Pure O OCD

Pure O OCD, also known as primarily obsessional OCD, is a lesser-known form of obsessive-compulsive disorder. It is characterized by recurrent, unwanted thoughts, ideas, or impulses (obsessions) that cause anxiety or distress, but do not involve visible compulsions. Compulsions, in traditional OCD, are defined as repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules.

What is Pure O OCD?

Unlike traditional OCD, which often involves both obsessions and compulsions, Pure O OCD sufferers may not have any observable compulsions. However, they may engage in mental compulsions, such as counting, praying, or repeating phrases in their head. These mental compulsions are often done in an attempt to neutralize or counteract the obsession, but they can also perpetuate the cycle of anxiety and distress.

Although the name implies that people with Pure O do not have compulsions, they do still engage in mental rituals or reassurance-seeking behaviors. These compulsions, however, aren’t as noticeable as overt behaviors; Pure O simply acknowledges these forms of OCD that don’t seem like traditional OCD and are typically more difficult to diagnose.

A common misconception is that Pure O is a milder form of OCD. Even though compulsions may not be physical behaviors, Pure O can still be significantly distressing and interfere with daily life.

OCD obsessions can vary widely, and consist of unwanted, distressing thoughts. Pure O obsessions tend to have a central theme of disturbing, intrusive thoughts or images, or frightening impulses that cause extreme anxiety and conflict with the person’s religious beliefs, morals, or societal norms. These obsessions are often more personal and terrifying for the individual than the fears of someone with traditional OCD. An example of this difference is that someone with traditional OCD may be overly concerned about security or cleanliness, whereas someone with Pure O OCD may be plagued by thoughts of harming a loved one, being a murderer, or experiencing a change in their sexuality. Individuals with Pure O understand that their fears are unlikely or impossible, but the anxiety experienced makes obsessions seem meaningful. They often will have thoughts of self-doubt and seek reassurance mentally or from others frequently.

Some common themes of obsessions in Pure O include:

  • Responsibility: excessive concern that one has harmed or will harm someone, either accidentally or on purpose
  • Violence: a constant fear or harming oneself or others
  • Health: consistent fears of having contracted a disease through seemingly impossible means
  • Relationship obsessions: consistently trying to determine a justification for remaining in a relationship or reassurance about the relationship or the partner’s feelings
  • Existential: persistent questioning of the nature of reality, the universe, or the self
  • Sexuality: persistent or recurring doubt about one’s sexual orientation, which can also include the fear that one is a pedophile

The compulsions, in Pure O OCD tend to involve mental rituals, such as mentally reviewing memories or information, repeating certain words, or un-doing or re-doing certain actions. Compulsive reassurance-seeking is also common, which can involve looking for self-assurance, researching online, asking others, or avoiding situations that might provoke anxiety. Reassurance-seeking behaviors can be difficult to identify as compulsions, and often can fatigue family members or friends.

The primary symptoms of OCD are obsessions and compulsions. However, individuals with OCD may also experience additional symptoms related to their obsessions and compulsions. These can include anxiety, difficulty sleeping, difficulty performing daily tasks, and avoidance of triggers that may lead to obsessions. Individuals with Pure O often have difficulty maintaining romantic relationships due to frequent reassurance-seeking and obsessions about sexuality or the relationship.

What causes Pure O OCD?

The exact causes of Pure O OCD aren’t fully understood, but the main driving factors include:

There appears to be a genetic component to OCD, as those with a family history of the disorder are more likely to develop it.

Abnormalities in the brain’s chemistry or function may contribute to the development of OCD symptoms.

The presence of obsessions and compulsions can be learned or acquired from observing family members or through gradual development over time.

  • Exposure to stressful life events or trauma can increase the risk of developing OCD or trigger the onset of intrusive thoughts.

Common Misconceptions about OCD

Obsessive-compulsive disorder can be a serious, debilitating disorder, yet it is often misunderstood or misrepresented. These are some of the most common misconceptions about OCD:

  • Someone can be “a little OCD”: Using the phrase “just a little OCD” to describe someone who is organized or neat is a common misconception. OCD is not a personality trait or quirk, it is a serious mental disorder.
  • OCD is always about cleanliness: OCD is not solely about cleanliness or organization, it can involve a wide range of intrusive thoughts and compulsions that can be related to various topics and fears.
  • Not all neatness equals OCD: Being highly concerned with organization or perfectionism does not necessarily mean that a person has OCD. Many individuals may put a lot of effort into being clean, tidy, or organized, but they do not have compulsions related to unwanted obsessive thoughts.

Treatment Options for Pure O OCD

Purely obsessional OCD is considered a life-long disorder, and without treatment it often persists for decades, but individuals can seek a number of treatments to help them manage or overcome their symptoms. Once a patient has been given a professional diagnosis of having obsessive-compulsive disorder, there are a number of treatments available that may help manage their condition.

Therapy is typically the first treatment option for individuals with Pure O OCD. Cognitive behavioral therapy (CBT) is a highly effective treatment for individuals with OCD, as it combines exposure and response prevention therapy and cognitive therapy. This method helps shift an individual’s reaction to their triggers and compulsions. By avoiding carrying out compulsions and learning to tolerate the anxiety associated with obsessions, the frequency and intensity of obsessive thoughts are gradually reduced over time.

There are several options when it comes to medications that can help patients with OCD by minimizing their obsessive-compulsive behaviors. In most cases, antidepressants are also FDA-approved to treat OCD, so doctors may try a series of antidepressant prescriptions to find the right option for their patients.

As of late 2018, the FDA has approved TMS as a treatment option for those diagnosed with OCD. TMS can modulate the anterior cingulate cortex, a region of the brain that is correlated with OCD symptoms. Patients who have not responded to other treatment options such as medication and or therapy may benefit from TMS as it is helpful in stimulating the brain. TMS often results in significant symptom relief.

Contact us for more information about how transcranial magnetic stimulation could help you manage your OCD when other treatments have failed, or to schedule your consult at Bespoke Treatment.


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