Pure Obsessional OCD or “Pure O”

“Pure O” OCD is a colloquial term in the OCD community short for “purely obsessional” OCD. The name is a misnomer, however, because individuals with pure O do in fact perform compulsions; they just happen to be fully mental. Examples of mental compulsions include praying, mental review, checking how you feel, checking bodily sensations, and repeating phrases. Unfortunately, lack of physical compulsions increases the risk for misdiagnosis, which is why awareness of it is so important.

Pure O can encompass a wide variety of themes just like OCD with physical compulsions. In fact, some argue that pure O doesn’t really exist, as it is simply OCD without visible compulsions. 

Here is a personal account of what it can be like to live with the “Pure O” subtype of OCD from one of our authors, Samantha Cartwright:

I’ve been dealing with intrusive thoughts for much longer than I’ve known I had OCD. That sounds like a strange statement to make when obsessive thoughts are indicative of OCD, but what if they aren’t accompanied by the outward performance of compulsions? For many years, I would skip over definitions and explanations of OCD symptomology while seeking out an explanation for my overwhelming thoughts because I never experienced physical compulsions such as hand-washing or checking or outward reassurance seeking. What I was also missing is the fact that I was indeed completing compulsions to neutralize my obsessive thoughts— they were just confined to the boundaries of my mind. 

For me, quelling the anxiety brought on by intrusive imagery and obsessive thoughts was a mental circus. A prime example being the instance when I convinced myself that if I didn’t count my steps in eights everywhere I went, a car would surely come up onto the sidewalk and run me over. While counting is most definitely still a compulsion, because it only took place inside my head and nobody else could see it happening I assumed that it didn’t fulfill the definition for what an OCD compulsion is. 

As I got older, my anxiety moved onto more mature themes such as romantic relationships. Pure OCD reared its ugly head again when I started trying to predict a 10-minute window in which my boyfriend would call, and if I wasn’t successful would convince myself that I was not a good partner or that he didn’t love me the way he told me he did. Again, it never dawned on me that these mental tasks were actually another form of performing compulsions. 

So, while Pure OCD is most definitely a valid subtype of OCD it is very often misunderstood and misdiagnosed because the compulsions attached to it are less visible and harder to recognize than those associated with other types of OCD. However, while Pure OCD is sometimes touted as a subtype that is purely obsessional, this is not true and it certainly does have a compulsive component to boot. If you are suffering with obsessive thoughts or intrusive images and have certain mental processes that help you neutralize them, you might just be suffering from this lesser known form of OCD and you should certainly seek help in the form of a specialized OCD therapist, or another professional who can lead you through therapies such as ERP. While you might not fit all of the general criteria for someone who suffers from OCD, there is a likelihood that you are still being affected by the disorder in alternative ways.

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