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? Therapists at the Center for the Obsessive Mind use 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 we provide here.


The Center for the Obsessive Mind offers

therapy in several states and internationally.

Learn more about where the staff practices, below.

Pastel skies and a pristine beach in Northern California, one of the areas where The Center for the Obsessive Mind helps people with Pure O.


The Center for the Obsessive Mind’s staff therapists offer online therapy for Pure O throughout California. Our Clients span from San Francisco down to Southern Orange County and San Diego. Whether you’re in Silicon Valley, Santa Barbara, Beverly Hills or Dana Point, the Center’s staff can support you in your recovery.

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


Staff members at the Center for the Obsessive Mind offer therapy for Pure O in the state of Utah. Since we provide online treatment, we work 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 The Center for the Obsessive Mind practices psychotherapy for Pure O in Florida.


Therapists at the Center for the Obsessive Mind also offer therapy for Pure O online in Florida. We see people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, we can provide specialized counseling remotely in your area.

The placid, clear waters of Sand Harbor in Lake Tahoe, one part of Nevada where The Center for the Obsessive Mind offers therapy for Pure O.


Therapists at the Center for the Obsessive Mind also practice teletherapy in Nevada. So if you’re seeking help in Glenbrook, Incline Village, Reno or Las Vegas, we offer specialized treatment for Pure O across the Grand Canyon State.

The Seven Sisters sea cliffs in Sussex, England, one international locale where  The Center for the Obsessive Mind provides counseling.


In addition to all of the locations previously listed, the staff at the Center for the Obsessive Mind offer teletherapy for Pure O to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment with The Center for the Obsessive Mind could look like.


Online therapy isn’t right for everyone. An assessment can determine if online therapy is appropriate for your needs. Reach out here to learn more. Check out this article from the American Psychological Association or read this article that our Director, Lauren Rosen, LMFT, contributed to.


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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 us and we will happily provide you with more information.