'Pure O': An Overview of Pure Obsessional OCD

Table of ContentsView AllTable of ContentsPure O vs. OCDSymptoms of Pure OGetting DiagnosedOther Types of OCDTreatment for Pure OCoping

Table of ContentsView All

View All

Table of Contents

Pure O vs. OCD

Symptoms of Pure O

Getting Diagnosed

Other Types of OCD

Treatment for Pure O

Coping

Close

Pure O is sometimes mistakenly seen as a “less severe” form of OCD. For those who experience symptoms of this disorder, the characteristic intrusive thoughts can be very disruptive and distressing.

While some studies have suggested there may be different subtypes of OCD, others suggest that the term “pure O” may be something of a misnomer.While people who experience these obsessions without any obvious behavioral compulsions, they do still engage in rituals that are mental and unseen.

By understanding that such mental rituals exist, therapists and other mental health professionals can ask patients about these symptoms. Without such questioning and prompting, patients may be reluctant to describe the symptoms that they are experiencing or may not even be aware that they should discuss these symptoms.

Obsessive-compulsive disorder itself involves having reoccurring obsessions and behaviors (compulsions). For example, a person with OCD might have uncontrollable thoughts about germs and cleanliness that result in an urge to wash their hands over and over again.

ObsessionsRepeated intrusive images, thoughts, and impulses that create a great deal of distressMaking attempts to ignore, suppress, or neutralize the obsessive thoughtsCompulsionsRepetitive actions, either behavioral or mental, that a person feels compelled to perform as a result of obsessive thoughtsEngaging in actions intended to reduce distress related to the obsessions or preventing some dreaded event

ObsessionsRepeated intrusive images, thoughts, and impulses that create a great deal of distressMaking attempts to ignore, suppress, or neutralize the obsessive thoughts

Repeated intrusive images, thoughts, and impulses that create a great deal of distress

Making attempts to ignore, suppress, or neutralize the obsessive thoughts

CompulsionsRepetitive actions, either behavioral or mental, that a person feels compelled to perform as a result of obsessive thoughtsEngaging in actions intended to reduce distress related to the obsessions or preventing some dreaded event

Repetitive actions, either behavioral or mental, that a person feels compelled to perform as a result of obsessive thoughts

Engaging in actions intended to reduce distress related to the obsessions or preventing some dreaded event

Obsessions

Obsessionsare recurrent, persistent, intrusive, and unwanted thoughts, images, or urges that cause anxiety or distress. Obsessions often center on somatic, sexual, religious, or aggressive thoughts as well as concerns with things such as symmetry and contamination.

Compulsions

Compulsions, on the other hand, are repetitive behaviors or mental acts a person with OCD is driven to perform in response to an obsession or according to a rigid set of rules that govern them. Compulsions are clearly excessive or not connected in a realistic way to the problem they are intended to address.

In a 2011 study, researchers found that individuals who experience the “pure obsessions” (sometimes described as “taboo thoughts” or “unacceptable thoughts”) also engage in mental rituals as a way of managing their distress.These rituals might include:

Compulsions still exist in pure O, but they are much less obvious because they are almost entirely mental in nature.

In addition to experiencing obsessions and/or compulsions, the DSM-5 diagnostic criteria for OCD also stipulate the following:

If you or someone you love are experiencing distressing symptoms that keep you from participating in everyday activities (such as eating, sleeping, or going to work), contact a mental health professional.

Although there is limited research on the exact causes of pure O, there are a variety of studies that have investigated OCD and its causes. These may include:

OCD Subtypes: Types of Obsessive-Compulsive Disorder

Treatment for OCD, including pure O, often involves the use of medication in combination withpsychotherapy, which can includecognitive-behavioral therapy(CBT), support groups, and psychological education.

Psychotherapy

Research suggests that cognitive-behavioral therapy can be very effective at treating pure O. However, it is essential thattherapistsand other mental health practitioners understand the importance of addressing the underlying mental rituals that characterize this subtype of OCD.

If the therapist believes that the patient only suffers from obsessions and does not also treat the mental rituals that accompany these cognitions, the treatment will not be as complete or effective.

Exposure and response prevention, also known as ERP therapy, is a form of behavioral therapy also used in the treatment of other presentations of OCD.It involves a trained therapist helping a client approach a fear object without engaging in any compulsive behaviors.

Clients intentionally expose themselves to those things that trigger their obsessions or compulsions but are prevented from engaging in compulsive behavior or obsessive thoughts. The goal of such therapy is to teach patients how to manage their symptoms without acting upon compulsions. This increases distress in the short term, but can improve symptoms and behaviors over time.

