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Pure O OCD: Signs, Symptoms & Treatments

Published: January 29, 2021 Updated: January 25, 2023
Published: 01/29/2021 Updated: 01/25/2023
Headshot of Melissa Boudin, PsyD
Written by:

Melissa Boudin

PsyD
Dena Westphalen, PharmD
Reviewed by:

Dena Westphalen

PharmD
  • What Is Pure O?Definition
  • Common Pure O ObsessionsObsessions
  • What Are Mental Compulsions?Compulsions
  • Pure Obsessional OCD TreatmentTreatment
  • How to Get Help for Pure OGet Help
  • Final Thoughts on Pure OConclusion
  • Additional ResourcesResources
Headshot of Melissa Boudin, PsyD
Written by:

Melissa Boudin

PsyD
Dena Westphalen, PharmD
Reviewed by:

Dena Westphalen

PharmD

People with Pure O OCD (also known as Pure O and pure obsessional OCD) experience recurring unwanted thoughts, images, or sensations that elicit anxiety or distress to such an extent that their life is continually disrupted.1 Pure O can be hard for others to notice because the accompanying compulsions aren’t external or physically displayed. Instead, a person with Pure O OCD will carry out internal rituals and mental compulsions.

NOCD: Effective, Affordable & Convenient OCD Therapy

Do live, face-to-face video sessions with a therapist specialized in treating OCD and get 24/7 support between sessions. NOCD is covered by many insurance plans and available nationwide.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by NOCD.

Visit NOCD

What Is Pure O?

Pure O is a type of obsessive compulsive disorder where compulsions are completed mentally. Some may feel that they only experience obsessions, and not compulsions. That is typically not the case, and instead, mental rituals are occurring under the surface in a covert manner.

Through psychoeducation during treatment with a therapist, an individual can learn to identify mental compulsions. To meet clinical criteria, the symptoms must interfere with important activities or cause significant distress.2

How Is Pure O Different From Typical OCD?

The name Pure Obsessional (Pure O) is a bit of a misnomer because it is, in fact, OCD. There are both obsessions and compulsions present. With that in mind, it is a name that has helped many people seek out treatment who otherwise would not have.

Media and pop culture often incorrectly portray OCD as solely related to hand-washing or organization. While OCD may present for some in this way, it is not the case for everyone. The name Pure O gives community to those who may not feel they fit the stereotypical OCD portrayal.

Common Pure O Obsessions

Obsessions vary person to person, but there are common themes within OCD. Obsessions can elicit a strong emotional reaction due to the nature of their content. This is due to obsessional thoughts being ego-dystonic; meaning they are not in line with your personal belief system and it’s not the type of thought you’d expect yourself to have.3

Common obsessions in OCD include:

1. Unwanted sexual thoughts, like:

  • “What if I am a pedophile and don’t realize it?”
  • “Am I sexually attracted to a family member?”
  • “Am I gay and haven’t realized it yet?”
  • “What if I am sexually attracted to animals?”

2. Unwanted Harm thoughts, like:

  • “What if I snap and stab someone?”
  • “Why if I lose control and hurt someone I love?”
  • “What if I hurt my pet accidentally?”
  • “What if I ran somebody over while driving?”

3. Religious or Moral Scrupulosity thoughts, like:

  • “Did I offend god?”
  • “What if I’m not living a life according to my religious or moral values?”
  • “What if I wasn’t 100% honest?”
  • “What if I accidentally cheated on a past exam?”

What Are Mental Compulsions?

Compulsions are defined as repetitive behaviors used to try to neutralize, investigate, counteract, or get rid of obsessions.4 Compulsions are what an individual does in response to these thoughts. With Pure O, most rituals are mental and not able to be outwardly observed by others.

Common mental compulsions in Pure O come include:

Mental reviews or mental checking:

  • Mentally reviewing past events to see if you missed any important details
  • Mentally reviewing a drive to see if you accidentally hit someone
  • Mentally checking to see if you’re still “appropriately” horrified by the thoughts
  • Mentally checking to see if you are sexually attracted to something forbidden
  • Mentally checking to see if you’re still attracted to your partner

Self-reassurance:

  • Repeating self-reassuring statements such as “I’ll be okay,” “don’t worry about this,” or “don’t be silly, that’s irrational”
  • Repeating positive self-affirmations

Praying:

  • Silently repeating a prayer
  • Praying for forgiveness due to unwanted thoughts

Counting:

  • Silently counting (family members, numbers, etc.)

Thought neutralization:

  • Replacing “bad” words or thoughts with “good” ones through specific patterns

Visible Compulsions of Pure O

Although Pure O is a nickname for OCD without observable compulsions, there are sometimes overt, or visible, compulsions that are present as well.

Common examples of visible compulsions for those with Pure O are:

Reassurance seeking:

  • Repeatedly asking someone if they think you did the right thing
  • Repeatedly asking someone if they think you’d ever hurt anyone
  • Repeatedly asking if something makes you a “bad person”
  • Seeking reassurance from online forums or searches

Confessing:

  • Sharing every detail of an interaction with a partner
  • Overwhelming need to share a “bad” thing you might have done

Avoiding:

  • Avoiding areas that could trigger obsessions (playgrounds, scary movies, songs, knives, etc.)

Checking:

  • Checking bodily sensations
  • Checking that things are “safe” or how they “should” be

The above compulsions are common, but this list is not exhaustive. Compulsions vary person to person and can change over time.

