Potentially controversial blog post ahead! But hear me out!
I can’t tell you how many times in online support groups I have seen people counting and listing all the different “types” of OCD they have. They sound overwhelmed that they have so many subtypes, whereas others may have just one of two types of OCD. They also don’t seem to know where to begin in treatment, or they wonder if treatment will even work for them since they have so many subtypes.
For a while, I’ve had mixed feelings about labeling the different types of OCD as a whole, or even making a distinction between “regular OCD” and “pure OCD.” I see both benefits and drawbacks to where the labeling can lead when not fully understood by the community.
I do see some purpose in labeling “subtypes” of OCD because this can be useful for rapidly communicating with OCD specialists and others in the OCD community about what intrusive thoughts you are experiencing. When you say ROCD, most everyone in the community knows that you are talking about relationship OCD. Subtype labels can also be helpful for taboo intrusive thoughts, such as POCD (fear of being a pedophile), which can be understandably difficult to disclose and talk about, even within the community. Other subtype labels include contamination OCD, sexual orientation OCD, scrupulosity OCD, and so on. These subtype labels can also be used to build a sense of community. I get that.
Still, I can’t help but find counting and listing all the different types of OCD you have problematic, or even harmful to the person labeling themselves with so many types of OCD. It creates an illusion that the different categories of intrusive thoughts are somehow actually different from each other. In reality, they are all OCD, they are all intrusive thoughts, and they are all an underlying fear of uncertainty. Over-identifying with subtype labels also creates a false picture that content matters in the treatment of OCD, when most OCD specialists would tell you that content is irrelevant. ERP therapy, sometimes in combination with medication, is still the research-supported, gold-standard treatment for OCD. Yes, you use the content of the thoughts and compulsions to build the exposures, but all “types” of OCD can be treated with ERP. Even Pure O can be treated with ERP.
When I was diagnosed with OCD, I did take the time to list out all of my obsessions and compulsions, so I could target them in ERP therapy. I found in useful to in a way organize my thoughts, bring the list to therapy, and then create exposure hierarchies and plans. And in recovery, I do occasionally label my intrusive thoughts by their subtype names, such as ROCD or existential OCD. But I never labeled myself as being diagnosed with ROCD, existential OCD, and countless other types of OCD. I sum them all up with an overarching diagnosis of OCD.
If anything, I jokingly say that because I studied evolutionary biology in college, I have the evolving type of OCD. Others call it “whack-a-mole” because it can feel like as soon as you work on one type of OCD, another pops up. My OCD’s focus has constantly shifted over the years, even as a child long before I knew I had OCD. In my twenty some years of having OCD, I’ve experienced probably over a hundred different “themes”, “subtypes”, or as I like to call them “flavors” of OCD. If I had treated each of these as a separate issue, I would have been understandably even more overwhelmed by OCD’s grip on my life. In treatment, we still had to pick which themes and exposures to work on first, but the focus was on which compulsions were causing the biggest impact in my life.
My goal is not to invalidate others with OCD, especially those who have just discovered the diagnosis or that there are countless others out there experiencing the same thoughts, compulsions, and “subtypes.” There is so much to be gained from connecting with others. My goal is to warn you that I don’t think it is productive to count how many types of OCD you have or have experienced. This can lead to a fear of treatment or comparing “who is sicker” or being even more overwhelmed with a diagnosis of OCD. OCD can be overwhelming enough as it is, and I only want the best for our community.
Awesome, related video from a friend!
I love feedback like this. It means a lot that it helps others!
Love this! As a person with anxiety, there are also a lot of subtypes, such agoraphobia, but over all it’s still anxiety. You are correct in saying that over time your mental illness can change. When I first started college, I was diagnosed with ocd, but my current doc believes it’s just anxiety with a few ocd tendencies. This was helpful to read, so thanks!
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Your form of OCD may, in fact, be subclinical. Has a therapist ever assessed you using the YBOCS, OCD-R, OBQ, or another similar assessment test to see where you might fall on the OCD continuum? Many of these tests are available online and can be self-administered.
I think this is a very valid point. My main problem is with the idea or even word “sub-type”. There in itself it poses a problem; it’s a very mis-leading word. Personally “theme” works best for me, and yes I too have used “flavour at times”. It is thought pieces, and discussions like this, that help to inform or remind people that OCD is just that… and whatever the theme, it’s the same shit going on in that monkey-mind! Hence the treatment is the same, but one’s discussion or exposures will differ according to what you believe about yourself (or not) on any given day! I say that because, for me, it can shift daily, hourly, monthly, yearly… depending on how “anxious” I am. Different situations may trigger different themes. Who knows! It’s just essential to work out which is the obsession and which is the compulsion, and if you can see both… you’re probably suffering. (sorry… went on bit long)
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