Guest blogger Jane Sutliff, Ph.D., specializes in cognitive behavioral approaches to treatment. She has been in independent practice since 2001. Her office is located in Louisville. For more information about Dr. Sutliff including her contact information go to:

Obsessive Compulsive Disorder, or OCD, is often misunderstood by the lay public, as well as many health care professionals.  On average it takes 14-17 years after developing symptoms before OCD sufferers are properly diagnosed.  Although there is effective treatment available (most notably a form of cognitive behavioral therapy called Exposure with Response Prevention – or ERP), the misdiagnosed client is frequently treated with incorrect approaches that can leave them feeling frustrated and hopeless.  This blog aims to describe some of the lesser known forms of OCD, where this occurs most frequently.

When most lay people think of OCD they think of someone who washes their hands repeatedly or cleans things excessively.  Maybe they will have heard of people who count things a lot or who repeatedly check to make sure their garage is closed or their stove is off.  But OCD thoughts and behaviors can come in many other varieties.  Some people have repeated thoughts or images of harming themselves or others, even though they have absolutely no ill intent or actual desire to harm.  Understandably, the OCD sufferer will be horrified by these thoughts and are likely to keep them a secret, even from loved ones and their providers.  They fear acting on these thoughts, and might go to great lengths to avoid things that they hope will minimize their risk.  For example, a woman with OCD might have images of stabbing her child, leading her to ask her husband to remove all knives from the home.  She might fear being left alone with the child.  Well meaning family members or health professionals might misunderstand her condition, and believe that she is suffering from post partum psychosis, even though the new mother is not actually at risk of harming her child.  She might be hospitalized or be given antipsychotic medication.

Another form of OCD that is less commonly discussed, is where the sufferer believes that they are a different sexual orientation than they are practicing.  This is not the same as someone who is truly questioning their sexual orientation.  A person might be fully heterosexual in practice and interest, but fear that they are gay.  They might repeatedly think about being gay, check themselves repeatedly for arousal around the same sex, or avoid any exposure to gay people at work or in public.  The OCD sufferer that has these thoughts might not be anti gay in their beliefs or politics, but still be repeatedly obsessing about being gay themself.

A third variety of upsetting obsessions of some OCD sufferers is the fear that they will sexually harm children, animals, or others.  They might have images of themselves harming these others, while actually having no desire to do so.  They might avoid children or animals completely, or “check” themselves for any signs of arousal when they are exposed to them.  Their obsessions produce great shame for the person with OCD, and are often misunderstood by others.

For more information on diagnosis, treatment and these lesser known subtypes of OCD, I highly recommend the website of the International Obsessive Compulsive Foundation.  In particular, Fred Penzel has written several articles about these topics such as “I think it moved”…  “But I love my kids…”, and “How do I know I am not really gay?”

There are many more subtypes of OCD and there are effective treatments.  If you think you, or someone you know, might have OCD, please see a therapist or psychiatrist who has expertise in this area.

Jane Sutliff, PhD