What are the 4 Types of OCD

Obsessive-Compulsive Disorder, also known as OCD, is more common in children than many parents realize, and it often shows up in ways that can be confusing or even easy to miss. For parents, noticing these behaviors, especially if they seem like simple quirks or routines, can be difficult.

I once worked with a parent whose kid has a bedtime ritual of checking under the bed and in the closet repeatedly before settling down for sleep and another midschooler who repeatedly seeks reassurance by asking the same question over and over, unable to feel at ease. Obsessive Compulsive Disorder can manifest in various ways, presenting through different behaviors. While these obsessions and compulsions may seem like quirks, they’re actually coping mechanisms for an overactive, dysregulated nervous system.

OCD is not just a phase or a collection of harmless habits or obsessive fear; it’s an actual mental health condition that affects how the brain responds to stress and emotions. Recognizing these patterns can empower you to help your child find calm and move toward healing.

The OCD brain forms a negative association between the behavior and the worry or anxiety temporarily decreasing. The more the behavior happens, the more obsessions and compulsions occur because of this negative habituation.

In that way, these behaviors decrease their worries and feelings of distress, albeit temporarily. OCD manifests itself in different ways for every child or teen, but at its core is a fear of worry actually happening, and that is what drives their obsessive thinking and compulsions.

Obsessions are thoughts that interrupt a person’s life. These obsessive thoughts often include persistent and disruptive mental images that can be difficult to control. It makes a person very upset or anxious to the point that they spend a considerable amount of time every day in obsessive thought to the point that they can no longer do their everyday tasks. Many people with OCD know that these thoughts aren’t real. Even so, they still feel distressed about it, thinking that they could make it happen.

Compulsions or compulsive rituals are things that children with OCD do in response to their obsessions. To counter these unwanted thoughts, they feel the urge to do something to reduce their anxiousness around these worries and obsessive fear. These actions and behaviors subsequently develop into their compulsions.

Children and young adults with OCD feel that they must keep repeating these compulsions to make their anxiousness disappear, even if they don’t like doing them. These become rituals. As a result, they spend one or more hours a day doing repetitive things.

They can carry out these compulsions for hours because doing so takes their minds off their anxieties and fears, and their brain gets negative reinforcement. These persistent and distressing thoughts are often completely illogical and don’t have to have any basis in reality. However, all these obsessions, compulsions, and rituals only provide temporary relief.

You need to put on your parent detective hat and observe any avoidance behaviors in your child that might indicate early signs of OCD. It is a complex disorder that can show up in many different ways.

4 Most Common Types of Obsessive Compulsive Disorder in Children and Teens

There are different types of OCD, and it can be challenging to determine and diagnose each one. Parents should seek the help of a mental health practitioner if a family member shows any symptoms of OCD. The International OCD Foundation offers resources and a ‘find help' tool to locate qualified therapists trained in OCD treatment. This clinical disorder is often overlooked and mistaken for anxiety, which can lead to anxiety triggered responses in children or teens, reinforcing their symptoms and making the condition even more challenging to treat.

A child or teen’s obsessions and compulsions may fall under these 4 different types of OCD:

1. Contamination OCD

Children and teens experiencing contamination OCD often demonstrate compulsive behavior aimed at decontaminating themselves in response to their fears of contamination.

For example, kids with contamination OCD may fear touching the ground, going outdoors, or getting their skin in contact with public objects.

If they end up feeling that something contaminated them, they will do a series of behaviors to alleviate their anxiety about being dirty, sick, or unclean. Their compulsions typically involve protecting themselves to avoid or remove the alleged physical and mental contamination. This is why people with contamination OCD are often thought of as frequent hand-washers—a common behavior but certainly not the only sign of OCD.

I recently worked with a teen boy who was obsessed that his parents spit in his food, and he couldn't eat as a result. His eating became so restrictive that he lost a significant amount of weight and wasn't getting enough nutrients, which compounded his issues. 

We were able to address his contamination fears while at the same time increasing his nutrient through supplements. These steps help calm his brain involved in these obsessive thoughts. A combination of PEMF with exposure and response therapy not only helped calm Jake's brain but also gave his parents resources not to accommodate the OCD. 

Contamination OCD: Common Obsessions

• Fear of contamination and contaminating others
• Fear of getting in contact with anything thought of as unclean
• Fear of germs
• Fear of being around sick people 
• Fear of getting poisoned 

Contamination OCD: Common Compulsions

• Excessive hand washing
• Repeated disinfection
• Frequent clothing changes
• Rigid cleaning and scrubbing
• Avoiding dirty areas or persons 

These rituals and compulsions can really hijack a child's or adolescent's life. An OCD sufferer can wash their hands from 50 to 200 times daily, which can lead to physical pain. They may also take showers that last for hours. 

The global COVID-19 pandemic was especially harsh for children and teens with OCD. Many sufferers experienced exacerbated OCD symptoms, while those in remission had a relapse. One study revealed that individuals with OCD have elevated obsessions and compulsions during the lockdown (Jalal et al., 2020). 

2. Orderliness or Symmetry OCD

Symmetry or orderliness OCD refers to the need for perfect arrangement, order, or sameness. People with symmetry OCD experience what is referred to as “neurotic anxiety” or looping intrusive thoughts if things don't feel or look right. They will also repeatedly think that something terrible will happen unless they perform their compulsions.  

Children and teens with orderliness OCD will ensure that their environment is in perfect order. Clutter and disorganization make them anxious. Their need to constantly put things in order or in symmetry may seem irrational, even to them. However, they can't seem to do anything about it. Research has shown that symmetry or ordering OCD is among the most frequent types among younger people (Jacobsen & Smith, 2017).

