‘Pure O’ and How to Treat It

What is ‘Pure O’ OCD?

‘Pure O’ is not an official diagnosed label, but is rather a subtype of OCD that’s characterized by intrusive thoughts, images or urges without any visible physical compulsions. Despite the name, people with ‘Pure O’ do actually engage in compulsions to alleviate their distress the same way as other OCD sufferers do, its just that the compulsions are mental and therefore ‘invisible’.  It could be replaying events over and over again in your mind, silently repeating phrases in your head, becoming hyper-aware of normal bodily sensations — just to name a few.

Though they can take many forms, the most common intrusive thoughts generally centre on themes of harm, relationships, sexuality, and religious or moral questions. These ideas and images can feel like an attack on a person’s sense of self and they often come with guilt and shame.

Many people with pure OCD are scared 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. Because their experience is internal, there often aren’t obvious visual clues an outside observer might notice to identify someone with pure OCD, but that makes it no less distressing.

Treating ‘Pure O’

Even though pure OCD compulsions are often not noticeable from an outside perspective, they are best treated like all types of OCD compulsions: with exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment, backed by decades of rigorous clinical research.

For pure OCD, a trained ERP therapist will be able to help you identify your mental compulsions and work with you to come up with the best course of treatment for exposure to them.

If you’ve ever tried not thinking about something, you know how difficult it is to control your thoughts (try to not think about a red-faced monkey for the next 30 seconds…see). ERP therapy takes the opposite approach: Instead of trying to make yourself stop your obsessive thoughts, you welcome them. In a way, many people with Pure O have built in exposure happening all the time, so that part of ERP is automatically taken care of.  So the only thing that needs to happen is the response prevention. But this is not that easy.

Because what you need to do is not try to not have the intrusive thoughts or obsessions (that’s basically impossible to do), but rather stop yourself doing whatever is you do to relieve your anxiety over them. This might be:

-       Researching on the internet for hours on end

-       Sitting and thinking for hours, trying to figure out what the thoughts mean

-       Seeking reassurance from other people (eg. Asking them if X is OK)

So what can you do instead when these intrusive thoughts appear? In addition to NOT doing your compulsions there are some positive things you can do.  The best thing I think to do is committed action in line with your values.  This approach is very much in line with Acceptance and Commitment Therapy (ACT), a mindfulness-based form of psychotherapy that encourages you to ‘get out of your head and into your life’ by focussing on your values and then making decisions to live in accordance with them despite what shows up on the inside.  So taking this approach, when intrusive thoughts show up you might just say ‘thanks mind for that thought, but I am going to go and do X right now’ and then go and do X or keep doing X (walk your dog, visit your friend, play with your kids, work on your novel, study for your exam, cook a nice meal, go to the gym, wash the dishes, mow the lawn…whatever it is that you want to do that takes you in the direction of the life you want).  Living out your values is powerful because many people think they can’t live their lives whilst experiencing certain thoughts or emotions.  But you can! Read though that list of activities again. Notice that you can do all of them even if distressing thoughts or emotions are happening inside of you.  A thought in your head cannot stop you doing anything! It’s just a thought. So next time an intrusive thought appears, acknowledge it, and then just keep doing what you’re doing!

‘Suffering occurs when people so strongly believe the literal contents of their mind that they become fused with their cognitions.’ – Steven Hayes

Other helpful tips for exposure with Pure OCD:

1.     Change the way you obsess. Find a way to corrupt the rules of OCD. For example you could write down the obsessions, you could sing it out loud, you could repeat it really fast (these are called defusion techniques)

2.     Write down your obsession and record yourself reading it into your Voice Recorder on your phone. Then play it back to yourself on repeat until you’re able to listen to it for 30 mins +. Bonus points for reading it in a silly voice (maybe use a cartoon voice) or a singing voice, or any kind of weird voice that makes the obsessional thought less serious and sticky.

A Note About Distraction

‘I’ve been told that using distraction is not good when trying to get rid of OCD (because then I’m tacitly acknowledging that the OCD is this big scary thing which feeds the belief that it’s scary). How do I know I’m not using committed action as a distraction?’

If you are distracting yourself using things that go against your values or the life you want to live (eg. Using drugs, blasting loud music, binge watching TV…) then yes, you are likely using distraction in an unhelpful way.  If however, when an obsession pops up, you go to the gym, or go for a walk, or just keep doing what you’re doing, then I would not call that a distraction. Additionally, it’s not a distraction if you acknowledge the thought. And remember, that in a very real sense, OCD and the compulsions are actually the distraction. Because they are distracting you from life! Living your life and doing what you’re supposed to be doing is not a distraction! OCD is the distraction from life!