Case study by Ufuoma Onemu

To mark OCD Awareness Week, Ufuoma Onemu explores some of the rarer subtypes of obsessive compulsive disorder, and the psychological elements that cause them.

When most people think of obsessive compulsive disorder (OCD), their thoughts automatically drift to people washing their hands multiple times or having a strong desire to arrange items in a particular order. In fact, the association of symptoms like these with the disorder is now so strong that many people use the term "OCD" almost as a personality trait.

Although these are indeed symptoms of common OCD subtypes, using ‘OCD’ as an adjective to describe our own behaviours or the behaviours of others can downplay the intensity of the disorder and the degree to which it can disrupt daily life.

OCD is a serious disorder that can interfere with a person’s ability to carry out their normal daily activities. It is characterised by intrusive, uncontrollable thoughts (obsessions) and/or distressing sensations that often lead to repetitive behaviours (compulsions) that result from a person's need to manage their distress or reduce obsessions. Compulsions and obsessions can be so strong that people living with the condition arrange their lives around appeasing their thoughts and methods of dealing with them, significantly affecting everyday living and their quality of life.

Another aspect of OCD that is heavily misunderstood is that there are many different subtypes of it, each driven by particular types of obsessions and with their own distinct underlying psychological characteristics.

Somatic obsessions/Body hyperawareness

People dealing with somatic obsessions are excessively aware of their body parts, bodily functions and/or sensations such as swallowing, blinking, being full after eating, urinating, defecating, breathing, the position of their bodies, and their heartbeat. People who live with this form of OCD have intrusive thoughts revolving around their body parts or functions.

For instance, a person may constantly wonder if their heart is working as it should be. Is it pumping enough blood to other parts of the body? Is it beating faster or slower than it should? These thoughts may lead to compulsive actions such as getting their heart checked every week at the hospital. This form of obsession is also called somatoform or sensorimotor obsessions.

Existential obsessions

Who am I? What is the purpose of my existence on Earth? Does life have any meaning?

Apart from philosophers, regular people sometimes ponder on these questions and can stop thinking about such thoughts even without arriving at a conclusive answer.

In people with OCD, existential obsessions focus on the meaning or purpose of one’s life and the person is unable to stop thinking about their life and its meaning. Distress may set in if these questions and thoughts don’t result in conclusive and satisfying answers.

This form of OCD may also revolve around death and what happens when people die.

Emotional contamination

Have you ever been worried about becoming too much like another person? People with this form of OCD have a fear of becoming contaminated with the personality traits of another person. They believe that specific people or places can contaminate their own being and personality negatively. For instance, a person may be afraid of passing a place where they had an accident because they don't want to be contaminated with bad vibes.

Responsibility obsessions

Remember when your mum left you in charge of something for the first time? Remember how worried you were that you couldn't live up to the responsibility? That niggling fear probably abated the moment you got the hang of the task. But for people with responsibility obsessions, this fear never fades.

Individuals with these obsessions have intrusive thoughts about harming others or creating severe problems because they were not careful enough. They are constantly worried about causing a fire, a car accident, or being responsible for events that lead to another person being hurt.

Morality obsessions

Have you ever said something to someone or in a social gathering and spent the night worrying about it? Did I offend someone? Did I come across as mean? Or you might have had to make a decision about something concerning you and other people and you might worry if you came across as unkind or selfish. Does this decision make me a good or bad person? These thoughts fade after a while and we forget about them.

For a person with OCD, these thoughts don’t naturally resolve, rather, they escalate.

This subtype of OCD manifests as a deep worry about the morality of the decisions they make. The person starts thinking about the consequences or morality of their actions. They are constantly scared that every decision they make is the wrong one or that they are not good people. This form of OCD is not limited to people with religious beliefs – anybody who has a moral compass that guides their actions can experience this form of OCD.

Relationship obsessions

Is he/she really the one? This is a question we have all asked ourselves a couple of times, but for people with this subtype of OCD, this question can result in severe distress. Relationship obsessions manifest as a deep preoccupation with the compatibility of their partner with themselves, their attractiveness, and if their partner is the right one for them. This form of obsession can even occur in healthy relationships and create problems for the couple.

OCD is a more diverse condition than you might think

OCD is a severe disorder that often disrupts a person's ability to function optimally. Repetitive hand washing, obsessive organisation habits, and sexual obsessions are some of the common subtypes and symptoms of OCD. But uncommon subtypes such as a fear of responsibility also exist. These subtypes may not be as easy to recognise but they create just as many difficulties for the individual.

Useful links:

• International OCD Foundation – About OCD

• OCD UK – Overcoming OCD

• OCD Action – Learn about OCD