What is Pure O OCD?
- Paul Vingoe
- 1 day ago
- 4 min read
Obsessive-Compulsive Disorder (OCD) is often misunderstood as a condition defined by visible compulsions like hand washing or checking locks repeatedly. However, there is a lesser-known form called Pure O OCD, which can be just as distressing but harder to recognize. This blog post explores what Pure O OCD is, how it differs from typical OCD, and what those affected can do to manage it.
Understanding Pure O OCD
Pure O OCD, short for Purely Obsessional Obsessive-Compulsive Disorder, is a subtype of OCD where the individual experiences intrusive, unwanted thoughts without the outward compulsive behaviours commonly associated with OCD. The term "Pure O" can be misleading because people with this form often do perform mental rituals or subtle behaviours, but these are not as obvious as physical compulsions.
What Are Obsessions in Pure O?
Obsessions are persistent, intrusive thoughts, images, or urges that cause significant anxiety or distress. Some of the obsessions that I have worked on with clients are:
Fear of harming others unintentionally
Intrusive sexual or violent thoughts
Doubts about morality or religious beliefs
Fear of saying or doing something inappropriate
Concerns about symmetry or exactness, but mentally rather than physically checking
These thoughts are unwanted and can be extremely disturbing, and the person tries to suppress or neutralise them, which can lead to mental rituals.
Mental Rituals and Compulsions
Unlike typical OCD, where compulsions are visible actions like washing hands or checking doors, Pure O compulsions are mostly internal. Examples include:
Repeating phrases silently to "cancel out" a bad thought
Mentally reviewing conversations or events to ensure nothing offensive was said
Seeking reassurance from others repeatedly
Avoiding certain topics or situations that trigger obsessions
These mental compulsions can be exhausting and time-consuming, often taking up hours each day.
How Pure O OCD Differs from Typical OCD
The main difference lies in the nature of compulsions. In typical OCD, compulsions are physical and observable. In Pure O, compulsions are mostly mental and hidden, making it harder for others to notice or understand the struggle.
This invisibility often leads to misunderstandings. People with Pure O may feel isolated or ashamed because their distress is not visible. They might also doubt their own experiences, thinking their thoughts are "just in their head" or that they should be able to control them.
Common Misconceptions About Pure O OCD
It’s just overthinking: Pure O is not simple worry or overthinking. The thoughts are intrusive, unwanted, and cause intense anxiety.
People with Pure O want to have these thoughts: The opposite is true. These thoughts are unwanted and cause distress.
No compulsions means no OCD: Mental compulsions are real compulsions. They serve the same purpose as physical ones, which is to reduce anxiety temporarily.
Pure O is rare: Estimates vary as Pure O is often underdiagnosed but 2019 figures are below**
Real-Life Examples of Pure O OCD
To understand Pure O better, here are some examples:
A person might have intrusive thoughts about accidentally harming a loved one and spend hours mentally reviewing every interaction to ensure they did not cause harm.
Someone else might experience unwanted blasphemous thoughts and engage in silent prayers or mental rituals to "undo" the thought.
Another individual could be plagued by doubts about their sexual orientation or morality, leading to constant mental checking and reassurance-seeking.
These examples show how Pure O can affect daily life, causing distress and interfering with normal functioning.
Managing Pure O OCD
Living with Pure O OCD is challenging, and distressing but there are effective ways to manage it. Treatment may involve a combination of therapy, medication, and self-help strategies.
Cognitive Behavioral Therapy (CBT)
CBT, especially Exposure and Response Prevention (ERP), is a very effective treatment for OCD, including Pure O. ERP involves gradually exposing the person to feared thoughts or situations without performing mental rituals, helping reduce anxiety over time.
Acceptance and Commitment Therapy (ACT)
ACT is another effective talking therapy that can help with Pure O. By paying attention to our thoughts and how they 'hook' us, we can learn to let them go.
Self-Help Techniques
Mindfulness: Practising mindfulness helps individuals observe their thoughts without judgement or reaction.
Journaling: Writing down intrusive thoughts can reduce their power and help track patterns.
Limiting reassurance seeking: Trying to reduce the need for constant reassurance can break the cycle of compulsions.
Education: Learning about Pure O helps reduce shame and increases understanding.
When to Seek Professional Help
If intrusive thoughts interfere with daily life, cause significant distress, or lead to avoidance behaviours, it is important to seek professional help. Early intervention can improve outcomes and reduce the impact of OCD on quality of life.
I work with OCD and intrusive thoughts (including Pure O), drawing on approaches such as CBT, ERP and ACT. You can read more about how I work here.
**It’s estimated that 1.2% of the population will be suffering from OCD, which based off estimates for the UK population means approximately 792,000. Many of those people will be experiencing unwanted intrusive thoughts, although not specifically sexual thoughts.
NICE guidelines report that only 5.5% of sufferers have obsessions related to sexual thoughts and 4.3% have obsessions related to the fear of harming someone. These topics are the commonly accepted focus of Pure O, which would mean approximately 77,616 people might have what some people call Pure O. (https://www.ocduk.org/pure-o-the-facts/)
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