Obsessive compulsive disorder - OCD treatment and therapy from NOCD

“Pure O” OCD

By Jithin Vijayan, MA LPC

Oct 13, 20224 minute read

Reviewed byPatrick McGrath, PhD

What is “Pure O” OCD?

Unlike other subtypes of OCD, “Pure O” Obsessional Compulsive Disorder as a diagnostic subtype does not refer to the content, themes, or categories of intrusive thoughts, images, or urges a person may struggle with, but rather to the affected person’s tendency to react to those thoughts, images, or urges primarily through mental or emotional responses rather than physical ones. Individuals who are “just obsessing” may engage in mental compulsions like rumination, rationalization and self-reassurance, or other mental checks and rituals in an effort to alleviate anxiety induced by their intrusive thoughts. 

Someone with “Pure O” OCD may go through a constant internal back and forth as they come upon different perspectives in which to understand their intrusive thoughts and ideas. They may experience mood swings as they sometimes feel as if a worst case scenario is imminent, while at other times are able to push away their thoughts as illogical or unlikely to occur. As with other types of anxiety, this constant engagement with one’s intrusive thoughts can reinforce the cycle of anxiety, intrusive thoughts, and compulsive responses.

“Pure O” OCD – Common obsessions

  • What if something terrible happens to me or a loved one?
  • Did I say or do something inappropriate in that situation?
  • Why was I so careless?
  • Why couldn’t I just have done things the right way?
  • Is there something wrong with me?
  • Is this the right job for me?
  • Am I in the right relationship?
  • Am I where I need to be in life?
  • Is life even meaningful?

Common triggers

People with “Pure O” OCD may be triggered by any situation that could provoke doubts and questions about their life, relationships, decision making, or general existence and circumstances. They may feel pressured to answer these questions as soon as they appear, as they may believe those answers to be heavily meaningful and impactful to their life and future.

Triggers for people with Pure OCD fears include:

  • Doubts about their work, life, or relationships
  • Mistakes they believe they might have made

How can I tell if it’s “Pure O” OCD, and not just stress, anxiety, and general worry?

Although anyone can experience stress and general worry about their life circumstances, individuals with “Pure O” OCD may go through a constant mental calculation that can end up feeling like an internal war. This can be debilitating for the affected individual as the perspectives they have towards their thoughts in any one instance could have profound impacts on their mood and behavior.

Common compulsions

When people with “Pure O” OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions like rumination, rationalization and self-reassurance, and other mental checks and rituals.

Rumination can refer to the various “what if” scenarios one may play out in their mind in an effort to predict, prevent, mitigate, prepare for, or proactively cope with any negative or worst-case situation the person fears. Rationalization and self-reassurance can refer to the individual’s efforts to try and figure out, and perhaps convince oneself, why the negative or worst case scenario may not actually occur or be as impactful as they fear. This “pushing back” the thoughts may seem like a very reasonable way to reframe one’s obsessive worry, however the ongoing engagement with their unwanted thoughts may still end up reinforcing their cycle of anxiety and mental compulsions rather than helping the person let go of the worry itself.

Compulsions performed mentally or physically by people with Pure OCD fears include:

  • Rumination
  • Rationalization and self-reassurance
  • Mental checks and rituals

How to treat “Pure O” OCD

“Pure O” OCD can be debilitating for people who struggle with it, but it is highly treatable. Through exposure and response prevention (ERP) therapy, a trained professional can help you identify the mental compulsions you engage with in response to any intrusive thoughts or ideas, and work through those challenging situations in healthy ways rather than ways that reinforce the anxiety and worry.

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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