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What is Pure Obsessional OCD (Pure-O)?

By Debra Kissen

 As with most types of Obsessive Compulsive Disorder’s (OCD), compulsions are known to be visual rituals such as washing, checking or even counting in order to minimize the distress brought on by their intrusive thoughts, or obsessions. If you are experiencing  “pure obsessional OCD” you still are engaging in compulsions but they will be less easily detected because they are primarily mental and not detectable to the outside observer. . Because of the hidden nature of this OCD, it generally is harder for people dealing with it to recognize what is going on, let alone to ask for help.

Common pure-O obsessions consists of fear of harming self or others (harm OCD), fear that you’re gay when you’re actually straight and vice versa (homosexual OCD or H-OCD), fear that you are not good enough for your partner (relationship OCD) and Pedophilia OCD (pOCD). The different types of mental compulsions range from thinking you’re a bad person, avoidance, answer seeking, reassurance and researching (Google is not our friend).  So how do you know if you have Pure-O? Everyone experiences intrusive thoughts, but when these thoughts become debilitating causing extreme discomfort and are reoccurring frequently, that is when it becomes Pure-O OCD. An example can be someone who is prepping dinner and while cutting the food, gets the thought “what if I lose control and hurt myself or my partner.” We can interpret this thought in many ways, but it is our reaction to the thought that can allow us to dodge or fall down the rabbit hole. We can think “that was a strange thought” and redirect back to prepping or we can try and figure out what this thought means about our character? Or think that it has to mean something because of the frequency of the thought. It important to remember that we are not our thoughts, and our thoughts are not reflective of our character.

A big factor that plays into compulsions is the inability to be 100% certain. What if I am gay? What if I don’t love my spouse? A lot of the time, we believe that we should be able to answer these questions with certainty and when one can’t figure it out, this leads to the reassurance and answer seeking or the mental un-doing. So then, how do you overcome Pure-O? There are a few answers: a combination of cognitive behavioral therapy (CBT) and mindfulness-based techniques, exposure and response prevention (ERP) and depending on severity, medication (SSRI) alongside the above treatments can help but not just medication alone. Doctors should always be consulted when considering the option of medication.

What does therapy look like? Therapy will consist of learning to identify, understand and change maladaptive thoughts and behaviors. Then you will begin to engage in exposures while preventing the compulsion in order to neutralize or or eliminate the fear altogether. For the example above, an exposure can be holding plastic knife and saying “I am going to lose and control and stab myself” then eventually moving to holding a chef’s knife and repeating the saying until anxiety has dissipated. 

Although ERP may help some people fully recover, It is also important to remember that the goal is to better manage the anxiety associated with the fears not eliminate the anxiety all together.

By: Dominique Apollon, M.Ed

Dr. Debra Kissen is CEO of Light On Anxiety CBT Treatment Center. Dr. Kissen specializes in Cognitive Behavioral Therapy (CBT)...

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