Table of Contents

The 4 Types of OCD

Clinically Reviewed by: Dr. Robin Campbell, LMFT, PHD

Obsessive-Compulsive Disorder (OCD) is a complex and often misunderstood condition, affecting both teens and adults with a variety of symptoms that can significantly impact daily life. New Hope Healthcare Institute in Knoxville, TN, specializes in dual diagnosis treatment, addressing both the mental health condition and any co-occurring disorders, providing a holistic approach to recovery. In this detailed guide, we will explore the four main types of OCD, offering insights into how each manifests and how they can be managed. With this knowledge, individuals and families can better understand the condition and take the first step towards healing.

What Is OCD

OCD is characterized by a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress. The main points to understand include:

  • OCD is not just about cleanliness or orderliness; it’s a multifaceted disorder with a range of symptoms.
  • Early recognition and treatment are crucial for managing OCD effectively.
  • Treatment approaches need to be tailored to the individual, as each type of OCD presents unique challenges.

The Four Types of OCD

1. Contamination Obsessions with Cleaning Compulsions

This type involves an intense fear of germs, dirt, or becoming contaminated in some way. It’s often what people first think of when they hear “OCD.”

  • Symptoms: Excessive washing and cleaning, avoidance of touching surfaces, and extreme hygiene practices.
  • Management: Treatment often includes Exposure and Response Prevention (ERP), a type of Cognitive Behavioral Therapy (CBT) that exposes individuals to their fear in a controlled environment, helping them gradually reduce their compulsive behaviors.

2. Symmetry and Ordering

A need for things to be perfectly arranged or symmetrical. Individuals with this type of OCD experience extreme discomfort when objects are out of order or asymmetrical.

  • Symptoms: Compulsive arranging, straightening, and the need to ensure everything follows a specific order or pattern.
  • Management: Similar to contamination OCD, ERP therapy plays a crucial role, along with strategies to tolerate discomfort and reduce the need for symmetry.

3. Forbidden Thoughts

This type involves unwanted, intrusive thoughts of a violent, sexual, or religious nature that are distressing to the individual.

  • Symptoms: Fear of acting on unwanted thoughts, avoiding situations related to these thoughts, and seeking reassurance.
  • Management: Treatment focuses on Acceptance and Commitment Therapy (ACT) and ERP, helping individuals to accept their thoughts without judgment and reduce compulsive behaviors.

4. Hoarding

Difficulty discarding items regardless of their actual value, driven by a fear of losing something important.

  • Symptoms: Accumulation of items to the point of clutter, distress at the thought of getting rid of items, and significant impairment in daily functioning.
  • Management: Cognitive Behavioral Therapy (CBT) tailored to hoarding behavior, often involves building decision-making skills and gradually reducing the compulsion to save items.

OCD Management Strategies

Contamination Obsessions with Cleaning Compulsions

  • ERP in Action: At New Hope Healthcare Institute, ERP for contamination OCD involves gradual exposure to the feared contaminants in a safe and controlled manner, under the guidance of a therapist. This might start with touching a doorknob and refraining from washing hands immediately, gradually increasing exposure to more feared items.
  • Supportive Therapies: Alongside ERP, supportive therapies may include stress management techniques and education about contamination to challenge and change the irrational beliefs driving the compulsions.

Symmetry and Ordering

  • Tailored ERP: For individuals struggling with a need for symmetry and ordering, ERP is customized to confront these specific compulsions. This might involve intentionally placing items asymmetrically and learning to tolerate the discomfort without correcting them.
  • Cognitive Strategies: Cognitive strategies are employed to address the underlying perfectionism and fear of disorder, helping individuals to gradually accept imperfection and reduce their compulsive behaviors.

Forbidden Thoughts

  • ACT and ERP Combination: Treatment for forbidden thoughts typically combines ACT with ERP, focusing on accepting the presence of these thoughts without engaging with them or performing compulsive rituals. This approach helps to reduce the shame and anxiety associated with such thoughts.
  • Mindfulness-Based Therapies: Mindfulness practices are often integrated into treatment, helping individuals to observe their thoughts without judgment and to focus on the present moment, rather than getting caught up in the content of the thoughts.


  • CBT for Hoarding: CBT for hoarding focuses on addressing the thoughts and beliefs about the need to save items and the difficulty in discarding them. This involves practical exercises to declutter, decision-making strategies, and exposure to discarding items while managing the anxiety it provokes.
  • Motivational Interviewing: Given the ambivalence often felt by individuals with hoarding disorder, motivational interviewing can be an effective strategy to enhance motivation and commitment to change.

Why Choose New Hope Healthcare Institute?

At New Hope Healthcare Institute, we understand the complexity of OCD and the courage it takes to seek help. Our dual diagnosis treatment approach ensures that both the OCD and any co-occurring conditions are addressed, providing a comprehensive treatment plan tailored to each individual’s needs. With our expert team and supportive environment, we are dedicated to guiding you or your loved one on the path to recovery.

If you or someone you know is struggling with OCD, New Hope Healthcare Institute is here to help. Our team of professionals is committed to providing compassionate care and personalized treatment plans. Reach out today at 866-806-1027 to take the first step towards healing and regain control over your life.


OCD is a chronic disorder that typically requires professional treatment to manage symptoms. While symptoms may fluctuate over time, seeking treatment is essential for long-term improvement.

Medication can be an effective part of treatment for many individuals with OCD, especially when combined with therapy. However, treatment plans are personalized, and decisions about medication are made on a case-by-case basis.

The length of treatment varies depending on the individual and the severity of their symptoms.

Yes, children can develop OCD, often showing symptoms around puberty, but it can occur in younger children as well. Early intervention is crucial to managing the condition effectively.

OCD can range from mild to severe, affecting individuals differently. The severity can also fluctuate over time, influenced by stress and other factors. Personalized treatment plans at New Hope Healthcare Institute are designed to address the specific severity and needs of each individual.

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