Pure Obsessional OCD


Pure Obsessional OCD, often referred to as “Pure O,” is the name used to describe OCD subtypes in which symptoms are mainly invisible. As with any form of OCD, people with Pure O have obsessions. They also experience covert mental compulsions, i.e. mental behaviors that people can’t see. It’s important to note that just because you can’t see compulsions, doesn’t mean they’re not there. People with Pure Obsessional forms of OCD do still perform compulsions, sometimes even observable ones, like reassurance seeking. That said, many of their compulsions are mental.


Mental compulsions are one of the main symptoms of Pure Obsessional OCD. Compulsions are actions taken to get certainty and reduce distress. These actions are excessive and impair the lives of those with OCD. So that begs the question – what is a mental behavior? Well, to start, there’s a difference between having thoughts and thinking. We all have thoughts pop into our heads that are outside of our control. People with OCD know this all too well. That said, thinking is an action. Thinking can take on many forms, for example:

  • Planning
  • Judging
  • Problem solving
  • Reflecting

Clearly some amount of thinking, like some amount of hand washing, can be helpful. Mental Compulsions, on the other hand, are not helpful. They are time consuming and sometimes aimed at getting certainty when that isn’t even possible. Their main purpose is to get rid of doubt and distress, even at the expense of a person living life on their terms.

Mental compulsions might look like:

  • Analyzing
  • Ruminating
  • Replaying
  • Rehearsing
  • Checking

So if someone with Relationship OCD has a thought that they might not be attracted to their partner, they may check their physical sensations to try to make sure that they are attracted. Likewise, someone with Sexual Orientation OCD might replay a scene in their minds in order to determine if they felt drawn to a person of a particular gender. If someone with Existential OCD feels uncertain about whether the world is a simulation, they might check their emotions and analyze their experiences to see if they feel real.

There are many more expressions of mental compulsions. Generally, a mental compulsion involves getting “stuck in your head” trying to figure something out with absolute certainty, even when it’s not figure out-able.



The good news is that even compulsions that are not visible are absolutely treatable. The goal of therapy is learning how to disengage from compulsions in the face of triggers. Exposure and Response Prevention (ERP) Therapy involves triggering anxiety and obsessive thoughts on purpose in order to help people learn to be in the presence of thoughts and anxiety without doing compulsions. Through doing exposures, individuals build their response prevention muscle so that over time they get better at saying no to compulsions.

The ultimate goals of ERP are to:

  • allow for the presence of doubt thoughts
  • make space for distress
  • accept the presence of uncertainty


While ERP is considered the gold-standard treatment for OCD, Acceptance and Commitment Therapy (ACT) is also an evidence-based treatment for OCD that can be used in conjunction with ERP. ACT draws upon mindfulness principles in order to support people in non-judgmentally witnessing and accepting their thoughts and feelings. By supporting this objective view of these internal experiences, ACT helps people to accept thoughts and feelings while they take actions based on what matters most to them. You can learn more about ACT here.

General Mindfulness as well as Meditation are also helpful approaches that support recovery from Pure O. Meditation can be very helpful for those with mental compulsions because the practice involves noticing and disengaging from thinking. This is, in essence, what people with Pure O learn to do in the face of rumination, analysis, replaying and other mental compulsions. In general, mindfulness can support individuals to peacefully coexist with thoughts and feelings.


Are you or a loved one struggling with a Pure Obsessional or Pure O subtype of OCD? Lauren uses Cognitive Behavioral Therapy, Exposure and Response Prevention and Acceptance and Commitment Therapy to support those with Pure O. You can learn more about the treatments and services she provides here.


Lauren is a licensed psychotherapist in

several states. Learn more about where

Lauren sees Clients, below.

Pastel skies and a pristine beach in Northern California, one of the areas where Lauren helps people with Pure O.


When she offers face to face work, Lauren does in-person therapy in Newport Beach. She also provides online therapy for Pure O throughout California. Her Clients span from San Francisco down to Southern Orange County and San Diego.

The red rock spires of Bryce Canyon in Utah, one of the states where Lauren offers counseling for Pure O.


Lauren provides therapy for Pure O in the state of Utah. Since she provides online treatment, she works with people who live all across the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.

Clear turquoise waters in the Keys, one of the places where Lauren practices psychotherapy for Pure O in Florida.


Lauren also offers therapy for Pure O online in Florida, and sees people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, Lauren can provide specialized counseling remotely in your area.

The iconic red rock and lush greenery of Sedona, one part of Arizona where Lauren offers therapy for Pure O.


Lauren also practices online therapy in Arizona. If you’re seeking help in Phoenix, Sedona, Scottsdale or Tucson, Lauren offers specialized treatment for Pure O across the Grand Canyon State.

The lavender fields of Provence, France, one international locale where  Lauren provides counseling.


In addition to all of the locations previously listed, Lauren offers teletherapy for Pure O to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment with Lauren could look like.


Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more.


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For more information about working with Lauren

call 310-824-5200 ext. 4 to speak with Client  

Coordinator Lisa O’Reilly at the 

OCD Center of Los Angeles

310-824-5200 ext. 17


1151 Dove St., Ste. 295
Newport Beach, CA 92660

©2021 by Lauren McMeikan Rosen, LMFT.

Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email me and I will happily provide you with more information