What is Pure Obsessional OCD (“Pure O”)? Learn with an OCD Therapist in San Francisco
Let’s dive into some FAQs about Pure Obsessional OCD:
What is “Pure O” OCD?
Pure Obsessional OCD, also known as “Pure O” OCD, is a subtype of Obsessive Compulsive Disorder (OCD). “Pure O” was once used to describe OCD where only obsessions were evident, and compulsions did not seem to be present. We now know that individuals with “Pure O” OCD do experience compulsions. They engage in mental compulsions, behaviors that are not unobservable from the outside. These behaviors can be more challenging to identify compared to physical compulsions. Pure Obsessional OCD can encompass any theme and individuals may struggle with obsessions related to fears of harm, morality, pedophilia, existentialism, and others.
The term “Pure O” OCD is misleading and therefore, not commonly used in clinical practice nowadays.
Can I have OCD without compulsions?
All forms of OCD involve compulsions, whether they are physical or mental. Compulsions are one of the driving forces in the OCD cycle. Some individuals with OCD experience compulsions without realizing it. I’ve had clients come into therapy telling me they are distressed and exhausted by their mental activity. They describe spending a lot of time “obsessing all day”. They’re not sure if it is OCD because they cannot identify any compulsions. After digging deeper into their thought process, we often discover that what they believe to be all-day obsessions are obsessions accompanied by time-consuming mental compulsions.
It can be tricky to distinguish obsessions from mental compulsions. I’ll share more about that below!
What’s the difference between an obsession and a mental compulsion?
Obsessions and mental compulsions both occur in the mind, so it can be hard to know when an obsession ends and a compulsion starts. One way to make the distinction is by looking at the function of the thought.
An obsession is an intrusive thought, image, urge, or sensation that shows up involuntarily and is out of your control. It causes emotional distress.
It can be a what-if question, a statement, a mental image, or a doubt that needs to be urgently resolved, attended to, or figured out.
A mental compulsion is a mental behavior or ritual that you are compelled to perform in response to an obsession. It is done to alleviate distress (but many times can have the opposite effect.)
Mental compulsions can feel automatic and appear to be productive reasoning. This can make them difficult to identify and recognize as being an OCD symptom. I often tell my clients that mental compulsions are voluntary, something they are actively doing. They do not provide any new or useful insights even though it might seem like it. Many individuals experience a sense of urgency to take action following an obsession. This is often a good indicator that a mental (or physical) compulsion may be about to take place.
It can be tricky to identify mental compulsions and to tell the difference between obsessions and mental compulsions. An OCD specialist can help you identify what is happening and teach you how to treat it.
What are some examples of mental compulsions with ‘Pure O’ OCD?
There are many kinds of mental compulsions that one could engage in. Some examples of mental compulsions that show up with “Pure O” OCD (and any OCD subtype) include mental reviewing, comparing, counting, neutralizing, checking, self-reassurance, and prayer. See the next section for some examples of “Pure O” obsessions and compulsions.
Mental compulsions can overlap or show up together. Labeling each of these kinds of thinking patterns can be helpful and increase self-awareness.
But what’s more important to know is that all compulsions are functionally the same.
They are acts used to reduce an uncomfortable feeling or to prevent a feared outcome from occurring. While they do provide short-term relief, in the long term they continue to reinforce the OCD cycle.
What are some “Pure O” OCD examples?
I’ve come up with a few “Pure O” OCD examples to demonstrate how obsessions and mental compulsions can show up. These are just some examples (the possibilities are endless):
“That child is cute. Maybe you want to molest them.”
Scan your body for signs of arousal or a groinal response
Express disapproval in your mind by repeating, “That’s wrong,” over and over
Mentally review past encounters with cute children and how you felt and acted
“What if I spontaneously run over those pedestrians crossing the street?”
Mentally review all the reasons why you would never be capable of hurting others
Mentally check and scan your body to ensure that you are steady, in full control, and that your foot is firmly on the brake
Count down “3, 2, 1” three times in your mind
A horrifying image of your dog lying dead in your apartment enters your mind.
Mentally retrace every step you took before leaving the house to ensure that you didn’t accidentally leave anything on, unlocked, or accessible to your dog
Recite in your mind one “Our Father”, one “Hail Mary”, and one “Our Father” (in that order)
Neutralize the horrifying image with a pleasant one of you and your dog snuggling
“What if I said something totally inappropriate at the get-together last night?”
Mentally ruminate by playing out the previous night’s interactions: what you said, how you said it, how others responded, etc.
Mentally scan your friends’ facial expressions, body language, and tone of voice when you talk to them to see if there are any signs that anything is wrong
Mentally compare past interactions with last night’s interaction to catch differences and similarities
“What if I don’t love my partner and I’m being disingenuous in this relationship?”
Mentally check your emotions when you’re with your partner
Mentally compare how others look and act when they are in love versus how you look and act
Mentally rationalize your love towards your partner; come up with a mental checklist of all the reasons this is not true
“What if there is something illegal in my luggage that I don’t know about and TSA finds it?”
Mentally check off every item you remember packing just to be sure
Reassure yourself that you have never done anything illegal or gotten into trouble ever in your life
Repeat in your mind “No, no, no” six times
What about “Pure O” OCD treatment? What kind of therapy helps?
The treatment for ‘Pure O’ OCD is the same as any other OCD subtype. It doesn’t matter whether your compulsions are physical, mental, or both. Some individuals do well with therapy alone, some with medication alone, and some find a combination approach of therapy and medication to be most helpful.
Exposure and Response Prevention Therapy (ERP therapy) has demonstrated good results in OCD recovery. Many OCD specialists will find it helpful to combine ERP therapy with Acceptance and Commitment Therapy (ACT), as they both align nicely. Inference-based CBT (I-CBT) targets the reasoning process that occurs in OCD and is another research-backed OCD treatment that is gaining more popularity in the United States.
How does ERP therapy work for “Pure O” OCD?
ERP therapy teaches you to not engage in mental compulsions in the same way as physical compulsions. Gradual exposures take place to trigger obsessions all while learning how to resist the mental compulsions. Self-monitoring is important in ERP therapy and can help build awareness of mental compulsions. This is important since individuals are typically less aware of when they are engaging in mental compulsions compared to physical compulsions.
Mental compulsions may feel automatic over time, but they aren’t.
They are behaviors that one is voluntarily engaging in. With ERP therapy, you can increase the likelihood of catching yourself in the sequence when it’s happening. The more familiar you are with how that process looks and feels, the easier it is to interrupt or stop it altogether.
I think I’m experiencing “Pure O” OCD symptoms. What should I do?
A good first step would be to connect with a licensed therapist for further assessment. An OCD specialist who is knowledgeable about OCD diagnosis and treatment would be most beneficial. It can be a bit challenging to identify some of the more sneaky OCD symptoms like mental compulsions. I share some other benefits of seeking care from an OCD Therapist here.
I am an online OCD therapist licensed in California and New York and would be happy to help! But if you are not in those two states or prefer to meet with someone in person, the IOCDF has a great directory of OCD therapists.
