10 OCD Themes That Are Not About Cleanliness

Obsessive-compulsive disorder (OCD) is a “mental health condition where distressing, intrusive thoughts (obsessions) trigger repetitive behaviors (compulsions) aimed at reducing anxiety or preventing something bad from occurring.” When most people think of OCD, they think of orderliness, cleanliness, color-coded closets, pristine lists, and grouping your Skittles into colors before eating them. Television and movies like Monk make the disorder look quirky, even comedic, or somehow “positive,” which deepens the misunderstanding of an incredibly disruptive and debilitating mental illness.

Many intrusive thoughts, anxieties, and obsessions have nothing to do with contamination or orderliness but often attack that which you value or fear the most. Scary, taboo, or unpleasant thoughts and feelings can latch onto someone’s children, values, relationships, health, and faith, leading to such a profound distortion of reality that one’s entire life becomes upended, thanks to the anxiety and resulting compulsions. Furthermore, many with OCD do not struggle as much with external, physical compulsions like cleaning, checking, or organizing, which is known as “Pure O.” Instead, they are fighting battles inside their heads.

This list intends to examine 10 OCD themes that have nothing to do with being clean and organized.

Related: Top 10 Best Coping Mechanisms for Mental Health

10 Postpartum

“I’m going to kill my baby,” thinks a new, loving, happy mother. Once she has this thought, panic and fear take over. Why would she think that? She wants this child and loves it with her entire being. The thought persists, and she wants to make it go away because it isn’t true. She decides that the only way she will hold her child is if her partner is present. It works, but only for a while. Soon, she refuses to hold her child because she fears her thoughts might come true. If she doesn’t touch the baby, she can’t kill it. Her fear, however, does not subside, and to worsen her experience, she is not bonding with the child she loves the way she wants to.

Such is an example of what it could be like for someone with postpartum OCD (pOCD), based on examples of the disorder provided by the International OCD Foundation.

Someone with pOCD may experience intrusive, unwanted thoughts about harming or losing their child, so they engage in compulsions or rituals such as avoidance or reassurance-seeking, hoping to get rid of the thoughts. Still, the cycle usually worsens the person’s experience rather than helps it. Without proper understanding and treatment, it can drive the sufferer further away from that which they truly love: their family.^[1]

9 Incest

Many OCD themes revolve around taboo or even violent subjects that bring immense distress to the person who has them. One such theme is “incest OCD.” When someone experiences incest OCD, they are plagued with thoughts like “What if I’m sexually attracted to my father?” or “What if I touched my sister sexually once and I don’t remember?” or “What if my desire to be around my family is proof that I’m actually sexually attracted to them?”

These thoughts can be worsened by what’s called a “groinal response,” which is a physical reaction in the genitals that feels similar to arousal, as it can include twitching, tingling, lubrication, or even an erection. The difference is that these symptoms are rooted in hyper-awareness and not true sexual arousal.

Someone with incest OCD will have such a deep fear of sexual attraction toward family members that they will avoid contact with those people, spend hours researching similar experiences on Google or Reddit for reassurance, reviewing memories, checking for groinal responses, or confessing their thoughts to others to abdicate themselves of guilt.

Someone with incest OCD does not care about their house being clean or how many times they wash their hands—they simply no longer wish to be terrified of their own bodies and their own families.^[2]

8 Pedophilia

Since OCD loves to latch onto the taboo and go against someone’s values, sexual themes are prominent in the OCD community. However, one is especially upsetting: pedophilia OCD.

Someone who experiences pedophile-themed OCD is the complete opposite of an actual pedophile. These people experience horrible, unwanted thoughts about doing sexual harm to children and spend so much time and energy on compulsions in an attempt to make the guilt, fear, shame, and anxiety go away.

They live in fear, believing they are the worst kind of human out there.

Thoughts include, “Did I look at that child for too long? Why did I do that? Does that mean I am aroused by them? Am I sexually attracted to children? Am I a creep? Am I a pedophile? Am I going to accidentally one day inappropriately touch a child? Why am I thinking these thoughts? Is it because I actually want to? Is it because I secretly like it?”

To an outsider, it seems rather obvious that this person does not feel attraction toward children, is not a pedophile, and will not become one. However, to the individual with OCD, these thoughts are real, terrifying, and urgent, and they must be dealt with immediately so that those fears do not come true.

Someone with OCD may avoid walking or driving past schools or playgrounds, therefore taking too long to get to work. They may not visit nieces and nephews or isolate themselves from their own children. They may do excessive research, confess their thoughts, or even go so far as to watch pornography just to see if they become aroused.

