A Deeper Dive into the Complexities of Obsessive Compulsive Disorder (OCD)

What is Obsessive-Compulsive Disorder (OCD)?

OCD is a chronic mental health condition characterized by intrusive and repetitive thoughts, images, or impulses (obsessions) that lead to compulsive behaviours or mental acts. These obsessions can be distressing, time-consuming, and interfere with daily activities.

In Australia, OCD is a prevalent condition, affecting approximately 2-3% of the population. Recent statistics indicate that more than 500,000 Australians suffer from this disorder, and this number is expected to grow significantly over the coming years.

How Do I Know If I Have OCD?

OCD can manifest in different forms, and its symptoms can vary from person to person. Some common OCD themes and their symptoms include:

1. Pure O:

Pure Obsessional OCD (or Pure O), is a form of OCD characterized by recurrent, persistent, intrusive thoughts or images or urges without any visible physical compulsions. These thoughts can be distressing, violent, or sexually explicit, and often lead to significant anxiety and avoidance behaviours. Pure O essentially means that the obsessions don’t produce ‘outwardly observable’ compulsions. This is not the same thing as not having compulsions, but rather that these compulsions occur internally.

Real-life example:

A person may experience reoccurring thoughts that they have done a harm to someone or contracted a terminal illness, leading to intense anxiety and distress.

2. Harm OCD:

Harm OCD is a form of OCD that involves excessive fear about causing harm to others or themselves, despite having no intention or desire to do so. Almost everyone has had thoughts about harming someone for example someone cutting you off when in traffic and you imagine running them off the road. However, people with Harm OCD continuously experience intrusive and disturbing thoughts or images of violence or harm, leading to avoidance behaviours and extreme anxiety.

Real-life example:

A person may be constantly afraid of accidentally causing harm to a loved one such as seeing knives in the kitchen and imagining stabbing your loved ones; or imagining  about forgetting to put the handbrake on and your car rolling down a hill and killing someone.

3. Relationship OCD:

Relationship OCD, also known as ROCD, is a form of OCD characterized by excessive doubt and uncertainty about their romantic relationship. Everyone has doubts if they are in the right relationship, if there is someone better for them out there, or if they are making a mistake. However, these thoughts are constant for OCD sufferers, and can make it impossible for sufferers to actually enjoy their relationship. People with ROCD often experience intrusive thoughts and images related to their partner’s trustworthiness, compatibility, or attraction.

Real-life example:

A person may constantly question their feelings towards their partner, leading to constant reassurance seeking and relationship dissatisfaction such as OCD sufferers obsess over these questions:  is this the right person for me?; is this a true love?; or is there someone better for me out there?; or am I attracted to my partner?; or do our personalities fit each other?; or is my partner a good person?

4. Sexual Orientation OCD:

Sexual Orientation OCD, also known as SO-OCD or Homosexual Obsessive Compulsive Disorder (HOCD), is a form of OCD that involves persistent and unwanted doubts about their sexuality. Most people have at some point explored or questioned their sexuality, and may have had sexual thoughts that don’t align with their identity. However, individuals with HOCD experience persistent doubts about their sexual orientation and interpret any evidence against their self-identified orientation as evidence that they are lying to themselves. Consequently, they often engage in a frantic search for reassurance and certainty.

Real-life example:

A male sufferer may notice an attractive man at the beach and immediately feels a sensation in his groin; or a woman notices that her female friend is attractive and obsesses about whether she would want to have sex with her; or a sufferers may purposely fantasize about having sex with someone of the opposite sex in an attempt to prove to themselves that they’re still straight.

5. Paedophilia OCD:

Paedophilia OCD, also known as POCD, is a form of OCD characterized by recurrent and intrusive thoughts about either being or becoming a paedophile. POCD sufferers often experience intense anxiety and distress related to their thoughts and fears of harming children, despite having no desire or intent of harming children.

Real-life example:

A person may have intrusive thoughts or images of sexually abusing a child; or a mother may get an intrusive thought of I could rub my child’s genitals, and then compulsively imagine this act to ensure they are adequately repulsed by the idea and therefore not a paedophile; or a POCD sufferer may notice an 11-year-old boy as “handsome”, and become convinced that this is evidence of their paedophilia.

6. Religious OCD:

Religious OCD, also known as Scrupulosity, is a form of OCD characterized by recurrent and intrusive thoughts about religion or God. It’s common for all religious followers to fall short of the expectations of their faith, just as non-religious individuals may fall short of their own moral beliefs. However, for those with Religious OCD, these failures, whether real or imagined, are magnified and lead to an intense desire for purity and perfection.

