When OCD Isn’t Obvious: A Guide to Lesser-Known OCD Subtypes

Obsessive-Compulsive Disorder (OCD) is widely recognized for symptoms like excessive handwashing or repeatedly checking locks, but these more visible behaviors don’t capture the full picture. Compulsions such as hand washing are common rituals performed to alleviate anxiety, especially in response to fears of contamination. In addition to these behaviors, many people with OCD experience common obsessions—intrusive thoughts or fears that are widely recognized, such as concerns about contamination, symmetry, or harm—which help define the typical presentation of OCD and contrast with lesser-known subtypes. Many individuals experience lesser-known OCD subtypes that are just as disruptive—if not more—yet frequently go undiagnosed. At the Baltimore Therapy Group, we believe in increasing awareness of these subtypes to reduce stigma and guide people toward meaningful support.

This article explores several rare forms of OCD, how they affect daily life, and what evidence-based treatment options are available.

Key Points

• OCD includes a range of under-recognized subtypes such as Somatic OCD, Harm OCD, Relationship OCD, and others, each presenting unique emotional and behavioral patterns.

• Understanding these lesser-known forms can validate personal experiences, reduce isolation, and encourage treatment. Recognizing risk factors for OCD, such as genetics, childhood experiences, and stress-related events, can also help with early identification and intervention.

• CBT, ERP, and SSRIs are considered first line treatment options and remain the most effective, research-backed treatments for all OCD subtypes. For more information on these therapies, visit the International OCD Foundation.

What Are Lesser-Known OCD Subtypes?

OCD involves unwanted intrusive thoughts (obsessions) and repetitive behaviors (compulsions). These intrusive experiences can include obsessional thoughts, unwanted thoughts, persistent obsession, and distressing mental images, all of which are characteristic of obsessive-compulsive disorder. These thoughts and behaviors vary depending on the focus or theme of the OCD. Some of the more overlooked subtypes include:

• Harm OCD

• Somatic OCD (Sensorimotor OCD)

• Scrupulosity

• Sexual Orientation OCD

• Existential OCD

• False Memory OCD

• Relationship OCD (ROCD)

• Real Event OCD

• Pure-O (Pure Obsessional OCD)

• Suicidal OCD

• Health OCD

• Insanity OCD

• Pedophilia OCD (P-OCD)

• Emetophobia (Fear of vomiting)

These subtypes may overlap with other disorders or be considered a related disorder, and understanding these distinctions is important for accurate diagnosis. Though these subtypes differ in content, they all share the core OCD mechanism of anxiety and compulsive attempts to gain certainty or relief, with compulsions being a type of compulsive behavior.

Related Disorders: What Else Looks Like OCD?

Obsessive-compulsive disorder (OCD) is part of a broader family of mental health disorders that share similar patterns of repetitive behaviors and mental acts. These related disorders include hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and olfactory reference disorder. While each disorder has its own unique features, they all involve persistent thoughts, urges, or images that drive individuals to engage in repetitive behaviors or mental rituals.

Recognizing these related disorders is crucial for accurate diagnosis and effective treatment planning. For example, someone with skin picking or hair pulling may not realize these are part of the obsessive compulsive and related disorders spectrum. Similarly, hoarding disorder and body dysmorphic disorder often involve obsessional thinking and compulsive behaviors that overlap with classic OCD symptoms.

It’s also important to note that people with OCD are at increased risk for developing other anxiety disorders, such as generalized anxiety disorder or panic disorder. These co-occurring mental health disorders can intensify OCD symptoms and complicate treatment. A comprehensive assessment by a mental health professional can help distinguish between OCD and related anxiety disorders, ensuring that individuals receive the most appropriate care for their specific symptoms and behaviors.