This particular theme comes with a great deal of shame, guilt, self-hatred, and embarrassment. Thanks to inaccurate portrayals of OCD and social misunderstandings, people with this form of OCD and other subtypes with stigmatized themes, help is often not sought out by those who may need it most.^[3]

7 Sexual Orientation

Sexual orientation OCD (SO-OCD) is the obsessive need to know for certain your sexuality, who you’re attracted to, and your sexual identity. Most people do question their sexuality from time to time. Others have stories of grappling with it, like finding the right time or the right way to come out as gay, for example. However, someone with SO-OCD is completely ensnared in a quest to know beyond all doubt exactly who they are and who they are attracted to, to the point that their lives can become completely disrupted.

Take Teagan, for example. She is a young woman whose testimonial for Rogers Behavioral Health is a prime example of what SO-OCD, and OCD in general, can put someone through. She writes, “I saw a TikTok that said, ‘If you get butterflies when looking at the same gender, sorry… you’re gay.’ Most people would hear this and either laugh or just move on without even questioning themselves, but not me and my doubt-infested thoughts. This sent me into a spiral like I’d never been in before… I could no longer see the world or who I was the same. I began having multiple, intense panic attacks back-to-back… I just ‘NEEDED’ to know if I was gay… like NOW!!”

Fears of ruining relationships, lying to oneself, not knowing one’s own identity, possibly facing stigma or ostracization by “coming out,” or not loving one’s current partner if they find out they are not of that orientation can drive someone with SO-OCD to time-consuming and distressing compulsions.

Reality and fear tend to get blended with OCD, and when that begins to attack your own sense of identity, that’s frightening.^[4]

6 Suicide

One of the most difficult themes of OCD to talk about and treat is suicidal OCD. While all thoughts of suicide should be treated with the utmost care and concern, there is a subtype of OCD that is actually driving the person to do the opposite of taking their own life.

Suicidal OCD is different from true suicidal ideation in that the thoughts of self-harm are unwanted and terrifying, and the distress the thoughts cause leads to extreme measures to prevent suicide—not act on it.

Suicidal OCD can manifest in many ways. It could be something like driving on an overpass and picturing yourself swerving your car over the edge or seeing a train and imagining yourself jumping in front of it. However, the thought fills you with fear and shock because you don’t want to do those things. Similarly, if you are going through a distressing time, you may think, “I don’t want to be here anymore,” which is immediately followed by shock, distress, fear, and panic because, again, the thought is not actually true.

Someone in these scenarios may avoid bridges, trains, roads, windows, and balconies. They may also avoid knives or guns, get rid of their weapons—knives, guns, and ammunition—or confess their thoughts to someone so they can make sure they don’t actually do it. They may question themselves and wonder if these thoughts are normal, if others have them too, and if they are actually likely to harm themselves.

These behaviors are meant to eliminate the thoughts and feelings because the person does not want them. Again, however, all thoughts of this nature ought to be treated with the utmost seriousness and case, as all cases are unique to the individual.

This section of this list is only meant to highlight the existence of a distressing category of obsessive-compulsive order that is a real experience that goes far beyond the quirkiness of a color-coded list.^[5]

5 Harm

Harm OCD is a broad theme that can include harm to oneself or others and can be a horrifying experience for someone with the disorder.

Someone with any variation of harm OCD might think things like: “What if I push this person in front of a car?” If they are feeling angry, they might think, “I should just stab them,” and then immediately be overcome with panic and ask themselves, “Why did I just think that?” If they are feeling distressed, sad, or frustrated, they might think about harming themselves and then freak out about having that thought in the first place.

Someone cutting vegetables might look at the knife and think about killing someone with it. A new mother might think about throwing her child down the stairs. They may fear they are a serial killer in the making, fear they are possibly self-harming or suicidal, or worry that they might “snap” and do something to themselves or others.

The media has taken this subtype and run with it in the wrong direction, making it a stigmatized subtype and furthering the misunderstanding of this serious mental illness.

Trap (2024) is a horror film that portrays a killer with obsessive-compulsive disorder and makes a connection between those urges and his kills. The film has faced criticism for its inaccurate and dangerous portrayal of the mental health condition because those with harm OCD are the least likely to do harm. In fact, they are those who highly value kindness, care, and safety.^[6]

4 Death

The fear of death is commonplace and persistent. Even those who do not actively “fear” death likely experience it when confronted with it. After all, our brains are hardwired to survive and resist death.

Unlike the normal discomfort and fear of death, this subtype of obsessive-compulsive disorder takes it to an entirely new level. Someone with death OCD grapples with obsessive intrusive thoughts about their own death, the process of dying, death coming to loved ones, and the afterlife. These fears are accompanied by compulsions, such as asking for reassurance that you won’t die, excessive research about illnesses or the afterlife, or avoiding certain images, movies, places, or objects that remind you of death or the afterlife.

