Contamination Obsessions
- Concern with dirt or germs.
- Excessive concern with environmental contaminants. Examples: asbestos, radiation, pesticides or toxic waste.
- Excessive concern with household items. Examples: cleansers, solvents.
- Concern or disgust with bodily waste or secretions. Examples: urine, feces or saliva
- Fear of blood. Fear could be a) related to blood-borne illnesses like AIDS or hepatitis or b) caused by just the sight of blood.
- Bothered by sticky substances or residues. Examples: adhesives, chalk dust or grease.
- Excessive concern with animals or insects. (Distinguished from Specific Phobia.)
- Concerned will get ill because of contaminants. Examples: AIDS or cancer
- Concerned will get others ill by spreading contaminants.
- No concern with consequences of contamination other than how it might feel.
- Excessive concern with becoming pregnant or of making someone pregnant.
- Concerned with having an illness or disease. Where to draw the line between somatic obsessions and the somatic preoccupations of Hypochondriasis is not always evident. Factors that point to OCD are presence of multiple obsessions, compulsions not limited to seeking reassurance, and persistence of symptoms
- Fear of eating certain foods. Examples: excessive concern about risks of certain foods or food preparations. (Distinguished from anorexia nervosa in which concern is gaining weight. )
Symmetry, Order, Exactness and “Just Right” Obsessions
- Need for symmetry or exactness. Examples: certain things can’t be touched or moved, clothes organized in closet alphabetically, bothered if pictures are not straight or canned goods not lined up. (Distinguished from OCPD, in which perfectionism is less dramatic.)
- Exactness in dressing. Examples: excessive concern about appearance of clothing such as wrinkles, lint, loose threads; may not wear garments out of concern they will become worn.
- Symmetry in dressing. Examples: bothered if stockings are not at the same height or shoe laces not tied at the same tension.
- Exactness or symmetry in grooming. Examples: bothered if hair not parted exactly straight or hair not precisely same length on each side of the head.
- Fear of saying the wrong thing or not saying it “just right”. Example: patient may appear to have thought-blocking because she is reviewing every interpretation of what she is about to say.
- Need for exactness related to feared consequences. Example: something terrible may happen if things aren’t in their proper place
- Need for exactness unrelated to feared consequences. Examples: can’t explain what might happen if things aren’t in their proper place; feels discomfort unless things are just right.
- Excessively bothered by things not sounding “just right.” Examples: re-adjusting stereo system until it sounds “just right,” asks family members to say things in just the right way.
- Finds certain sounds irritating.* Examples: “sh” sound, lisps, static/noise, sniffing/coughing, ticking clocks, dripping water. (Distinguished from irritability not specific to OCD.)
- Need to know or remember. Examples: needing to remember insignificant things like license plate numbers, bumper stickers, advertising slogans, names of actors.
Safety, Harm and Violent Obsessions
- Fear of harm due to carelessness. Exclude contamination obsessions.
- Fear might harm self on impulse. This involves unwanted impulses or inexplicable acts. Examples: fear of stabbing self with a knife, jumping in front of a car, leaping out an open window, or swallowing poison. (Distinguished from suicidal ideation secondary to depression.)
- Fear might harm others because not careful enough. Examples: parked car rolling down hill, hit a pedestrian because not paying attention, customer gets injured because you gave him wrong materials or information.
- Fear might harm others on impulse. Examples: physically harming loved ones, stabbing or poisoning dinner guests, pushing stranger in front of a train. (Distinguished from homicidal intent.)
- Fear of being responsible for terrible events. Examples: fire, burglary, flooding house, company going bankrupt, pipes freezing.
- Fear of blurting out obscenities or insults. Examples: shouting blasphemies in church, yelling fire in the movie theatre, writing obscenities in a business letter.
- Fear of doing something else embarrassing. Examples: taking off clothes in public, walking out with unpaid merchandise. (Distinguished from Social Phobia.)
- Violent or horrific images. Examples: intrusive and disturbing images of car crashes or disfigured people.
Hoarding/Saving Obsessions
- Need to hoard or save things. Examples: afraid that something valuable might be discarded with recycled newspapers even though all valuables are locked up in the safe. (Distinguished from hobbies and concern with objects of monetary or sentimental value. Hoarding can be present in OCPD, but if pronounced it is usually better explained by OCD.)
- Fear of losing objects or information.
- Fear of losing people. Example: otherwise rational man feared “losing” his 5-year old daughter when mailing envelopes.
- Fear of losing something symbolic. Example: patient concerned that her “essence” would be left behind when getting up from a chair.
Other Obsessions
- Pathological doubting. Examples: after completing a routine activity patient wonders whether he performed it correctly or did it at all; may not trust his memory or his own senses (i.e., “his mind doesn’t trust what his eyes see.”).
- Pathological indecisiveness. Examples: continual weighing of pros and cons about nonessentials like which clothes to put on in the morning or which brand of cereal to buy. Differentiate from worries about real-life decisions characteristic of GAD.
- Excessive concern with functioning of, or injury, to a body part. Examples: protecting face or eyes from damage; obsessed with mechanical functioning of feet. In most cases of preoccupations with physical appearance, BDD is most appropriate diagnosis.
- Colors with special significance. Examples: black connected with death, red associated with blood and injury.
- Superstitious fears. Examples: black cats, breaking mirror, stepping on side walk cracks, spilling salt, omens.
- Lucky or unlucky numbers. Example: the number 13.
- Intrusive meaningless thoughts or images.
- Intrusive nonsense sounds, words or music. Examples: songs or music with no special significance played over like a broken record.
Last reviewed: By John M. Grohol, Psy.D. on 17 Feb 2006
