Pure O, short for purely obsessional OCD, is a form of obsessive-compulsive disorder (OCD) where people experience intrusive thoughts without physical compulsions. Instead of visible behaviors, compulsions often take the form of mental rituals—like replaying memories, seeking reassurance, or analyzing thoughts for meaning.
While pure O is commonly described as “obsessions without compulsions,’ experts emphasize that compulsions are almost always present. They’re just less visible, which can make this presentation harder to recognize.
Think you have pure O? Read on to assess your symptoms and determine if you might have this OCD subtype.
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’s best 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 an accurate 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.
While managing OCD on your own may seem appealing, reaching out to a mental health professional who specializes in the condition is important. According to NOCD 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.”
How do clinicians diagnose pure O OCD?
Clinicians diagnose pure O OCD using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Key elements include:
- Recurrent, unwanted intrusive thoughts, images, urges, feelings, or sensations (obsessions)
- Attempts to neutralize or manage those thoughts with mental rituals (compulsions)
- Significant distress or impairment caused by these cycles
Because compulsions in pure O are often mental, they can be missed without careful questioning. Trained OCD specialists are familiar with these more subtle signs and can make an accurate assessment.
What should you do if you think you have pure O?
If you think you have pure O, the best step is to consult a licensed mental health professional who specializes in OCD. Evidence-based treatment is available and highly effective.
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
Studies show that ERP therapy is highly effective, with 80% of people with OCD experiencing a significant reduction in their symptoms.
Other approaches that may help include:
- Medication (typically SSRIs)
- Mindfulness-based strategies
- Acceptance and commitment therapy (ACT)
These are typically done in combination with ERP therapy, depending on the individual’s needs.
Severe or treatment-resistant OCD may benefit from the following therapies:
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Gamma knife radiosurgery (GKRS)
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
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.