Key Takeaways‘Pure O’ or ‘purely obsessional’ OCD is a term used to describe people who experienceunwanted, intrusive thoughts(obsessions) without any visible ritual behaviors (compulsions).So, while the term “Pure O” is still sometimes used, multiple research studies suggest that true purely obsessional OCD does not exist.When you carefully assess for mental compulsions and subtle reassurance-seeking, almost everyone withOCDappears to have both obsessions and compulsions. It’s just that the compulsions aren’t always obvious, visible actions, likehand washingorchecking.These mental rituals can be easily missed or not recognized as OCD symptoms, since they happen internally rather than being physical actions others can observe.The term “Pure O” is misleading and unhelpful because it may prevent people from recognizing mental compulsions, hindering proper diagnosis andtreatment of their OCD.
Key Takeaways
The Myth of the Pure Obsessional in OCD
When researchers looked more closely at people who seemed to have “Pure O” or purely obsessional OCD, they found that mental rituals and reassurance-seeking were common compulsions that had been previously overlooked.
Covert compulsions are still compulsions
The unobservable nature of mental compulsions may cause them to be missed or mistakenly classified as an obsession.
The most shameful forms of OCD are more likely to have covert mental compulsions.
They found that mental compulsions (like mentally repeating words or phrases) and reassurance-seeking behaviors loaded together with taboo thoughts (sexual, religious, or aggressive obsessions) had been considered signs of “pure obsessions.”
This suggests that people with these obsessions did have compulsions, too – just mental ones rather than physical actions. The compulsions were subtle and easy to miss without careful assessment.
They found that among those withreligiousand sexual obsessions, mental rituals were actually the most common compulsion. This was true even though, at first glance, many seemed to have no compulsions.
Here are some examples of the kinds of mental rituals they observed:
How to Identify Mental Compulsions
Identifying mental compulsions in “Pure O” can be challenging, as these rituals are often subtle and not as observable as physical compulsions.
By increasing awareness of your thought patterns and mental habits, you can start to identify the mental rituals that may be part of your OCD cycle.
Some common examples of mental compulsions in “Pure O” include:
Is Pure O in the DSM-5?
The DSM-5 criteria for OCD require the presence of obsessions, compulsions, or both. The manual defines compulsions as behaviors or mental acts that the individual feels driven to perform in response to an obsession or based on rigid rules. This definition includes both observable compulsions and mental rituals.
While the DSM-5 allows for a diagnosis of OCD based on obsessions alone, it does not formally recognize “Pure O” as a distinct subtype.
The concept of purely obsessional OCD may not accurately reflect the clinical reality, as mental compulsions and reassurance-seeking often accompany obsessions when assessed carefully.
Sources
Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder.Journal of Consulting and Clinical Psychology, 71(6), 1049-1057.https://doi.org/10.1037/0022-006X.71.6.1049
Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., Liebowitz, M., Simpson, H. B., & Foa, E. B. (2011). Myth of the pure obsessional type in obsessive–compulsive disorder.Depression and Anxiety, 28(6), 495-500.https://doi.org/10.1002/da.20820
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
