Step 1: Obsessive compulsive disorder (OCD) is characterised by recurrent obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviours done to reduce anxiety). It has four classic major symptom patterns.
Step 2: Contamination is the most common pattern, an obsession about dirt or germs, usually followed by a washing compulsion (the washer).
Step 3: Pathological doubt is the second most common pattern, an obsession about whether a task was done correctly, followed by compulsive checking (the checker). Intrusive thoughts (pure obsessions) are the third pattern, recurrent obsessional thoughts, often of a sexual or aggressive nature, without a clear compulsion. Symmetry or precision is the fourth pattern.
Step 4: Since contamination, pathological doubts, and intrusive thoughts are all recognised major symptom patterns of OCD, the correct answer is All the above.