‘Pure O’ OCD: A Type of Obsessive-Compulsive Disorder With Mental Compulsions
Key takeaways:
Obsessive-compulsive disorder (OCD) is a mental health condition that involves obsessions and compulsions.
Pure obsessional (or “pure O”) is an unofficial type of OCD where compulsions mainly show up as thoughts instead of actions.
Like all types of OCD, pure O can be treated with medications and therapy.
Table of contents
You may be familiar with some of the symptoms of obsessive-compulsive disorder (OCD), such as intrusive thoughts, obsessions, and compulsions. Some of these symptoms can be very noticeable — excessive hand-washing, counting out loud, or double-checking locks or stoves, to name just a few.
But did you know that some people with OCD don’t have obvious symptoms? It’s possible to have OCD where both the obsessions and compulsions take place in your head. This is sometimes called pure obsessional (or “pure O”) OCD, because the compulsions are mostly invisible to others.
What is pure O OCD?
Pure O is an unofficial type of OCD. As with other types of OCD, people with pure O have obsessions and compulsions. But the difference is, most (or all) of the compulsions are mental. This means the compulsions are not visible to the outside world.
People with pure O usually try to neutralize the obsessions using their own minds, or inner logic. This can look different from “normal” OCD, where the compulsions are easy to see — such as hand-washing or counting out loud.
Pure O OCD vs. other types of OCD
OCD is unofficially divided into different subtypes based on the content of a person’s obsessions. But technically, there’s really only one type of OCD, according to the DSM-5-TR. The DSM-5-TR is a handbook that clinicians use to diagnose mental health conditions.
All people with OCD have obsessions, compulsions, or both. The difference is that people with pure O have compulsions that are less obvious because they’re almost entirely mental.
Obsessions are recurring intrusive thoughts, images, or urges that are hard to control. They’re often accompanied by feelings of fear, anxiety, or distress. Obsessions are usually followed by an attempt to either suppress or neutralize them with a compulsion.
Examples of pure O obsessions
Like those with other types of OCD, people with pure O tend to have intrusive, distressing obsessions about topics, such as:
Sex
Illnesses
Accidents
Violence
Religion
Relationships
With pure O OCD, these obsessions lead to “invisible” mental compulsions, such as:
Replaying events over and over in your mind
Mentally monitoring your verbal and physical behavior
Counting things silently in your head
Silently repeating phrases, questions, or facts
Silently asking yourself questions about your identity and actions
Praying
Playing mental word games
Thinking of “good” thoughts to neutralize “bad” ones
Sometimes, pure O compulsions can also be actions. These could include:
Asking other people for reassurance
Avoiding people, places, or situations that are related to the obsession
Keep in mind: It’s normal to have obsessive thoughts or do comforting rituals from time to time. And most people count in their head or pray at times. But for people with OCD, the obsessions and/or compulsions are distressing, time-consuming, and disruptive to daily life.
What causes pure O OCD?
As with most other mental health conditions, there’s no clear cause of OCD. Experts believe that it may be caused by different overlapping factors, such as your:
Family history (genetics)
Brain structure and functions
In children, a sudden onset of OCD can be caused by strep bacteria. This is referred to as Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS). PANDAS only affects children and is accompanied by other symptoms, such as changes in mood, irritability, and inattention.
Experts still don’t know why some people with OCD have behavioral compulsions, while people with pure O OCD have mostly mental compulsions. Future research may help us better understand the causes of OCD.
How do I know if I have pure O OCD?
The only way to know for sure if you have OCD is to be evaluated and diagnosed. OCD can be diagnosed by a trained mental health professional, such as a psychiatrist, psychologist, or therapist.
Pure O can be hard to recognize. People with pure O OCD don’t always have the OCD symptoms that you see portrayed in movies and on television. But they do have obsessions, compulsions, or both — just like all people with OCD.
If you suspect that you may have OCD, consider reaching out to a mental health provider for an evaluation. They will ask you questions about your symptoms and mental health history. This will help them determine if you have OCD. If you do have OCD, they will be able to talk to you about your treatment options.
How can I stop obsessive thoughts?
It can be hard to stop obsessive thoughts on your own. But fortunately, OCD is treatable. The most effective treatment for OCD is a combination of therapy and medication, especially for those with severe symptoms.
Therapy for pure O OCD
Therapy is a great place to start. Exposure and response prevention (ERP) therapy is usually the first-choice option for treating OCD. During ERP, a trained therapist helps you work toward facing the thoughts, images, and situations that trigger your obsessions without resorting to your compulsions. ERP can help you feel less controlled by your obsessions and more in control of your own life.
Other types of therapy can also help with OCD. Cognitive behavioral therapy (CBT) can help you recognize thinking errors that may increase your anxiety. CBT can also help you learn coping skills to manage your OCD symptoms.
Acceptance and commitment therapy (ACT) is another type of therapy that can treat OCD. ACT helps you learn mindfulness skills to manage your OCD symptoms. An ACT therapist will also help you identify your values and work toward building the life you want rather than one controlled by OCD.
Medications for pure O OCD
Medications can also help, particularly if used together with therapy. A type of antidepressants called selective serotonin reuptake inhibitors (SSRIs) can help reduce OCD symptoms. These include:
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Your healthcare provider may recommend other medications for OCD, as well, depending on your symptoms. People with OCD typically require higher doses of medications than those with depression. It may also take 8 to 12 weeks to notice improvements. And you may need to try more than one medication to find the best option for you.
The bottom line
Pure O OCD can be hard to spot — especially since the compulsions almost always occur mentally or internally. But even though the compulsions aren’t visible, they can still cause a lot of anxiety, shame, and distress.
If you experience unwanted thoughts, urges, and images, speak with a mental health provider about whether you could have OCD. Treatment can keep your OCD under control and stop obsessions and compulsions from interfering in your daily life.
Why trust our experts?
References
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International OCD Foundation. (n.d.). Subtypes of OCD.
Murayama, K., et al. (2020). Impacts of stressful life events and traumatic experiences on onset of obsessive-compulsive disorder. Frontiers in Psychiatry.
National Institute of Mental Health. (2019). PANDAS—Questions and answers.
National Institute of Mental Health. (2022). Obsessive-compulsive disorder.
Sibrava, N. J., et al. (2011). Prevalence and clinical characteristics of mental rituals in a longitudinal clinical sample of obsessive compulsive disorder. Depression and Anxiety.
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Substance Abuse and Mental Health Services Administration. (2016). Table 3.13: DSM-IV to DSM-5 obsessive-compulsive disorder comparison. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.
Williams, M. T., et al. (2011). The myth of the pure obsessional type in obsessive-compulsive disorder. Depression and Anxiety.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