Orderliness or Symmetry OCD: Obsessions

• Overly concerned that something will happen if something is not in the proper order
• Feels anxious when things are asymmetrical
• Has an imperative need to achieve balance

Order or Symmetry OCD: Compulsions

• Lining up things 
• Compulsive counting
• Positioning items in perfect order
• Ordering or arranging items by size or color  
• Repetitive behaviors related to visual checks
• Rewriting things  
• Straightening up things 
• Counting  

3. Checking OCD

This is one of the types of OCD that may be mistaken for perfectionism, as the individual feels compelled to avoid mistakes at all costs. These individuals don't trust their memory, so they keep checking the things around them. Sometimes, they even question these memories. One research studied how Checking OCD can cause memory distrust (Van den Hout & Kindt, 2003). 

Children and teens with Checking OCD display an exaggerated fear of being uncertain. As a result, they doubt their abilities to do everyday tasks and avoid social blunders. Because they are so unsure of themselves, they constantly fight intrusive thoughts of being careless or irresponsible. 

Individuals with Checking OCD also don't want to be blamed or scorned by others. As a result, they become overly conscientious, which feeds the OCD. But by being so, they become irrational and more susceptible to making the mistakes they dread. 

They feel that they have to check things several times over or else, something terrible will happen. However, they also think they can never achieve perfection even after constantly checking. In the end, they get frustrated and are ashamed of their actions. 

Many years ago I worked with a young woman who had to check septic and sewer caps because she feared she would fall in them. She knew it was completely irrational but yet she could no longer leave her house because of her checking behaviors. 

Checking OCD: Common Obsessions

Some of the significant fears of individuals with Checking OCD are the following:

• Fear of starting a fire 
• Fear of hitting people while driving
• Fear of inducing harm due to carelessness 
• Fear of sending messages or emails with wrong content or inappropriate materials
• Fear of losing things
• Fear of leaving home unlocked 

Checking OCD: Common Compulsions

• Repeatedly checking that all home appliances are off
• Constantly ensuring that all window and door locks are working
• Always inspect things closely 
• Never-ending seeking of reassurance about their concerns  
• Engage in mental rituals to go over things that they did and didn't do 
• Repeatedly saying certain words or phrases 

4. Harm OCD

Sufferers of this OCD subtype have unwanted intrusive thoughts about being aggressive or doing a violent act to themselves or another person. Children and kids suffering from Harm OCD will have certain compulsions to make those violent thoughts go away.

Anybody can have violent thoughts and shrug them off. But for those with OCD, these thoughts worry them greatly. They believe that these thoughts have meaning or that they will enact them somehow.

For that reason, children and kids with Harm OCD need reassurance that they will never act on their thoughts. It’s the reason why they perform rituals or compulsions to reduce the anxiety associated with their violent thoughts. Treating OCD often involves a combination of therapy and medication to help manage these intrusive thoughts and reduce anxiety.

Completing these ritualistic behaviors will make them feel less anxious, but only for a short while. They’ll always do these compulsive behaviors every time the thought comes, making it an endless cycle of obsessions, fear, and doubt.

Children with harm OCD may engage in self-harm and are frequently misdiagnosed as suicidal. Many practitioners don’t understand that they have a fear that they will harm themselves and don’t actually want to or have a plan. I have worked with dozens of kids who were placed in a psychiatric facility where their OCD was missed.

Harm OCD: Common Obsessions

• Getting violent mental thoughts and images and then worrying that they will act on them
• Thinks about inadvertently causing harm and never realizing it
• Terrified of hurting themselves or others on impulse
• Constant worrying about losing control and becoming a vicious person

Harm OCD: Common Compulsions

• Locking away sharp and pointed objects
• Reviewing one’s every action to check if they caused harm
• Avoiding violent movies, TV shows, or news
• Excessive research of crimes online
• Compulsive praying and belief in spiritual items
• Always asking if they are capable of hurting themselves or others

Natural Solutions and Treatments for OCD Symptoms

Managing OCD is not a walk in the park. It requires dedication and ongoing reinforcement to cultivate self-regulation skills, ultimately helping to mitigate obsessive fears and their symptoms. The emotional distress that accompanies OCD is challenging not only for the children and teens who experience it but also for their parents. That's why, in my practice, I advocate for family therapy alongside other effective treatments such as ERP, CBT, Psychoeducation, Neurofeedback, and PEMF therapy. 

Exposure Response Prevention (ERP)

Exposure and Response Prevention Therapy is one of the best OCD treatment options. It is an effective treatment which exposes OCD patients to trigger their feelings of discomfort until they can regain control and eventually ignore them entirely. It is done in a very safe and systematic way under the care of a highly trained therapist. To be able to treat OCD, exposure therapy may initially increase the child’s anxiety but will eventually address it.

Psychoeducation 

Psychoeducation plays a crucial role in treating OCD, both for the parent and the child, to effectively overcome the behavioral habituation that affects the entire family. Understanding obsessive compulsive disorder helps parents grasp how OCD impacts a child’s brain and behaviors, ensuring a more effective therapy process. 

Natural Solutions 

Now that you understand what the 4 types of OCD are, and if you want to stay away from medication and you're seeking natural ways to support your child, I’ve created a quick, practical resource to guide you. My Natural OCD Thought Tamer Parent Kit is packed with helpful tips and techniques you can implement right away to empower your child and help them talk back to OCD instead of reinforcing it. Inside this parent kit, you will find my recommended supplements for OCD, calm brain tools, and other strategies to help you manage OCD at home.  This therapist-tested tool will help you make sense of your child’s behaviors, teach them self-regulation, and equip them with coping skills to break free from the grip of OCD. Click here to learn more.