October is OCD Awareness Week — and new research is revealing a far more complex picture than the stereotypes suggest.
For decades, obsessive-compulsive disorder has been misunderstood. The public imagination still conjures a picture of excessive handwashing or meticulous order. But for many people, OCD (Obsessive Compulsive Disorder) doesn’t look like that at all. And over the past ten years, research has caught up with what clinicians have long suspected: that the disorder takes many forms — some subtle, some silent, and some so taboo that people hesitate to speak of them at all.
These “hidden” subtypes don’t fit neatly into the old caricature. They are also one reason it takes, on average, seven years from symptom onset to diagnosis (Albert et al., 2022). As OCD Awareness Week 2025 begins, it’s worth looking at what modern science has revealed about this diversity — and why it matters.
When the compulsions are invisible
One of the most common misconceptions about OCD is that compulsions are always visible. The stereotype of repeated handwashing or checking the stove is easy to spot; but for many, the rituals take place entirely in the mind.
People with what’s often called “Pure O” — short for primarily obsessional OCD — experience a relentless stream of intrusive, distressing thoughts. The compulsions are internal: silent checking, rumination, mental reassurance. Clinicians have debated whether “Pure O” should even be considered a distinct subtype, but large symptom-cluster studies suggest it’s common and often missed. Because these mental rituals leave no trace, both patients and professionals sometimes fail to recognise them for what they are: compulsions.
The result? Years of private torment that may be mistaken for anxiety, depression, or even a moral crisis.
The obsessions no one talks about
Another under-recognised form of OCD revolves around thoughts that are violent, sexual, religious or otherwise taboo. Sometimes known as harm OCD or scrupulosity, these obsessions can be devastating. The thoughts are ego-dystonic — the opposite of what the person actually wants — but they generate crushing guilt and fear.
Recent clinical studies have shown that people with taboo or harm obsessions experience greater distress and longer delays to diagnosis than those with more “typical” contamination fears (Abramowitz et al., 2021, Journal of Anxiety Disorders). Many never disclose their symptoms because they fear being judged or misunderstood.
This is where public awareness can make a real difference: by normalising the idea that intrusive thoughts are part of OCD — not evidence of danger or intent.
The ‘just-right’ feeling and the problem of perfection
Not everyone with OCD is driven by fear of harm or contamination. For some, the distress comes from a sense that things simply aren’t right. They might spend hours aligning objects, rewriting emails, or repeating phrases until the internal tension releases — briefly. Researchers call this the “just-right” phenomenon, and studies using fMRI have found overactivity in the brain’s error-detection circuits (Menzies et al., 2008, Brain).
It’s not about perfectionism so much as an intolerable discomfort when something feels incomplete. In everyday life, this form of OCD can masquerade as fussiness, high standards, or quirky habits — all of which makes it easier to miss.
When love becomes uncertainty: Relationship OCD
Not all obsessions are about germs or symmetry. Some fixate on love itself. Relationship OCD (ROCD) is one of the most quietly distressing subtypes of the disorder — and one of the least recognised.
People with ROCD experience intrusive doubts about their partners or relationships: Do I really love them? Are they the right one? What if I’m making a mistake? These aren’t ordinary relationship jitters, but looping, distressing thoughts that can consume hours of the day. To relieve the anxiety, people may seek constant reassurance, replay conversations, test their feelings, or compare their relationship endlessly with others.
In recent years, psychologists such as Dr Guy Doron at Reichman University in Israel have led research into this emerging field. Their studies show that ROCD shares the same underlying cognitive patterns as other forms of OCD — particularly intolerance of uncertainty and inflated responsibility for harm (Doron et al., Journal of Obsessive–Compulsive and Related Disorders, 2016).
A related presentation, sometimes called retroactive jealousy OCD, centres on intrusive thoughts about a partner’s pastromantic or sexual experiences. The sufferer might feel driven to interrogate, analyse, or mentally replay those past events — not out of distrust, but because their mind is stuck in a cycle of doubt and imagined threat. Early research suggests this pattern fits the same obsessive–compulsive framework, with similar benefits from targeted CBT and exposure-based therapy (Doron & Derby, Frontiers in Psychology, 2020).
ROCD and its offshoots highlight a central truth about OCD: the disorder attaches itself to whatever we value most. For some, that’s cleanliness or order. For others, it’s love, morality, or the fear of losing what matters. Recognising that pattern — rather than the surface theme — is what allows people to get the right help.
OCD in older adults — the invisible demographic
OCD is often seen as a young person’s disorder, but recent work suggests it affects older adults more than we realised. A 2024 meta-analysis found that around 2.4% of older adults worldwide meet criteria for OCD (BMC Geriatrics). Yet older people are rarely included in clinical trials or awareness campaigns, meaning their experiences — and their needs — are underrepresented.
Symptoms in later life often overlap with anxiety, depression, or dementia, leading to underdiagnosis. As one geriatric psychiatrist put it: “We talk about intrusive thoughts in teenagers, but we forget that the same circuits don’t retire at 65.”
Subthreshold symptoms and the grey area
There’s also growing evidence that obsessive-compulsive symptoms exist on a spectrum. In the long-running Zurich cohort study, about 8.7% of adults reported significant OCD symptoms without meeting full diagnostic criteria (Angst et al., 2004). These “subthreshold” forms still cause distress and impairment — yet they often slip through the cracks of formal care.
Researchers argue that recognising this spectrum could help with earlier intervention and prevention, rather than waiting until distress becomes disabling.
Why the hidden forms matter
Recognising these lesser-known presentations isn’t just an academic exercise. It’s the difference between years of untreated suffering and effective, targeted help. Cognitive behavioural therapy with exposure and response prevention (ERP) remains the most evidence-based treatment for OCD, but clinicians are now adapting it to fit the more internal or shame-laden forms — addressing mental rituals and guilt as well as visible behaviour.
As OCD researcher Jonathan Abramowitz has put it, “OCD wears many masks, but the core mechanism — doubt, distress, and the drive to neutralise it — is the same.”
The past decade of research has expanded our map of the disorder. The next step is making sure our healthcare systems, and our language, catch up.
The takeaway for OCD Awareness Week 2025
OCD isn’t one thing. It’s not just cleaning or checking or counting. It can be moral doubt, mental rehearsal, endless rumination — and it can happen quietly, behind a composed exterior.
The message for OCD Awareness Week 2025 is simple: OCD doesn’t always look like OCD. And the more we understand its hidden faces, the sooner more people will find their way to the help that works.
