ARC Blog

What is ‘Pure-O’ OCD?

You may not realize that you have Pure-O. 

You would only be aware of the torturous thoughts and constant analysis that goes on in your head. Some people might Google to find out what on earth is going on, but generally, people keep these thoughts a secret from others because of the intense shame that comes with them.

This intriguing and rare form of OCD (Obsessive-Compulsive Disorder) is thought to involve only the Obsessions, but not the Compulsions that are usually a part of OCD.

This at first appears to be true, but it does actually involve compulsions (more on that later).

Most people who have this, don’t realize it.

If you were a mom and kept having thoughts about drowning your baby, or your brain starts suggesting that maybe you could be gay, and you find that unfathomably distressing – who are you going to talk to about that?

You’re probably going to hide it.

Keep it a secret for years, maybe your whole life.

Would you assume that the reason you have a sudden questioning of your sexuality is that you have a psychological condition that misinterprets random, harmless ponderings as dangerous intentions and desires?

You’d probably start off thinking that the thoughts are important and must be analyzed immediately.

“Am I gay even though I don’t want to be?!”

You might Google to find out what this means.

Deliberately conjure up mental images of same-sex friends while monitoring your feelings:

“Do I like them?”

“Am I turned on?”

“Do I want to have sex with them?”

You might avoid programs or movies with attractive people of the same sex to avoid having this anxiety triggered.

Maybe spend many hours a day in a spiral of rumination and problem solving, trying to figure out what is wrong with you and how to fix it.

Unfortunately, all of these attempts to rid yourself of doubt and worry are compulsions. Which maintains the problem.

Normally OCD consists of recurring intrusive thoughts (obsessions) and behaviors that the person carries out to nullify these obsessional thoughts (compulsions).

Pure-O, is not an official subtype of OCD. 

It was coined to describe a kind of OCD where the person seems to have only obsessions and no compulsions. However, this is not actually what’s happening.

With Pure-O, you’re still trying to counter the obsessional thoughts with compulsive behaviors, it’s just that the behaviors are internal – they are thought-based.

To use an example, let’s say you were having an intrusive obsession – wondering if you are a pedophile and may harm children. This is absolutely not what you want to happen and are afraid of it coming to pass. So you try to prevent it by checking in with your feelings perhaps…

“Any attraction towards children?” You wonder.

“I’m not sure… maybe?”

“Is this an attraction?”

“What if it is?”

“I can’t be sure…”

“I better keep thinking about it until I’m certain there’s no chance of it happening.”

But the doubt lingers. As does the distress and anxiety that goes with it.

Because of the difficulty of being certain about the feeling of attraction (and the effect of anxiety on attraction), sexual orientation doubts are common among straight and gay sufferers of Pure-O. The mental anguish and experimentation involved can resemble a coming out process, so they often get misinterpreted by sufferers, and by those around them.

It can even happen when you have nothing against being another orientation. But you still end up with powerful anxiety. This is because of the feelings of doubt and the belief that you need certainty to be safe. Your brain tells you that you must know your identity, what kind of person you are, and to feel sure of this, to be able to move on. Which feeds into doing more thought compulsions while you desperately try to gain that certainty.

Now, generally, all the compulsions with Pure-O won’t actually be thought-based. You can’t help but have some spill-over into behaviors. Some people might avoid knives or certain people that are involved in intrusive thoughts. 

Or engage in checking… Checking the internet. Seeking reassurance from others. Checking in with your body’s sensations (that one’s sort-of a thought… you get why I said there’s a cross-over between thought-based compulsions and behavioral compulsions).

Treatment for Pure-O

Pure-O OCD causes a lot of distress and also tends to make it difficult to go about daily life. Just like other forms of OCD. However, the tricky bit is in the treatment.

