Pure obsessional OCD (pure O) is a form of obsessive-compulsive disorder (OCD) in which people experience obsessions—intrusive thoughts, feelings, urges, images, and sensations that cause anxiety. The primary differences between pure O and other forms of OCD lies in how you respond to these obsessions.
Many people with OCD engage in visible compulsions—repetitive physical behaviors such as washing, checking, or counting, which are performed to alleviate anxiety caused by obsessions. However, people with pure O experience mental compulsions, instead. Mental compulsions can look like repeating phrases or prayers in your head, reviewing past actions, or even avoiding certain thoughts or situations that may trigger your anxiety.
Mental compulsions are usually invisible to others, making it harder for those around you to recognize your symptoms and distress—and sometimes making it harder for you to identify that you’re dealing with OCD. But, mental compulsions can be just as intense and debilitating as physical compulsions, so it’s important to know if you’re engaging in these behaviors.
Concerned you have pure O? While only a licensed therapist can diagnose you, becoming aware of your symptoms can be an important first step in treatment. Read on for a test to assess your symptoms and help you determine whether you have signs of pure O.
Pure obsessional (pure O) OCD Quiz
Below you’ll find a list of 9 questions to help you assess whether you might be experiencing symptoms of pure O. Answer “yes” to any that you relate to and keep track of your number of “yeses.” This quiz should take no more than a few minutes.
Before you begin, it’s important to understand that this quiz is only a screening tool to help identify symptoms that may indicate you are experiencing symptoms of pure O OCD. It is not a diagnostic test. If you find that many of these questions resonate with your experience, it can be a good idea to reach out to a mental health professional for a more thorough evaluation.
1. Do you experience frequent, unwanted, disturbing thoughts that feel completely out of line with your actual values or beliefs (like violent, sexual, or immoral thoughts)?
2. Do these thoughts make you feel anxious, guilty, or ashamed, even though you know they don’t reflect what you truly want or believe?
3. Do you mentally repeat words, phrases, or prayers to try to “cancel out” or neutralize your bad thoughts?
4. Do you mentally go over past events or conversations, trying to make sure you didn’t do something wrong or unintentionally hurt someone?
5. Do you spend a lot of time worrying that your thoughts or actions could lead to harm, even if you know there’s no real danger?
6. Do you avoid certain places, situations, or people because you’re worried they might trigger intrusive thoughts?
7. Do you feel like your mind won’t stop replaying intrusive thoughts or images?
8. Do you often try to reassure yourself by repeating affirmations in your head, or researching online to alleviate anxiety caused by intrusive thoughts?
9. Do your thoughts get in the way of your day-to-day life, or affect work, school, or socializing?
Results of your pure O quiz
It’s worth reiterating that an online test can’t give you a true OCD diagnosis, and that this isn’t an exhaustive list of pure O symptoms. That said, if you found that you answered “yes” to the majority of these questions, that’s a good indicator that you should see a mental health professional.
Even though managing on your own can seem appealing, reaching out to a mental health professional who specializes in OCD is important. According to licensed therapist Marybeth Overstreet, MA, LPC, it’s also crucial to find the right provider. “It can get tricky when asking a primary care physician because they might not have a good understanding of OCD,” she says. “Instead, I would recommend finding someone who is licensed in treating OCD to give you an assessment.”
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Can you have OCD if you don’t have compulsions?
“People with pure O sometimes believe that they don’t do compulsions,” says licensed therapist Tracie Ibrahim, MA, LMFT, CST. “However, they just have mental compulsions that aren’t physical.”
For example, you may mentally replay a conversation in your mind to make sure you didn’t say something wrong. While this might not seem like a harmful behavior, the repetitive nature of replaying the memory to try to reduce anxieties and fears makes it a compulsion. And, these sorts of mental rituals can still take up a lot of time and energy, leaving you feeling drained and anxious.
Ibrahim says some people who identify with pure O also engage in physical compulsions, but have a harder time recognizing these behaviors: “Oftentimes, people with pure O are doing physical compulsions such as seeking reassurance from others, confessing, researching online, etc., but they don’t know these behaviors are compulsions.”
What does pure O feel like?
Living with pure O might feel like being trapped in your own mind, constantly questioning whether your thoughts are “normal” or whether you’re a bad person for having them. Mental rituals can consume a lot of time and energy, leaving you feeling exhausted and distressed.
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You might also feel like your experience with OCD isn’t “real” or that your struggles aren’t as valid because your compulsions aren’t outwardly visible. It’s important to know that mental compulsions are just as significant as physical ones. What you’re going through matters, and just because your struggles aren’t visible doesn’t mean they aren’t impacting you in a big way.
Fortunately, there are strategies for managing pure O. With the right treatment, you can learn how to face your intrusive thoughts without resorting to mental compulsions.
Pure O treatment
You might be wondering: What does treatment look like when compulsions aren’t physical? The most effective treatment for pure O, like any other subtype of OCD, is exposure and response prevention (ERP) therapy—a specialized form of cognitive behavioral therapy (CBT). In ERP therapy, you’ll work with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, while resisting the urge to do compulsions. The goal is to tolerate the anxiety that intrusive thoughts cause, while reducing the need to engage in compulsions to help relieve that anxiety.
You’ll begin by working with a therapist to create a list of exercises where you’ll face your fears and resist responding with compulsions. You’ll start with the least challenging sounding exercises, and work your way up—all while sitting with discomfort and uncertainty.
For pure O OCD, you might begin by imagining a situation that usually triggers you to mentally repeat a phrase or review the details—like driving in your car, if it typically causes worries that you may have unintentionally hit someone. If you usually reassure yourself by replaying your actions or double-checking the details to make sure nothing went wrong, your therapist might encourage you to imagine the possibility of causing harm, instead. In doing so, you’ll experience discomfort and uncertainty, which is part of learning to resist the compulsion.
As you progress, the goal is to gradually expose yourself to these situations, making sure you resist the compulsion to mentally “check” or reassure yourself. This can be challenging at first, as the anxiety may feel overwhelming. Eventually, however, the more you practice sitting with discomfort without performing the mental ritual, the less power these thoughts will have over you, and the need to perform compulsions will decrease.
Bottom line
Pure O OCD can make you feel alone, especially since compulsions may be hard to recognize. However, reaching out for support—whether it’s through therapy or peer groups can help you realize that you’re not the only one dealing with these intrusive thoughts. With the right treatment, you can learn to manage and eventually reduce the impact OCD may have on your life.