Pure Obsessional OCD

WHAT IS 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

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.

TREATMENT FOR PURE O

EXPOSURE AND RESPONSE PREVENTION (ERP)

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

ACCEPTANCE AND COMMITMENT THERAPY (ACT) & MINDFULNESS

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.