Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.
Harm obsessions with checking compulsions: If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others and use checking rituals to relieve your distress. For example, you might imagine your house burning down and then continually drive by your house to make sure that there is no fire. Or, you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.
Obsessions without visible compulsions: This symptom subtype often relates to unwanted obsessions surrounding sexual, religious, or aggressive themes. For example, you could experience intrusive thoughts about being a rapist or that you will attack someone. You may often use mental rituals such as reciting particular words, counting in your head or praying to relieve the anxiety you experience when you have these involuntary thoughts. Triggers related to obsessions are usually avoided at all costs.
Symmetry obsessions with ordering, arranging, and counting compulsions: When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are “just right.” For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color. This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example: “If I arrange my desk perfectly my husband won’t die in a car accident.” However, this is not always the case.
Hoarding: Hoarding is now recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items that are judged to be of limited value by others such as old magazines, clothes, receipts, junk mail, notes, or containers. Often your living space becomes so consumed with clutter that it becomes impossible to live in. Hoarding is often accompanied by obsessional fears of losing items or possessions that may be needed one day and excessive emotional attachment to objects. People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes and are often are unable to maintain steady employment. Importantly, compulsive hoarding can occur independently of OCD.