Real-life example:

A person may feel guilty for not following certain religious rituals or beliefs, leading to excessive and repetitive behaviours to compensate for their perceived wrongdoing.

7. Moral Scrupulosity/Real Event OCD:

Moral Scrupulosity, also known as Real Event OCD, is a form of OCD characterized by recurrent and intrusive thoughts related to past moral or ethical transgressions. People with Real Event OCD obsesses over a past action(s) that induces feelings of extreme guilt, shame, and a self-doubt, leading to repetitive behaviours and avoidance.

Real-life example:

A person may feel guilty for past mistakes, such as cheating or lying, leading to excessive rumination and repetitive behaviours to seek forgiveness or compensation.

8. Contamination OCD:

Contamination OCD is a form of OCD characterized by excessive fear over the possibility of becoming contaminated by germs or getting sick. While it’s normal to be cautious about personal hygiene and avoiding sickness, for those with Contamination OCD, these thoughts become constant and debilitating.

Real-life example:

A person may avoid public places or objects, such as doorknobs or public restrooms, due to fear of germs and contamination; or washing hands before eating to avoid contamination, but doing it fifty times; or a sufferer may avoid eating at restaurants, worried that the chef might have accidentally transferred a deadly disease while preparing the food.

9. Existential OCD:

Existential OCD is a form of OCD characterized by recurrent and intrusive thoughts related to existential questions and concerns. While everyone ponders these questions at some point in their lives, from those who contemplate them late at night to those who pursue degrees in philosophy, however, for individuals with existential OCD, these questions become all-consuming and debilitating. People with Existential OCD often experience significant anxiety and distress related to their thoughts and fears about death, the meaning of life, and the universe’s nature.

Real-life example:

A person may constantly question the purpose of their life or the universe such as what is the purpose of life?; or how can we be certain that our experiences are real?; or does human existence even matter?

10. Somatic OCD:

Somatic OCD, also known as Hyper-awareness OCD/Sensorimotor OCD, is a form of OCD characterized by excessive worry and preoccupation with bodily sensations or functions. While we may all occasionally think about our breathing or blinking, however, for those with Somatic OCD, these thoughts can be crippling and often lead to fears that this awareness of bodily processes will become permanent.

Real-life example:

A person may constantly worry about their health or bodily functions, leading them to engage in excessive checking behaviours such as obsessing over the positioning of body parts or external stimuli like different noises such as cicadas in the background or white noise at a coffee shop.

Can OCD Be Cured?

While there is no known cure for Obsessive-Compulsive Disorder (OCD), it is possible to manage symptoms effectively with treatment. With OCD being a chronic condition, there is a possibility that symptoms may return, but it is important to remember that while there is no guaranteed cure for OCD, managing symptoms through proper treatment and therapy can lead to better outcomes and improved quality of life.

What Are the Most Effective Treatments for OCD?

The most effective treatments for OCD are Cognitive Behaviour Therapy (CBT) and/or medication. More specifically, the most effective treatments are a type of CBT called Exposure and Response Prevention (ERP), which has the strongest evidence supporting it’s use in the treatment of OCD, and/or a class of medications called selective serotonin reuptake inhibitors, or SSRIs which can help reduce OCD symptoms in some people.

Taken together, ERP and medication are considered the “first-line” treatments for OCD. In other words, about 70% of people will benefit from ERP and/or medication for their OCD.

How Does a Psychologist Help with OCD?

In Australia, Psychologists are trained mental health professionals who specialize in diagnosing and treating various mental health conditions, including OCD. A psychologist can help individuals with OCD by:

  • Conducting a comprehensive assessment of their symptoms and diagnosing OCD.
  • Developing a personalized treatment plan that may include therapy such as:
  • Cognitive-behavioural therapy (CBT): a type of therapy that helps people identify and modify their thoughts and behaviours related to OCD. CBT is a highly effective treatment for OCD, with up to 60-80% of people experiencing significant symptom improvement.
  • Exposure and Response Prevention (ERP): a type of CBT that involves gradually exposing people to their feared situations or triggers and teaching them to resist the urge to perform compulsive behaviours.
  • Providing ongoing support and guidance throughout the treatment process.
  • Teaching coping strategies and techniques to manage OCD symptoms.
  • Working with the individual to identify and address any underlying issues that may be contributing to their OCD symptoms


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Australian Psychological Society. (2019). Clinical practice guideline for the treatment of obsessive-compulsive disorder.

OCD Australia. (2021). OCD themes. https://www.ocdaus.org/ocd-themes/

National Institute of Mental Health. (2021). Obsessive-compulsive disorder. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

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