Understanding OCD: Common Subtypes and How ERP Therapy Can Help
What Is OCD?
Obsessive-Compulsive Disorder is one of the most talked about disorders in pop-culture, but not many people truly understand what OCD is. OCD is defined by the presence of obsessions (persistent, unwanted, distressing thoughts/urges) and/or compulsions (repetitive behaviors/mental acts performed to reduce distress) that are time-consuming (e.g., more than one hour per day) or cause significant impairment in daily life (APA, 2013).
In basic terms, this disorder consists of a cycle of obsessions → anxiety → compulsions → temporary relief → reinforcement. So no, your impeccable cleanliness and liking for things being organized does not mean you have OCD. But, if this cycle sounds familiar, there is relief through evidence-based therapy.
Common Subtypes of OCD
The most common image people have of someone with OCD is a neat freak or type A person - but there are many common themes in which OCD presents itself (even more than the list below). The most common ones are:
Contamination OCD
Fear of germs, uncleanliness, or toxins
Common compulsions: excessive showering or washing hands, avoiding public places
Harm OCD
Fear of hurting someone else or oneself
Common compulsions: double checking, seeking reassurance and avoidance of anxiety-producing situations
Hit and Run OCD
A highly common sub-type of Harm OCD focused solely on hurting someone while driving
Common compulsions: double checking mirrors, doubling back, avoiding driving
Pure O (primarily obsessional) OCD
Intrusive thoughts, often related to identity and values
Common compulsions: the compulsions are internal such as rumination and “figuring things out”
Health Anxiety / Somatic OCD
Recurring thoughts about having a disease or being ill
Common compulsions: Googling symptoms, seeking medical reassurance, checking how your body feels or looks
Why OCD Feels So Convincing
Everyone has intrusive thoughts, typically they come and go with little notice or response to them. However, for those with OCD, the intrusive thoughts stick around, latch on to one’s identity and sense of self and cause real fear. Thoughts and actions are often fused together - for example, someone with OCD believes “If I think this, it must be true” or “If I had that thought, it must mean something about me”.
While OCD presents itself in many different themes, the common underlying issue is intolerance of uncertainty. People with OCD seek certainty, which is why so many compulsions are about seeking reassurance, whether it be about a situation or their own identity.
The brain’s false-alarm system is hypervigilant with OCD - the brain senses a threat (an intrusive thought) and immediately reacts (compulsion), seeking clarity and safety. The tricky part about OCD, is that the compulsions often provide a temporary relief of anxiety, tricking the brain into thinking they “worked”, so the brain falls into a cycle of obsessions → anxiety → compulsions → temporary relief → reinforcement.
So how does one break the cycle?
What Is ERP Therapy?
Exposure Response Prevention is the gold-standard, evidence based treatment model for OCD. ERP helps someone face fears in a manageable, step-by-step method alongside a trained counselor. This technique trains the brain to ride the wave of anxiety, resetting the overactive alarm system that was causing compulsions.
Exposure: gradual exposure to anxiety producing situations
Starts off with the least frightening scenario and builds as one gains confidence
Response Prevention: not doing the compulsion, instead learning to tolerate anxiety and uncertainty
Teaches the brain, this is not actually dangerous
ERP always focuses on the same tasks:
Face the fear (in a safe environment)
Do NOT do the compulsion
Tolerate uncertainty
The intrusive thoughts are not “fixed” or “eliminated”, instead the client is able to manage them without compulsions.
Common Misconceptions About ERP
Fears around ERP include:
“ERP will be too intense” -> The pace is set between you and the counselor
“It will make anxiety worse” -> Anxiety increases short term, but decreases long term
“I need the thoughts to go away” -> The goal is changing the relationship to the thoughts rather than the thoughts going away completely
Facing fears can be scary, but with the help of a trained professional, it is completely safe and possible.
Click here to learn more about ERP.
When to Seek Help for OCD
OCD gets in the way of living daily life in many ways including:
Spending +1 hour a day acting on compulsions
Avoiding situations due to fear
Constantly seeking reassurance from others, the internet or yourself
If the OCD cycle of thoughts, anxiety, and compulsions is seeming all too familiar, support is available through experienced professionals who understand what it's like. ERP is a specialty of CBT and works across all subtypes of OCD. Counselors collaborate with clients to individualize treatment exactly to their specific thoughts and compulsions.
If you are ready for a change, contact our office to schedule an appointment.