Skin Picking and Hair Pulling: The Overlooked Compulsions

Skin picking (excoriation disorder) and hair pulling (trichotillomania) are two compulsive behaviors that often fly under the radar when discussing obsessive compulsive disorder. These disorders involve repetitive actions that can cause significant distress and physical harm. For instance, skin picking can lead to infections, scarring, and even disfigurement, while hair pulling may result in noticeable hair loss, skin irritation, and emotional pain.

Despite their impact, these anxiety disorder behaviors are sometimes dismissed as bad habits rather than recognized as symptoms of a mental disorder. Individuals struggling with skin picking or hair pulling often experience intense anxiety or tension before the behavior, followed by a sense of relief—mirroring the cycle seen in other forms of OCD. The distress caused by these compulsions can affect self-esteem, relationships, and daily functioning.

Treatment for skin picking and hair pulling typically involves cognitive-behavioral therapy (CBT) which helps individuals identify triggers and develop healthier coping strategies. Selective serotonin reuptake inhibitors (SSRIs) are also commonly prescribed, as they can reduce symptoms of anxiety and depression that frequently accompany these disorders. Support groups and peer communities can provide additional encouragement and understanding, making recovery more attainable.

A Closer Look at These Subtypes

Pedophilia OCD (P-OCD)

This form involves intrusive, unwanted sexual thoughts about children, which may include distressing mental images and obsessional thoughts. These thoughts are ego-dystonic—meaning they go against the person’s values and desires—and cause intense anxiety. Avoidance of children or repeated mental checking, a type of compulsion, are common responses.

Somatic OCD

This subtype focuses on bodily sensations such as breathing, swallowing, or blinking. People become hyperaware of these automatic processes and may fear they’ll never stop noticing them, leading to constant distraction and distress. This can lead to compulsive behavior, such as repeated checking or monitoring of bodily sensations, as individuals attempt to reduce their anxiety or prevent negative outcomes.

Existential OCD

Centered on big, philosophical questions—such as the meaning of life or reality itself—this subtype leads to obsessive rumination and uncertainty, driven by persistent obsession and unpleasant thoughts about existential questions. These thoughts may feel endless and unresolved, contributing to anxiety and disconnection.

Scrupulosity

This OCD subtype revolves around moral or religious fears. It is important to distinguish between normal religious practices which are positive and functional, and compulsive rituals driven by OCD, which are performed to reduce anxiety and can be disruptive. A person may obsess over whether they’ve sinned, prayed “correctly,” or offended others. This can lead to excessive praying, confessing, or moral reassurance-seeking.

Suicidal OCD

People with this subtype experience terrifying intrusive thoughts about harming themselves, which are examples of obsessive fears and unpleasant thoughts, despite having no intention or desire to do so. They may avoid potentially dangerous objects or environments and engage in constant mental checking.

Sexual Orientation OCD

This form involves intrusive doubts about one’s sexual orientation, which are often experienced as obsessional thoughts. The uncertainty can cause intense anxiety, and compulsions often involve reassurance-seeking or avoiding situations that trigger doubt, both of which are forms of compulsive behavior.

False Memory OCD

This subtype is marked by obsessive doubt about past actions, which may involve persistent obsession, unwanted thoughts, and distressing mental images. Individuals worry they may have done something terrible, even if there’s no evidence. They may mentally replay events repeatedly or ask others for validation.

Real Event OCD

Unlike False Memory OCD, this form focuses on real but often minor past events. The individual obsesses over what they did, often driven by obsessive fears and obsessional thoughts about moral failings, and experiences guilt, shame, and fear of judgment.

Insanity OCD

Individuals with this subtype fear they are losing their minds or developing a severe mental illness, including concerns about developing mental disorders or other disorders. They may constantly monitor themselves for signs of psychosis or repeatedly seek reassurance from others about their mental state.

Relationship OCD (ROCD)

This subtype involves persistent doubts about a current relationship. People may fixate on their partner’s traits or question whether they’re truly in love, leading to distress and frequent rumination. These symptoms can also impact social situations and interactions.