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Medication

Medications may includeselective serotonin reuptake inhibitors (SSRIs)or the tricyclic antidepressant Anafranil (clomipramine). Second-generation antipsychotics, also known as atypical antipsychotic medications, are also used to augment SSRIs. One review suggested that approximately 40% to 60% of patients respond to treatment with SSRIs with a 20% to 40% reduction in OCD symptoms.

The specific treatment (or combination of treatments) depends on a patient’s particular needs. For example, a therapist may use CBT alone if a patient is unable to or doesn’t want to take medication. Or, they might prescribe medications alone to patients who aren’t motivated to pursue exposure-based treatments or who don’t have access to a CBT provider.

OCD Medications: How Antidepressants and Antipsychotics Can Help

Although treatment for OCD usually entails consulting with a qualified mental health professional, there are a number ofOCD self-help strategiesthat you can start using right now to help you or someone you love cope with pure O symptoms.

Pure O may not involve the outward behaviors that often come to mind when people think of OCD. However, the hidden mental rituals that characterize the purely obsessional form of the disorder are a type of compulsion, even though they may go unseen.

If you find yourself experiencing distressing obsessions and/or mental compulsions that are interfering with your daily life, consider talking to a mental health professional. They can help you understand your symptoms and find the best treatment to meet your needs. Though talking about your thoughts isn’t always easy, it is the first part of getting the help you may need to find relief.

If you or a loved one are struggling with Pure O, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with Pure O, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

11 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stewart SE.Obsessive-compulsive disorder. In: Camprodon J, Rauch S, Greenberg B, Dougherty D, eds.Psychiatric Neurotherapeutics. Current Clinical Psychiatry. New York: Humana Press; 2016. doi:10.1007/978-1-59745-495-7_2Williams MT, Farris SG, Turkheimer E, et al.Myth of the pure obsessional type in obsessive-compulsive disorder.Depress Anxiety. 2011;28(6):495-500. doi:10.1002/da.20820Norman LJ, Taylor SF, Liu Y, et al.Error processing and inhibitory control in obsessive-compulsive disorder: A meta-analysis using statistical parametric maps.Biol Psychiatry. 2019;85(9):713-725. doi:10.1016/j.biopsych.2018.11.010Rahimi A, Haghighi M, Shamsaei F.Pure obsessive compulsive disorder in three generations.Iran J Psychiatry Behav Sci. 2015;9(2). doi:10.17795/ijpbs1116Baer L.Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.J Clin Psychiatry. 1994;55 Suppl:18-23.Starcevic V, Brakoulias V.Symptom subtypes of obsessive compulsive disorder: Are they relevant for treatment?.Aust N Z J Psychiatry. 2008;42(8):651-661. doi:10.1080/00048670802203442Abramowitz JS, Deacon BJ, Whiteside SPH.Exposure therapy for anxiety: Principles and practice. Guilford Press; 2011.Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Kellner M.Drug treatment of obsessive-compulsive disorder.Dialogues Clin Neurosci. 2010;12(2):187-197. doi:10.31887/DCNS.2010.12.2/mkellnerManjula M, Sudhir PM.New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.Indian J Psychiatry. 2019;61(Suppl 1):S104-S113. doi:10.4103/psychiatry.IndianJPsychiatry_531_18Abrantes AM, Brown RA, Strong DR, et al.A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment.Gen Hosp Psychiatry. 2017;49:51-55. doi:10.1016/j.genhosppsych.2017.06.010

11 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stewart SE.Obsessive-compulsive disorder. In: Camprodon J, Rauch S, Greenberg B, Dougherty D, eds.Psychiatric Neurotherapeutics. Current Clinical Psychiatry. New York: Humana Press; 2016. doi:10.1007/978-1-59745-495-7_2Williams MT, Farris SG, Turkheimer E, et al.Myth of the pure obsessional type in obsessive-compulsive disorder.Depress Anxiety. 2011;28(6):495-500. doi:10.1002/da.20820Norman LJ, Taylor SF, Liu Y, et al.Error processing and inhibitory control in obsessive-compulsive disorder: A meta-analysis using statistical parametric maps.Biol Psychiatry. 2019;85(9):713-725. doi:10.1016/j.biopsych.2018.11.010Rahimi A, Haghighi M, Shamsaei F.Pure obsessive compulsive disorder in three generations.Iran J Psychiatry Behav Sci. 2015;9(2). doi:10.17795/ijpbs1116Baer L.Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.J Clin Psychiatry. 1994;55 Suppl:18-23.Starcevic V, Brakoulias V.Symptom subtypes of obsessive compulsive disorder: Are they relevant for treatment?.Aust N Z J Psychiatry. 2008;42(8):651-661. doi:10.1080/00048670802203442Abramowitz JS, Deacon BJ, Whiteside SPH.Exposure therapy for anxiety: Principles and practice. Guilford Press; 2011.Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Kellner M.Drug treatment of obsessive-compulsive disorder.Dialogues Clin Neurosci. 2010;12(2):187-197. doi:10.31887/DCNS.2010.12.2/mkellnerManjula M, Sudhir PM.New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.Indian J Psychiatry. 2019;61(Suppl 1):S104-S113. doi:10.4103/psychiatry.IndianJPsychiatry_531_18Abrantes AM, Brown RA, Strong DR, et al.A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment.Gen Hosp Psychiatry. 2017;49:51-55. doi:10.1016/j.genhosppsych.2017.06.010