With OCD that has outward behaviors, you can use the highly researched and very effective Exposure with Response Prevention Treatment. This is where you get exposure to the anxiety-provoking thoughts, but prevent the compulsive behavior that your anxiety thinks is protecting you (like washing your hands). When the feared event doesn’t happen, the brain tones down its expectation of danger and you get reduced anxiety and urges to do the compulsive behaviors.

With Pure-O, a lot of the compulsions are internal. So it gets a bit trickier. The same treatment works, but thoughts are harder to prevent than physical behaviors.

Imagine, you have a frightening image or thought pop up and want to do your usual method of feeling safer again. But you need to NOT do that, so your brain can see it’s safe. Unfortunately, the intense effort that is put into escaping intrusive thoughts or preventing them only serves to highlight their importance to our brain. The more you fight them, the more your brain will bring it up again, until it feels like you’re having these unwanted thoughts constantly.

How do you not think a thought??

I find the best method is, rather than try to NOT do something, is to focus on DOING something else. And with anxiety, the best approach is to do the opposite of what the anxiety is driving you to do. Thus, frightening thoughts about stabbing someone you care about – the treatment would be to think about stabbing them.

It’s the quickest way for your brain to realize that you’re not going to do them harm just because your brain is having images of this.

Intrusive thoughts are commonly about violent acts, overwhelming doubts, and sexual imagery. Anything ego-dystonic (they’re against your sense of self, your ego). They’re not thoughts that actually fit with you. The intrusions will pick on anything you find unacceptable or repugnant.

Usually, outside of movies, if you’re afraid you might do something, like hurt somebody, and this is out of character for you, then it’s an intrusion, not some kind of premonition or desire on your part. It has nothing to do with you, who you are, what you will do. Except in so far as telling you that you are averse to that action or way of being.

It will be really tempting to try to reason with the thoughts. Don’t bother. It may improve things for a week, but it easily becomes just another compulsion. Your brain wants you to analyze and figure out this thorn in your brain. You may get some relief. But it’ll only last until your brain thinks of another reason for the anxiety.

It’s hard to out-logic OCD. 

It was non-rational to begin with. OCD is based on what’s called ‘Emotional Reasoning’. This is where you start with a feeling and come up with a reason for it post-hoc. For OCD the original feeling that people describe is one of discomfort, that something isn’t right. Your brain then comes up with a reason that things don’t feel right. Something that is wrong or could mean danger.

What needs to happen to reduce this kind of anxiety is repeated, graded exposure to the feared thought, image or perceived urge. Until your brain adapts to seeing that nothing bad happens. It starts to accept that life is incredibly uncertain and yet mostly safe. Your brain starts to habituate to the “not quite right” feeling (it’s learned that it doesn’t mean danger and ignores it) and intrusive thoughts start to bother you less frequently.

So, in short, Pure-O is a term sometimes used to describe when someone has OCD with mostly thought-based compulsions. 

This often goes unrecognized and can be very shameful for the person suffering from it, as the thoughts are often sexual or violent and are not things that most people are concerned about. It is trickier to treat, as the target of the treatment, the compulsions, are internal. However, I’ve had people make significant improvements with the right treatment.

If you would like more information on anxiety (what goes on in the body and brain) and what the journey to recovery looks like, don’t miss out on my Anxiety Reducer Guide: 

Also, if you’ve resonated with this article, I’d really encourage you to get help from a professional who knows how to work with Pure-O and can be with you on your journey through this. 

Therapy for Pure-O can take a while and will require commitment from you as doing the exposure means facing thoughts and images that will make you so anxious you think you can’t stand it. But you can get through it and feel safe in your own head once again.

Michael Burrows

Clinical Psychologist | Anxiety Specialists

Michael Burrows lives in Wellington, New Zealand, with his wife, Becky, and super fluffy Samoyed, Momo. Becky has worked through and out the other side of her own anxiety and together they run Anxiety Specialists (Momo helps too). Since 2020 they provide online treatment through their Anti-Anxiety Academy to passionately help others reduce and overcome their anxiety using their effective step-by-step Domino Process.
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