impact on social interaction and relationships.
Examples include ordering books, toys, pictures, clothes, overall neatness, getting rid of blemishes or spots etc.
Dia has to arrange her closet from shirts, pants, whites, colours and skirts from left to right in pairs of 7. If one item goes awry, she has to start all over again till it’s right.
Intrusive Thoughts/ Ruminations
It refers to where a person generally suffers with obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature, for example, thoughts of causing violent or sexual harm to loved ones which don’t involve specific immediate compulsions these are called intrusive thoughts However, it can be argued that everybody alive will have intrusive thoughts, the difference being that from an OCD perspective it is generally assumed that the thoughts are both unpleasant and repetitive (constant).
Eg. The thought of constantly winning the lottery is an intrusive thought but it is pleasant. A person with OCD will think that the intrusive thought they have is majorly distressing.
Common intrusive thoughts might include:
Relationship Intrusive Thoughts, Sexual Intrusive Thoughts, Religious Intrusive Thoughts, Violent Intrusive Thoughts, Body focussed obsessions.
Rumination is a term often used to describe all obsessional intrusive thoughts, and the definition of rumination perhaps helps encourage that belief “a deep or considered thought about something”, but this is slightly misleading from an OCD context. In the context of OCD a rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive.
Unlike obsessional thoughts, ruminations are not objectionable and are indulged rather than resisted. Many ruminations dwell on religious, philosophical, or metaphysical topics, such as the origins of the universe, life after death, the nature of morality, and so on. One such example might be where a person dwells on the time-consuming question: ‘Is everyone basically good?’.
They would ruminate on this for a long period of time, going over in their mind various considerations and arguments, and contemplating what superficially appeared to them to be compelling evidence.
Dia sometimes thinks she will hurt everyone around her, to counter those scary thoughts she starts joining her hands in prayer everyday for 3 hours.
Sources: https://www.ocduk.org/ocd/types