Pure Obsessional OCD (Pure-O)

Unlike other subtypes with visible compulsions, Pure-O is dominated by mental rituals like ruminating or silently reassuring oneself, which may include intrusive mental images and compulsive behavior that are not outwardly visible. These internal cycles are just as disruptive as physical compulsions.

Health OCD

Similar to illness anxiety disorder, Health OCD involves intrusive fears about having a serious illness, which are examples of obsessive fears and unpleasant thoughts. Repeated body-checking, internet research, and doctor visits are common compulsive behaviors.

Emetophobia (Vomiting OCD)

A lesser-known OCD subtype, emetophobia centers on the fear of vomiting, where certain situations or foods can trigger obsessions related to illness. Individuals may engage in avoidance behaviors, which are a form of compulsive behavior, such as avoiding certain foods, social settings, or travel to prevent the possibility of nausea or illness.

Diagnosis and Assessment: Recognizing the Unseen

Diagnosing obsessive compulsive disorder can be challenging, especially when symptoms are subtle or primarily internal. Many people with OCD experience significant distress from their obsessions and compulsions, even if these symptoms aren’t obvious to others. A thorough diagnostic evaluation is essential to uncover these unseen struggles and provide the right support.

Mental health professionals rely on the criteria outlined in the Diagnostic and Statistical Manual (DSM-5) to diagnose OCD. This includes the presence of obsessions, compulsions, or both, that are time consuming (often taking up more than an hour a day), cause significant distress, and interfere with daily life. The assessment process may involve a physical exam, psychological evaluation, and structured interviews to explore the nature and severity of symptoms.

Standardized tools like the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) are often used to measure the intensity of obsessions and compulsions. Recognizing the full range of OCD symptoms—whether they involve visible behaviors or internal mental acts—ensures that individuals receive an accurate diagnosis and effective treatment plan tailored to their needs.

Pediatric OCD: When the Unusual Starts Young

Obsessive compulsive disorder doesn’t just affect adults—it can begin in childhood or adolescence, sometimes in ways that are easy to overlook. Pediatric OCD may show up as excessive cleaning, checking, or arranging, but these behaviors are often mistaken for being “picky,” “perfectionistic,” or simply part of a child’s personality. In reality, these symptoms can signal a serious mental health disorder that requires attention.

Children with OCD may struggle with anxiety, distress, and disruptions in their daily routines. Early recognition and intervention are key to preventing symptoms from worsening over time. Treatment for pediatric OCD usually involves cognitive-behavioral therapy (CBT) , often with a focus on exposure and response prevention (ERP) . Medication, such as selective serotonin reuptake inhibitors (SSRIs), may also be recommended for moderate to severe cases.

Family members play a vital role in supporting a child with OCD. Encouraging participation in therapy, like family therapy, providing emotional support, and helping children practice coping skills can make a significant difference in treatment outcomes. With the right support, children and adolescents can learn to manage their OCD symptoms and lead fulfilling lives.

Why These Forms of OCD Are Overlooked

Lesser-known OCD types often escape recognition for several reasons:

• Many individuals conceal their symptoms due to shame or fear of being misunderstood.

• Mental health professionals may not always receive training on these subtypes, resulting in misdiagnosis.

• Lack of public knowledge about the diverse forms of OCD leads to stigma and underreporting.

The prevalence of these subtypes may be higher than in the general population due to specific risk factors, such as genetics, childhood experiences, and stress-related events, which can contribute to their development and underrecognition. According to some studies, it can take over a decade for someone with OCD to receive an accurate diagnosis. This delay has serious consequences on mental health and quality of life.

Effective Treatment for All OCD Subtypes

At the Baltimore Therapy Group, we use evidence-based approaches to help individuals manage every form of OCD, no matter how uncommon. Treating OCD effectively involves a combination of targeted therapies and, for moderate to severe OCD, first line medications such as SSRIs are typically recommended. Severe OCD may require more intensive interventions, including a combination of medication and specialized psychotherapy.

