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Pure OCD

What is Pure O?

Pure Obsessional OCD, shortened to Pure O, reports only the obsessions and none of the compulsions that arise in Obsessive-Compulsive Disorder; hence the name Pure Obsessional OCD.

The label Pure O came into the popular domain when it was first used by Dr Phillipson1 while working in groups with people with OCD. He noted a set of individuals who did not appear to perform observable rituals to neutralise their upsetting thoughts.

How is Pure O different from OCD?

It’s OCD without compulsions, obsessions without compulsions, and disturbing thoughts without the need to carry out rituals that people associate with OCD.

OCD comprises both obsessions and compulsions. The person has a disturbing thought (an obsession) and tries to counter this by performing a compulsion, such as handwashing, after touching something. In this example, if the person touches something and worries that their hands may be contaminated, this thought results in high anxiety levels and is eased when the person washes. They feel compelled to clean, hence the name, compulsion.

In Pure OCD, the person will have an uncomfortable thought but no observable compulsions that fit the more stereotypical notion of OCD.

The compulsions will be hidden from view, or the person will not recognise them as compulsions.

Examples of Pure OCD

Intrusive thoughts or images that disturb you are an example of Pure OCD. To ease your discomfort, you may seek reassurance through mental analysis. This is a hidden-from-view mental compulsion known as a covert compulsion.

Types of unwelcome thoughts that disturb include;

Is Pure O an actual diagnosis?

In terms of diagnosis carried out by mental health professionals, the answer is no, but that does not mean it does not exist or is not helpful.

Mental health professionals use a diagnostic tool called DSM or other diagnostic manuals, and Pure OCD does not exist there. They will not give you a diagnosis of Pure OCD.

Some clinicians do not think Pure OCD is a helpful label and is OCD. I can’t entirely agree with this (although I understand the rationale), as labels are essential for people to make sense of their experiences.

People suffering from doubt, uncertainty and distressing thoughts, but do not recognise themselves in what they see as the ‘traditional’ symptoms of OCD, may not seek help if they do not have a label to describe what is happening to them.

The horror and shame associated with their thoughts are enough to stop someone from seeking treatment, and without a label, how would they know where to start?

The ability to assign the label Pure O, Pure OCD or indeed anything else to their experience can be a step toward seeking help, as perhaps for the first time the person does not believe they are capable of the terrible thoughts in their head, but see the experience as a symptom of something, a sign of Pure O.

What help is available for Pure OCD?

Suppose you now realise that the thoughts in your head are not saying something bad about you but are a symptom of something happening to your emotional health. In that case, there are things you can do to move past the thoughts.

Do I need to see my doctor?

Meeting with your doctor is an excellent place to start. They can make a referral to meet with a psychologist, like me, to undertake an assessment. This is nothing to worry about. The evaluation is to assign the label and develop a treatment plan.

The label or diagnosis is okay too. For example, if I had pain in my foot that affected my quality of life, if I met my doctor and gave me the label of a sprained ankle, we both know what we are dealing with. The simple label of the sprained ankle would allow me to access treatment.

It’s the same for your obsessive thoughts. Suppose a mental health professional assigns the label OCD. In that case, you know you are not going crazy, and the psychologist can explain your thoughts and follow guidelines on what works best for OCD.

Don’t be put off when you are told OCD, as that will be the diagnosis that makes the most sense of your symptoms. As I said above, there is no official diagnosis of Pure O. It can be helpful for you to think of Pure O as a type of OCD, as for you to feel better, you need to learn to manage your thoughts (obsessions) and the hidden compulsions, which is the treatment for OCD.

You can read more about the different treatments available in the following articles.

Exposure response prevention

CBT for unwanted thoughts

Dr Phillipson OCDONLINE