Obsessive-Compulsive Disorder Exposure Hierarchies

OCD can be very idiosyncratic and, also, the main focus of the obsessions and compulsions can change with time. As a result, patients often find it most helpful to write their own list of anxiety-inducing activities. The hierarchies below include some of the most common OCD triggers but may not include your particular triggers, in which case, write (and rate) your own.

Rate each activity on a 0-100 anxiety scale for how anxious it would make you feel on a typical day (with "100" being the most anxious you've ever felt and "0" being totally calm). Activities currently rated between a 20 and a 60 are usually good to try as Real-Life Exposures. With repetition, you should notice that any particular activity becomes easier with time. You can then move on to a harder activity on your list. You can also re-rate the hierarchy periodically to track your progress.

Obsessive-Compulsive Disorder Hierarchies 

Contamination (Showering)

Showering only three times a day (each untimed)

Showering only twice a day (each untimed)

Showering only once a day (each untimed)

Showering only three times a day (each less than 30 min)

Showering only twice a day (each less than 30 min)

Showering only once a day (each less than 30 min)

Showering only three times a day (each less than 10 min)

Showering only twice a day (each less than 10 min)

Showering only once a day (each less than 10 min)

Contamination (Hand Washing)

Washing your hands 30 times a day or less (each untimed)

Washing your hands 20 times a day or less (each untimed)

Washing your hands 10 times a day or less (each untimed)

Washing your hands 5 times a day or less (each untimed)

Washing your hands 30 times a day or less (each two minutes or less)

Washing your hands 20 times a day or less (each two minutes or less)

Washing your hands 10 times a day or less (each two minutes or less)

Washing your hands 5 times a day or less (each two minutes or less)

Checking

Checking (locks/lights/stove etc) 20 times a day or less (unlimited repetitions)

Checking (locks/lights/stove etc) 10 times a day or less (unlimited repetitions)

Checking (locks/lights/stove etc) 5 times a day or less (unlimited repetitions)

Checking (locks/lights/stove etc) only once a day (unlimited repetitions)

Checking (locks/lights/stove etc) 20 times a day or less (10 repetitions or less each time)

Checking (locks/lights/stove etc) 10 times a day or less (10 repetitions or less each time)

Checking (locks/lights/stove etc) 5 times a day or less (10 repetitions or less each time)

Checking (locks/lights/stove etc) only once a day (10 repetitions or less each time)

Checking (locks/lights/stove etc) 20 times a day or less (5 repetitions or less each time)

Checking (locks/lights/stove etc) 10 times a day or less (5 repetitions or less each time)

Checking (locks/lights/stove etc) 5 times a day or less (5 repetitions or less each time)

Checking (locks/lights/stove etc) only once a day (5 repetitions or less each time)

Checking (locks/lights/stove etc) 20 times a day or less (1 repetition or less each time)

Checking (locks/lights/stove etc) 10 times a day or less (1 repetition or less each time)

Checking (locks/lights/stove etc) 5 times a day or less (1 repetition or less each time)

Checking (locks/lights/stove etc) only once a day (1 repetition or less each time) 

Perfectionism/Symmetry

Arranging/organizing/correcting mistakes 3 hours or less each day

Arranging/organizing/correcting mistakes 2 hours or less each day

Arranging/organizing/correcting mistakes 1 hours or less each day

Arranging/organizing/correcting mistakes 30 minutes or less each day 

“Superstitious” Rituals

Doing superstitions ritual (i.e. tapping, moving, verbalizing, reassurance seeking) 30 times or less a day

Doing superstitions ritual (i.e. tapping, moving, verbalizing, reassurance seeking) 20 times or less a day

Doing superstitions ritual (i.e. tapping, moving, verbalizing, reassurance seeking) 10 times or less a day

Doing superstitions ritual (i.e. tapping, moving, verbalizing, reassurance seeking) 5 times or less a day

Doing superstitions ritual (i.e. tapping, moving, verbalizing, reassurance seeking) once a day