Pure OCD (purely obsessional OCD) is a form of obsessive-compulsive disorder (OCD) where people experience intrusive, distressing thoughts, images, urges, feelings, or sensations, and often engage in mental rather than visible compulsions. It’s a widely used term, but it’s not a separate diagnosis in the DSM-5. Instead, it’s a way to describe OCD that’s harder to spot because the compulsions happen mainly in the mind.
What is pure O OCD?
Pure O OCD is a type of OCD in which a person’s compulsions are largely mental or covert.
- In a study of 225 patients with OCD, 12.9% reported mental compulsions as their main compulsion.
- Unlike more visible compulsions like checking or handwashing, the rituals in pure O OCD are often thought-based.
- Common mental compulsions include reassuring yourself, analyzing memories, or silently repeating phrases to reduce anxiety.
Many people with pure OCD are terrified of sharing these experiences for fear of being judged. “It’s common for people with ‘pure O’ OCD to feel like they are the only ones dealing with this,” shares Nicholas Farrell, PhD, LP, Director of Clinical Development and Programming at NOCD.
Common intrusive thoughts in pure O OCD
People with pure O experience unwanted, intrusive thoughts, images, urges, feelings, or sensations (known as obsessions) that cause significant distress.
These can include:
- Thoughts of harming yourself or others
- Sexual or taboo thoughts
- Religious or blasphemous thoughts
- Fears of acting immorally or inappropriately
Intrusive thoughts are a normal part of life, but in pure O OCD, the thoughts feel intolerable and lead to significant anxiety.
Mental compulsions and hidden behaviors in pure O OCD
- Silently repeating words or prayers
- Mentally reviewing past events for reassurance
- Neutralizing a “bad” thought with a good thought
- Ruminating to try to “solve” or “figure out” something
How pure O OCD differs from other types of OCD
Pure O OCD differs mainly in how compulsions present.
- Traditional OCD compulsions (like washing or cleaning) are behavioral and visible.
- Pure O compulsions are often hidden, making it appear that the person is “only obsessing.”
However, all forms of OCD share the same cycle: obsessions → anxiety → compulsions → temporary relief.
Signs and symptoms of pure O OCD
You may be experiencing pure O OCD if you:
- Have frequent, distressing, intrusive thoughts that feel uncomfortable
- Spend hours mentally reviewing, analyzing, or seeking reassurance
- Avoid triggers out of fear of having certain thoughts or feelings
- Feel intense guilt or shame about the content of your thoughts
If these symptoms are significantly interfering with your daily life, it’s best to seek help from a mental health professional with specialized training in OCD.
Is pure O OCD treatable?
Yes. Pure O OCD is highly treatable. With the right approach, many people see significant improvement in their symptoms.
Effective treatments for pure O OCD
The most effective treatment for pure O OCD is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
- ERP therapy helps you gradually face feared thoughts and reduce compulsive behaviors.
- Studies show ERP therapy works for all OCD subtypes, including pure O, with 80% of people showing a significant improvement in their symptoms.
Other treatment options may include:
- Medication: SSRIs are often prescribed to reduce moderate to severe OCD symptoms when combined with ERP therapy.
- Acceptance and commitment therapy (ACT): In combination with ERP therapy, ACT helps you live with uncertainty rather than fighting it.
Severe, treatment-resistant pure OCD may benefit from the following treatments:
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Intensive outpatient programs (IOPs)
- Gamma knife radiosurgery (GKRS)
A mental health professional—preferably an OCD specialist—will guide you in finding the right treatment approaches to reduce your symptoms and get your life back from pure O.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
FAQs about pure O OCD
Can you have OCD without compulsions?
No. Even if compulsions are mental or subtle, they are still part of the OCD cycle.
What does pure O OCD feel like?
It often feels like you’re stuck in your head, constantly battling thoughts that feel disturbing or dangerous.
Can you recover from pure O OCD?
Yes. Many people achieve lasting relief with ERP therapy and other evidence-based treatments.
Bottom line
Pure O OCD can feel isolating because the compulsions are mostly invisible, but it’s still the same OCD cycle—and it’s highly treatable. With the right therapy, you can learn to live with uncertainty, reduce compulsions, and regain your quality of life.
Key takeaways
- Pure O OCD isn’t “obsession-only”—mental compulsions are part of the cycle.
- Intrusive thoughts are common, but in Pure O, they feel intolerable and lead to hidden rituals.
- Exposure and response prevention (ERP) therapy is the most effective treatment, with up to 80% success in reducing symptoms.
- Pure O OCD is highly treatable, and early intervention can dramatically improve quality of life.
