The Overlooked Form of OCD

Purely Obsessional OCD, also known as 'Pure OCD' or 'Pure O', is a lesser-known form of Obsessive-Compulsive Disorder that needs more attention. Many of you might be familiar with some of the symptoms of Obsessive-Compulsive Disorder (OCD), such as obsessions, compulsions, and intrusive thoughts. Some of these symptoms can be visibly noticeable - obsessive cleaning, excessive hand washing, or double-checking. But for people with Pure OCD, compulsions might be hidden. 
So, how exactly does Pure OCD differ from OCD? Read on to learn more about this mental condition.

How is Pure OCD different from classic OCD?

People with Pure O have obsessions and compulsions, just like people with OCD. The difference, however, is that the compulsions in people with Pure OCD are mostly in their heads. These inner thoughts usually focus on relationships, sexuality, religious or moral questions, and themes of harm. These ideas and visuals can become so overwhelming that they can feel like an attack on the person’s sense of self. These are followed by an extreme sense of guilt. Mental compulsions then become the person’s way of coping with the anxiety these thoughts cause them. 

Pure Obsessional OCD, THOUGHTS
According to clinical psychologist Monnica T. Williams and her colleagues, “Recognition of compulsions performed by those previously considered purely obsessional can aid in the improved diagnosis and treatment of people with OCD.”
So even though the person doesn't want to want to perform these compulsive behaviors, they feel like they must follow along or their anxiety will worsen. This is similar to the behavioral compulsions in people with OCD who keep repeating certain behaviors, rituals, or routines.
Pure OCD can be difficult to diagnose. This is because many people with Pure O are reluctant about sharing their experiences with others for fear of being judged.  

Symptoms of Pure OCD

People with Pure O OCD do have obsessions and compulsions, just like all people with OCD. For people with OCD, however, the thoughts and compulsions tend to last only a few seconds and don’t cause any considerable distress. For example, a person with OCD might have uncontrollable thoughts about washing their hands even at bedtime. But they can shortly dismiss the idea and move on.

Pure Obsessional OCD, Distress
For people with Pure OCD, the thoughts and urges can be frequent and highly distressing. Their obsessive thoughts tend to be about:
* Sex
* Relationships
* Religion
* Violence
* Illnesses
* Accidents
These obsessive thoughts then lead to mental compulsions such as:
* Mentally observing your verbal and physical behavior
* Mentally replaying events over and over 
* Revolting thoughts like engaging in sexual acts with a child
* Silently thinking about causing self-harm and harm to others 
* Silently asking oneself questions about the nature of oneself or reality 
* Thoughts about committing sacrilegious acts
* Persistent thoughts that they've said or done something inappropriate
* Silently repeating phrases, questions, or facts
Pure Obsessional OCD, overthinking
A 2011 study found that people who experience “unacceptable” or “taboo” thoughts tend to engage in mental rituals to cope with the distress. Some of these rituals might be:
* Mentally repeating certain words
* Thinking about re-doing or un-doing some actions
* Constantly reviewing memories or information
To relieve the distress caused by these thoughts, people with Pure OCD tend to compulsively seek reassurance. This may include:
* Repeatedly asking others for assurance
* Avoiding people, places, or situations that may trigger their obsessive thoughts
* Using superstitious rituals or behaviors to protect themselves from the obsessive thoughts

What causes Pure O OCD?

There’s no clear cause of Pure O OCD. This type of obsessive-compulsive disorder is not listed as a separate diagnosis in the DSM-5, a handbook used by clinicians to diagnose mental health conditions. According to it, OCD is characterized by the presence of obsessions, compulsions, or both. It can be caused by genetics, brain structure, and function, or personal history of trauma.
But it remains unclear why some people with OCD have behavioral compulsions and why people with Purely Obsessional OCD have mostly mental compulsions.


Treatment for OCD, including Pure O, can be done with therapy and medications. Since it’s much harder to prevent mental activity than physical behavior, Pure OCD can be a little difficult to treat initially. But the following treatments can help:
Exposure and Response Prevention Therapy: This behavioral therapy is also used in the treatment of other presentations of OCD. A trained Exposure and Response Prevention (ERP) therapist will be able to spot mental compulsions and work with the patient to come up with the best possible treatment. Usually, they ask the patients to intentionally expose themselves to the thoughts that trigger their obsessions without engaging in any compulsive behaviors. The idea is that over time, patients will learn how to manage their symptoms without acting upon compulsions.
Pure Obsessional OCD, therapy

Mindfulness-Based Cognitive Behavioral Therapy (CBT): This form of therapy teaches people with Pure OCD that intrusive thoughts have no power over them and that they are normal. It involves cognitive-behavioral techniques with mindfulness strategies to help patients better understand and manage their invasive thoughts and compulsions without placing any judgments upon them.

Medication: When therapy alone doesn’t help, doctors may prescribe medicines. Medications may include antidepressants like Zoloft and Prozac, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and paroxetine, or serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine. The specific treatment will depend on the patient’s particular needs.

Related: 10 Hidden Diseases Doctors Find Hard to Diagnose

The Bottom Line

Purely Obsessional OCD can be hard to spot since the compulsions and thoughts are almost always in the person’s head. However, if untreated, it can take over a person’s ability to think about anything other than their intrusive thoughts. This can lead to severe anxiety, hopelessness, shame, and distress. Also, people with Pure OCD can delay treatment as there’s no visible proof of their experience. Therefore, it’s important to know what obsessive thoughts and mental compulsive behaviors need to be watched out for so that the best course of treatment can be decided upon. 

If you or someone you love is experiencing the distressing symptoms of Pure OCD, contact a mental health professional.

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