Harm OCD involves unwanted, intrusive thoughts about causing violence or injury to others—often to people you care about most. These thoughts feel profoundly disturbing and completely at odds with your values. You might avoid knives, driving, or being alone with loved ones. You analyze whether the thoughts mean something about who you are, searching for proof of your safety or goodness. The more you try to suppress or neutralize these thoughts, the more persistent they become. Treatment helps you learn that thoughts aren't threats, and that trying to control them is what keeps them alive.

Relationship OCD involves obsessive doubts about your romantic relationship. You might constantly question whether you love your partner enough, compare them to others, or analyze your feelings for "proof" that the relationship is right. You might seek reassurance, mentally review positive moments, or avoid commitment out of fear you're making a mistake. The doubt feels urgent and real, but the certainty you're searching for never arrives. Treatment helps you stop testing your feelings and start engaging with your relationship as it actually is.

Contamination OCD involves intense fears about dirt, germs, illness, or other forms of contamination. You might wash your hands excessively, avoid public spaces or certain objects, or create elaborate rules about what's "clean" and "safe." The fear often extends beyond physical illness to include emotional or moral contamination—feeling "tainted" by contact with certain people, places, or ideas. Compulsions provide temporary relief but strengthen the belief that contamination is dangerous and must be controlled. Treatment helps you gradually face feared contaminants without ritualizing, learning that uncertainty is tolerable.

Religious scrupulosity involves obsessive fears about sinning, offending God, or failing to meet religious standards. You might confess excessively, repeat prayers until they feel "right," or avoid situations that could lead to spiritual contamination. Intrusive blasphemous thoughts feel like evidence of moral failure, demanding constant vigilance and mental correction. The rituals provide brief relief but deepen the belief that your faith requires absolute certainty. Treatment helps you distinguish between genuine devotion and compulsive fear, allowing you to practice your faith without OCD hijacking it.

Health anxiety involves obsessive fears about having or developing a serious illness. You might constantly check your body for symptoms, research diseases online, seek medical reassurance, or avoid health-related information that triggers panic. A headache becomes a brain tumor; fatigue means cancer. Sometimes the physical symptoms are real but medically unexplained—doctors find nothing, yet the sensations persist, fueling more monitoring and intrusive thoughts about what's being missed. The reassurance—from doctors, tests, or googling—provides only brief relief before the next symptom demands investigation. Health anxiety overlaps significantly with illness anxiety disorder and can present as part of OCD when driven by clear obsessional loops and compulsions. Treatment helps you stop treating bodily sensations as emergencies, learning to tolerate uncertainty about your health without compulsive checking.

Existential OCD involves obsessive questions about reality, meaning, consciousness, or existence itself. You might get stuck on questions like "What if nothing is real?" or "What happens after death?" or "Do I have free will?" These questions feel urgent and demand answers, pulling you into hours of mental analysis or reassurance-seeking. The more you try to resolve the uncertainty, the more distressing it becomes. Treatment helps you stop treating philosophical questions as emergencies that require solving, allowing you to engage with life even when metaphysical certainty remains out of reach.

"Pure O" refers to OCD presentations where compulsions happen primarily in your head rather than through visible behaviors. You might spend hours mentally reviewing, analyzing, or neutralizing intrusive thoughts—but to an outside observer, nothing appears wrong. The obsessions often involve taboo content like harm, sexuality, relationships, or morality, and the mental rituals feel automatic and necessary. Despite the name, Pure-O isn't purely obsessional—the compulsions are just harder to see. Treatment helps you identify and resist mental rituals, breaking the cycle that keeps intrusive thoughts powerful.

Sexual Orientation OCD involves intrusive doubts about your sexual orientation that feel at odds with your established sense of self. You might obsessively monitor your attractions, analyze past relationships for "signs," or avoid situations that trigger uncertainty. The thoughts feel urgent and demand resolution—proof that you're really straight, really gay, or really bisexual. Seeking certainty through mental review, reassurance, or testing only strengthens the loop. Treatment helps you stop treating the thoughts as questions that need answering, allowing you to live according to your values rather than your fears.

Moral scrupulosity involves obsessive fears about being a bad person. You might replay interactions to confirm you didn't lie or hurt someone, confess past mistakes repeatedly, or avoid situations where you could do something "wrong." The obsessions demand proof of your goodness—proof that never feels sufficient. Treatment helps you stop seeking certainty about your character and start living according to your values instead.

Sexual intrusive thoughts involve unwanted, disturbing sexual imagery or impulses that feel completely at odds with your values. These might include fears about being attracted to children (POCD), family members, animals, or violent sexual scenarios. The thoughts cause intense distress precisely because they contradict who you are. You might avoid people, places, or situations that trigger the thoughts, seek reassurance about your character, or mentally review whether you felt arousal. Treatment helps you stop treating the thoughts as dangerous evidence and start recognizing them as the content OCD uses to create doubt.

Just Right OCD involves an overwhelming need for things to feel, look, or be "just right." You might arrange objects symmetrically, repeat actions until they feel complete, or experience physical discomfort when things are uneven or misaligned. The compulsion isn't driven by a specific feared outcome—it's the intolerable sense that something is "off" or incomplete. You might touch, tap, or reorder things repeatedly, seeking a feeling of resolution that's always temporary. Treatment helps you tolerate the discomfort of "not right" without correcting it, breaking the cycle of perfectionism and control.

Gender OCD involves intrusive doubts about your gender identity that feel at odds with your established sense of self. You might obsessively monitor your feelings, analyze past experiences for "signs," or research transgender experiences seeking certainty. The thoughts feel urgent and demand resolution—proof about who you "really" are. You might avoid clothing, situations, or conversations that trigger the doubts, or seek reassurance from others. Treatment helps you stop treating the thoughts as questions that must be answered, allowing you to live authentically without needing absolute certainty about your identity.

Checking and reassurance-seeking are common compulsive patterns across OCD presentations. You might check locks, appliances, or your body repeatedly, or replay events mentally to confirm nothing bad happened. You seek reassurance from others—asking if you're a good person, if you said something wrong, or if everything will be okay. Each check or question provides temporary relief but reinforces the belief that certainty is necessary and achievable. Treatment helps you resist the urge to check or ask, building tolerance for the discomfort of not knowing.

OCD Doesn't Follow a Script

OCD thought content can be about literally anything. While the presentations listed here represent common patterns, your obsessions don't need to fit neatly into a prepackaged category to be valid—or treatable.