“Pure O” is not a formal mental health diagnosis. It refers to a form of OCD in which people may have compulsions that involve mental rituals more so than specific actions.
Although pure obsessional OCD, commonly referred to as “pure O,” is not a clinical or diagnostic term, many people use it to describe their experience of obsessive-compulsive disorder (OCD). Pure OCD is not separate or distinct from OCD.
The two core symptoms of OCD are obsessions (intrusive and distressing thoughts) and compulsions. Compulsions, most of the time, refer to repetitive actions or rituals that people with OCD engage in to relieve the anxiety that obsessions cause.
Because pure O involves mental compulsions instead of visible compulsions, it’s not always easy to identify.
Pure O is a form of OCD. OCD symptoms may include:
- Obsessions: These are intrusive and persistent thoughts and images that cause great distress and cannot be easily managed at will.
- Compulsions: These are rituals that someone with OCD engages in to distract and relieve themselves from the anxiety that obsessions cause. Not everyone with OCD engages in compulsions.
The main difference between classic OCD and pure O is the nature of the compulsions.
Unlike people with other presentations of OCD, who may have both physical and mental compulsions, those with pure O may experience mostly mental compulsions.
Examples of physical compulsions may include handwashing or checking object symmetry, and examples of mental compulsions may include mentally praying, repeating mantras, and counting.
Compulsions in pure O may also involve going over an event repeatedly in your mind, seeking reassurance, or mentally counteracting or neutralizing an obsessive thought.
The term “pure O” is somewhat misleading because people with this condition do have compulsions. That’s why researchers have suggested that the term is a
No. Although a mental health professional may use the term “pure O OCD” to describe the characteristics of your condition, pure obsessional OCD or pure O is not a separate diagnosis from OCD.
“Pure O” can be a useful term because it captures the specific experience of some people with OCD of having internal compulsions, distinguishing it from the experience of outward compulsions.
To diagnose OCD, a mental health professional will explore whether you fit the following criteria:
- You experience obsessions, compulsions, or both.
- Your obsessions and compulsions are disruptive and distressing, and take up an hour or more of your day, every day.
- These symptoms cannot be explained by substance use or other conditions.
Pure O OCD can center on thoughts, images, and even sounds relating to any theme. Many people experience a variety of OCD “themes” — for example, someone might experience anxiety around germs and becoming ill, while someone else may get distressed about symmetry and organization.
Pure O obsessions
Pure O obsessions can relate to any topic or issue. They go from occasional worries or fleeting intrusive thoughts to persistent and highly distressing thoughts or images that deeply affect the individual.
Some examples of common OCD obsessions are:
- upsetting thoughts or images that may be violent, sexual, or blasphemous
- images of harming yourself or someone else
- thoughts about your sexual orientation
- worry that you said or did something bad in the past
- fears of saying something offensive, rude, or obscene
- fear that you or your family will become ill
- fear of contaminating food, objects, or your body with germs
- distressing doubts about your relationships or feelings about your partner
OCD obsessions may focus on different themes or fears.
Pure O compulsions
In pure O OCD, you may experience compulsions such as:
- mentally counting
- reassuring yourself
- mentally repeating phrases, affirmations, or mantras
- mentally reviewing past events
- visualizing images that comfort you
Most people engage in some of these behaviors occasionally. Self-reassurance and visualization are not always compulsions in themselves. But in OCD, you engage in these or other compulsions to soothe the distress associated with an obsession.
The point in OCD isn’t always what you do but why you do it. Compulsions are responses to obsessions.
Many people with pure O OCD find it challenging to pinpoint why they’re engaging in mental compulsions. Some might realize that their mental compulsions aren’t helpful and are contributing to their anxiety.
If you think you’re experiencing obsessions or compulsions, it’s a good idea to speak with a therapist who specializes in treating OCD.
It’s not entirely clear why some people develop OCD and others do not. But some factors may increase your chances of developing OCD.
Risk factors include:
genetics - certain patterns of thinking, such as an inability to cope with uncertainty, an increased sense of responsibility, and magical thinking
- intense and persistent stress or trauma
- other mental health conditions
Autoimmune disorders
Like other forms of OCD, pure O responds to treatment. With the right management plan, you can find relief from pure O OCD symptoms.
Treatment options for OCD may include a combination of:
- Talk therapy: Cognitive behavioral therapy and exposure and response prevention are two possible therapy approaches for OCD. Therapy is usually the first line of treatment for OCD.
- Medication: If you have severe symptoms, a healthcare professional might prescribe a selective serotonin reuptake inhibitor such as fluoxetine (Prozac) or sertraline (Zoloft), a tricyclic antidepressant called clomipramine, or an antipsychotic medication.
If needed, a healthcare professional may complement your treatment with:
- Deep brain stimulation: This surgical procedure involves delivering electrical pulses into areas of your brain associated with OCD.
- Transcranial magnetic stimulation: This noninvasive procedure involves delivering magnetic pulses to your brain.
Different treatments (or combinations of them) may work for each person. For example, not everyone with OCD will benefit from medication. And for some people, talk therapy alone is enough to manage OCD symptoms.
You may also benefit from lifestyle strategies such as maintaining a regular sleep schedule and exercising to relieve stress.
Not sure how to find a therapist? Our guide can help.
Although it’s called “pure obsessional” OCD, people with this form of OCD do experience compulsions. However, those compulsions tend to be mental rituals and are therefore not noticeable to others.
OCD can be difficult to cope with, but it is treatable. Like other forms of OCD, pure O OCD can be treated with medication, therapy, or both.