For example, someone with intense death-related OCD may fear that they will suddenly die. To mitigate the fear, they may ask their spouse, “Do you think I’m going to have a heart attack?” They may avoid driving to prevent a car accident. They may also avoid hospitals or driving past cemeteries and funeral homes. One writer shared her story and said she avoided imagery and mentions of the Devil because she associated it with the afterlife.

It’s also not uncommon for those suffering from OCD to engage in magical thinking. This is when superstitious thoughts take hold, and you believe that your thoughts, anxieties, and triggers are causally related to external events. For example, someone with OCD may see a Halloween costume of the Devil and interpret it as a “sign” or an omen that their death is nigh. They may have a dream in which a loved one dies, and they will live in extreme anxiety, believing their dream is a prophecy.

When this happens, compulsive behaviors once again set in and can take over a person’s life.^[7]

3 Religious Scrupulosity

There is one subtype of OCD that somewhat incorporates superstition, and that is religious or moral scrupulosity OCD. Someone suffering from scrupulosity OCD has unwanted and pervasive fears around morality and religion.

Fears of doing something “wrong,” not being “pure” enough, not practicing religion perfectly, sinning, death, divine punishment, and possession, as well as obsessions with rituals, sacrifice, and doctrine, take over the lives of those who grapple with scrupulosity OCD. Subsequently, they engage in compulsions and rituals to help mitigate the intrusive, relentless thoughts. Examples include prayer, confession (to a religious leader or a loved one), rituals done to perfection or until they feel “just right,” hyper-awareness of behavior, scanning memories or monitoring thoughts for sins, and avoiding places or events that could trigger these thoughts or lead something “bad” happening.

This particular category of OCD can be particularly distressing, as our religion (or ethics, if you are not “religious”) plays a part in our day-to-day lives. Concerns with how we treat our partners, whether we made the “right” decision, or if we honored our god(s) with genuine, correct reverence are daily engagements. When our thoughts and actions become so rigid and full of anxiety, it can be difficult to know where healthy practice ends and self-sabotage begins.

That blurred line between anxiety and reality is difficult for anyone, regardless of which part of your life it affects.^[8]

2 Relationship

With OCD, all themes stem from levels of uncertainty, unpredictability, or an overall lack of control. Most OCD thoughts tend to stem from slim possibilities or have little to no evidence to substantiate them. With harm OCD, for example, the person knows that they will not cause another harm at the end of the day. Someone with incest OCD ultimately knows that their thoughts are not real—even if it takes a lot of work to get there. The anxiety that these thoughts cause is ultimately proof that they are egodystonic, meaning they go against the person’s values and identity.

Relationship OCD, however, is considered to be an especially challenging subtype of OCD.

Someone with ROCD constantly experiences doubts about their relationship. This typically manifests in romantic relationships but could latch onto any important relationship.

ROCD sows seeds of doubt about your love for your partner, their love for you, infidelity, the strength of the relationship, whether or not it’s worth your time, your partner’s flaws, attraction, and ability to handle conflict. While some relationship doubts are normal, someone with OCD cannot tolerate these doubts or questions, leading to chronic, intense anxiety, depression, panic, or paranoia about themselves, their partner, and/or their relationship.

This can lead to compulsions like researching relationship topics on Google or Reddit, asking others constantly for advice or reassurance (including from their partner), confessing their thoughts to their partner (including fears about cheating or not loving them), checking for “signs” that everything is okay (or not), or testing yourself or your partner by flirting with others—just to see how you or they feel, so you can “make sure.”

This subtype of OCD can be particularly painful due to the potential to sabotage healthy relationships by responding to problems where none exist or to stay in unhealthy relationships by writing your doubts off as ROCD.

Considering that OCD usually latches onto that which you value or want the most, someone with ROCD has the potential to be isolated and distressed, given that they feel constant anxiety and doubt. That anxiety is present whether they are single or in a relationship or whether that relationship is working for them or not.

It creates a cloud of doubt and loneliness so profound that even that which you love the most feels unsafe and contaminated.^[9]

1 Meta (Do I Even Have OCD?)

The kicker of all OCD subtypes just might be what is called meta OCD. This theme focuses on the disorder itself, questioning whether your spirals and behaviors are even OCD at all.

What if this isn’t OCD? What if I’ve been lying to myself or my therapist, and we’ve got it all wrong? What if I’m doing my treatment wrong? What if I’m stuck like this forever? What if I missed something?

The OCD begins to attack the individual, their treatment, their progress, and their reality, which can completely sabotage their treatment and overall wellness.

Compulsions associated with this theme include going to multiple therapy appointments or avoiding them, excessively researching OCD or taking quizzes, ruminating or other mental compulsions, or asking others for reassurance.

This theme is sneaky, as it can develop after someone has begun treatment for their OCD with another theme, thus proving to be another obstacle for them to tackle in therapy. Fortunately, meta OCD is not uncommon and can be handled just like any other theme.^[10]