Cognitive Behavioral Therapy (CBT)

CBT targets the distorted thinking patterns that drive OCD. Clients learn how to challenge unhelpful beliefs and reduce anxiety by changing how they respond to obsessions. CBT also helps individuals resist ritualistic behaviors, even when a person feels driven or OCD feel driven to perform them.

Exposure and Response Prevention (ERP)

ERP is considered the gold standard for OCD treatment. It involves gradual exposure to triggering thoughts or situations while resisting the urge to perform compulsions, including resisting ritualistic behaviors even when fearing a terrible happening. Over time, anxiety decreases and confidence grows.

Medication: SSRIs

Selective serotonin reuptake inhibitor (SSRI) medications like fluoxetine and sertraline are commonly used to treat OCD. According to guidelines from the National Institute for Health and Care Excellence (NICE) and the American Psychiatric Association, SSRIs are considered first line medications for OCD, especially in pediatric cases, as they regulate brain chemistry and reduce the frequency and intensity of obsessive thoughts and compulsions.

When combined, CBT, ERP, and SSRIs offer a powerful toolkit for long-term OCD recovery.

Managing Life with a Rare OCD Subtype

Living with an uncommon OCD subtype can be isolating, but it doesn’t have to be. While most people may experience occasional intrusive thoughts, those with rare OCD subtypes might spend up to eight hours a day on compulsions, which can significantly impact daily life. Connecting with others, establishing a daily routine, and practicing mindfulness can make a meaningful difference. Support groups, therapy, and trusted relationships provide much-needed validation and encouragement.

At the Baltimore Therapy Group, we’re committed to helping individuals find clarity and relief—whether their OCD is widely recognized or falls outside the norm.

Advocacy and Research: Finding Your Voice and Community

Advocacy and research are powerful tools in the fight to improve understanding and treatment of obsessive compulsive disorder and related mental health disorders. Organizations like the International OCD Foundation (IOCDF) offer education, resources, and support for individuals with OCD and their families, helping to reduce stigma and promote access to effective treatment.

Getting involved in advocacy—whether by joining support groups, participating in online communities, or attending conferences—can help individuals find their voice and connect with others who share similar experiences. Sharing personal stories and supporting policy changes can lead to greater awareness and acceptance of mental health disorders.

Research is equally important, driving the development of new treatments and deepening our understanding of the causes and mechanisms behind OCD and related disorders. By participating in research studies or supporting organizations that fund scientific work, individuals can contribute to better outcomes for everyone affected by these conditions. Together, advocacy and research pave the way for a future where mental health is prioritized and everyone has access to the care they need.

Final Thoughts

Every OCD experience is valid, even when it doesn’t fit the typical mold. The lesser-known subtypes can be just as debilitating as the more familiar ones, but they’re also just as treatable. With proper care and support, healing is absolutely possible.

If you or someone you love is struggling with OCD in any form, know that help is available. Reach out to the Baltimore Therapy Group to start a journey toward better understanding, less anxiety, and greater control.

Frequently Asked Questions

What are some uncommon types of OCD?

Examples include Pedophilia OCD, Existential OCD, Real Event OCD, and Scrupulosity. These forms involve obsessions and compulsions that aren’t always visible but can cause significant emotional distress. Some uncommon OCD types may be mistaken for a related disorder or other disorders, so accurate diagnosis by a mental health professional is important.

Is ERP effective for all OCD subtypes?

Yes. ERP is highly adaptable and effective across OCD variations. The specific exposures and compulsions addressed may differ, but the framework remains reliable. ERP specifically targets ritualistic behaviors associated with OCD, helping individuals gradually face feared situations while resisting these rituals to reduce anxiety and challenge obsessive thoughts.

Can medication help with rare OCD symptoms?

Yes. Selective serotonin reuptake inhibitor (SSRI) medications are often prescribed to help manage obsessive thoughts and compulsions. When combined with therapy, such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP), they can significantly improve outcomes.