Compulsions (both visible and invisible to others) are often exhaustive and frustrating for the individual engaging in them. They may want to get out the door for an important appointment, but feel as though they can’t until a ritual is completed. The problem with compulsions is that they reinforce the idea that you cannot tolerate the discomfort or anxiety you’re experiencing.

Treatment For OCD

NOCD: Effective, Affordable & Convenient OCD Therapy – NOCD therapists specialize in Exposure and Response Prevention (ERP) Therapy, the most effective OCD treatment. Treatments are covered by many insurance plans, Visit NOCD


Talkiatry: Virtual psychiatry – Get OCD help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment


Choosing Therapy partners with leading mental health companies and is compensated for marketing by NOCD and Talkiatry.

Pure Obsessional OCD Treatment

The gold-standard treatment for Pure O is Exposure and Response Prevention (ERP) and/or medication.5 These treatments have greatly improved prognosis for OCD.6 The promising outcomes referenced are largely due to ERP, a type of cognitive behavior therapy (CBT).

Therapy

Through working with an OCD therapist, individuals can expect to be treated with ERP. The goal in OCD treatment is to build skills to handle the presence of unwanted thoughts without engaging in compulsions. These skills develop through exposures, where the individual gradually exposes themselves to feared stimuli while resisting compulsions.

When completing ERP, the individual often uses a hierarchy and gradually builds tolerance for more challenging exposures. Studies have shown that individuals with covert compulsions (like in Pure O) also benefit as long as exposures are adapted.7 This can be done through the use of scripting or audio recordings.

Your therapist will never force you to do an exposure you’re not willing to do. Together you build a hierarchy and decide where you want to start. Oftentimes, this means taking a look at your values and what is most important for you. Your therapist may ask; what is important to you that OCD has gotten in the way of? This can be a jumping off point for value-driven exposure work.

Medication

Medication alongside therapy has been shown to be effective for OCD.8 The class of medications that are front-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs).9 A physician or psychiatrist will work with a patient to find the right medication for them and to consider side effects or possible risks with the medications.

Lifestyle Changes

While ERP and/or medication are the gold-standard treatment for OCD, certain lifestyle changes may also aid in recovery. This can involve taking an inventory on sleep, caffeine intake, substance use, overall stress, and exercise. A psychiatrist or therapist can work with the patient to assess their lifestyle and work on making healthy changes.

How to Get Help for Pure O

If you feel you may be struggling with OCD, don’t hesitate to ask for help. A good first step is visiting the International OCD Foundation’s website. IOCDF provides valuable resources to individuals, parents and families. Another great option for getting help is by using an online directory, where you can search for a therapist with specific qualifications, like someone who works specifically with people who have OCD.

Final Thoughts on Pure O

OCD can be debilitating and overwhelming. If you or someone you love is struggling with OCD, know you are not alone. Reaching out to a trusted friend or OCD specialist can be a scary, but powerful, first step.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

OCD Therapy

NOCD: Effective, Affordable, & Convenient OCD Therapy Do live, face-to-face video sessions with a therapist that specializes in treating OCD and get 24/7 support between sessions. NOCD is covered by many insurance plans and is available nationwide. Visit NOCD

Virtual Psychiatry

Talkiatry Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment

Choosing Therapy Directory

You can search for therapists by specialty, experience, insurance or price, and location. Find a therapist today.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by NOCD and Talkiatry.

For Further Reading

  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov
9 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • What is OCD? (2020, November 05). IOCDF.  Retrieved from https://iocdf.org/about-OCD

  • Abramowitz, J. Woodrow, S. (2018,July). I’m More Than My OCD: Putting Things in Perspective. IOCDF Conference, Washington D.C.

  • What is OCD? (2020, November 05). IOCDF. Retrieved from https://iocdf.org/about-OCD

  • How is OCD Treated? (2019, August 05). IOCDF. Retrieved from https://iocdf.org/about-ocd/ocd-treatment/

  • Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry. 2006 Jun; 51(7):407-16. doi: 10.1177/070674370605100702. PMID: 16838822.

  • Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry. 2006 Jun; 51(7):407-16. doi: 10.1177/070674370605100702. PMID: 16838822.

  • O’Connor, K., Todorov, C., Robillard, S., Borgeat, F., & Brault, M. (1999). Cognitive-Behaviour Therapy and Medication in the Treatment of Obsessive-Compulsive Disorder: A Controlled Study. The Canadian Journal of Psychiatry, 44(1), 64–71. https://doi.org/10.1177/070674379904400108

  • Kellner M. (2010). Drug treatment of obsessive-compulsive disorder. Dialogues in clinical neuroscience, 12(2), 187–197. https://doi.org/10.31887/DCNS.2010.12.2/mkellner

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: January 29, 2021
    Original Author: Madeline Moersch, LCSW
    Original Reviewer: Dena Westphalen, PharmD

  • Updated: January 19, 2023
    Author: Melissa Boudin, PsyD
    Reviewer: No Change
    Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources.

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Headshot of Melissa Boudin, PsyD
Written by:

Melissa Boudin

PsyD
Dena Westphalen, PharmD
Reviewed by:

Dena Westphalen

PharmD
  • What Is Pure O?Definition
  • Common Pure O ObsessionsObsessions
  • What Are Mental Compulsions?Compulsions
  • Pure Obsessional OCD TreatmentTreatment
  • How to Get Help for Pure OGet Help
  • Final Thoughts on Pure OConclusion
  • Additional ResourcesResources
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