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Stewart SE.Obsessive-compulsive disorder. In: Camprodon J, Rauch S, Greenberg B, Dougherty D, eds.Psychiatric Neurotherapeutics. Current Clinical Psychiatry. New York: Humana Press; 2016. doi:10.1007/978-1-59745-495-7_2Williams MT, Farris SG, Turkheimer E, et al.Myth of the pure obsessional type in obsessive-compulsive disorder.Depress Anxiety. 2011;28(6):495-500. doi:10.1002/da.20820Norman LJ, Taylor SF, Liu Y, et al.Error processing and inhibitory control in obsessive-compulsive disorder: A meta-analysis using statistical parametric maps.Biol Psychiatry. 2019;85(9):713-725. doi:10.1016/j.biopsych.2018.11.010Rahimi A, Haghighi M, Shamsaei F.Pure obsessive compulsive disorder in three generations.Iran J Psychiatry Behav Sci. 2015;9(2). doi:10.17795/ijpbs1116Baer L.Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.J Clin Psychiatry. 1994;55 Suppl:18-23.Starcevic V, Brakoulias V.Symptom subtypes of obsessive compulsive disorder: Are they relevant for treatment?.Aust N Z J Psychiatry. 2008;42(8):651-661. doi:10.1080/00048670802203442Abramowitz JS, Deacon BJ, Whiteside SPH.Exposure therapy for anxiety: Principles and practice. Guilford Press; 2011.Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Kellner M.Drug treatment of obsessive-compulsive disorder.Dialogues Clin Neurosci. 2010;12(2):187-197. doi:10.31887/DCNS.2010.12.2/mkellnerManjula M, Sudhir PM.New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.Indian J Psychiatry. 2019;61(Suppl 1):S104-S113. doi:10.4103/psychiatry.IndianJPsychiatry_531_18Abrantes AM, Brown RA, Strong DR, et al.A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment.Gen Hosp Psychiatry. 2017;49:51-55. doi:10.1016/j.genhosppsych.2017.06.010

Stewart SE.Obsessive-compulsive disorder. In: Camprodon J, Rauch S, Greenberg B, Dougherty D, eds.Psychiatric Neurotherapeutics. Current Clinical Psychiatry. New York: Humana Press; 2016. doi:10.1007/978-1-59745-495-7_2

Williams MT, Farris SG, Turkheimer E, et al.Myth of the pure obsessional type in obsessive-compulsive disorder.Depress Anxiety. 2011;28(6):495-500. doi:10.1002/da.20820

Norman LJ, Taylor SF, Liu Y, et al.Error processing and inhibitory control in obsessive-compulsive disorder: A meta-analysis using statistical parametric maps.Biol Psychiatry. 2019;85(9):713-725. doi:10.1016/j.biopsych.2018.11.010

Rahimi A, Haghighi M, Shamsaei F.Pure obsessive compulsive disorder in three generations.Iran J Psychiatry Behav Sci. 2015;9(2). doi:10.17795/ijpbs1116

Baer L.Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.J Clin Psychiatry. 1994;55 Suppl:18-23.

Starcevic V, Brakoulias V.Symptom subtypes of obsessive compulsive disorder: Are they relevant for treatment?.Aust N Z J Psychiatry. 2008;42(8):651-661. doi:10.1080/00048670802203442

Abramowitz JS, Deacon BJ, Whiteside SPH.Exposure therapy for anxiety: Principles and practice. Guilford Press; 2011.

Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117

Kellner M.Drug treatment of obsessive-compulsive disorder.Dialogues Clin Neurosci. 2010;12(2):187-197. doi:10.31887/DCNS.2010.12.2/mkellner

Manjula M, Sudhir PM.New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.Indian J Psychiatry. 2019;61(Suppl 1):S104-S113. doi:10.4103/psychiatry.IndianJPsychiatry_531_18

Abrantes AM, Brown RA, Strong DR, et al.A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment.Gen Hosp Psychiatry. 2017;49:51-55. doi:10.1016/j.genhosppsych.2017.06.010

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