Pure O in OCD: What It Is and How to Manage It

By: Suzanne Feinstein, PhD

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According to the International OCD Foundation, about one out of every 50 Americans have obsessive-compulsive disorder.

OCD manifests in various forms, one of which is known as “Pure O.” Unlike traditional OCD, Pure O often involves symptoms other than repetitive behaviors or rituals.

What Is Pure O in OCD?

Pure O, short for “Purely Obsessional OCD,” is a subtype of OCD characterized by intrusive, distressing thoughts or images, often accompanied by intense anxiety.

Unlike typical OCD, where compulsive behaviors are outwardly visible, individuals with Pure O experience compulsions internally, such as mental rituals or reassurance-seeking behaviors. These obsessions can range from fears of harm or contamination to taboo or morally disturbing thoughts.

Pure O OCD Symptoms

Are you wondering if you have Pure O rather than OCD in general?

Fortunately, Pure O OCD presents with identifiable symptoms that can serve as a prompt to seek a professional evaluation for a definitive diagnosis.

Intrusive Thoughts

The hallmark symptom of Pure O OCD is intrusive thoughts. These thoughts are often unwanted, distressing, and intrusive, causing significant anxiety or discomfort. Examples include thoughts of harming oneself or others, fears of being contaminated, or doubts about one’s morality or integrity.

Mental Rituals

Individuals with Pure O engage in mental rituals as a way to alleviate anxiety or neutralize intrusive thoughts. These rituals may involve mentally counting, repeating phrases, or seeking reassurance from oneself or others. While these rituals are not visible to others, they can consume significant amounts of time and mental energy.

Avoidance Behaviors

To cope with the distress caused by intrusive thoughts, individuals with Pure O may engage in avoidance behaviors. This could involve avoiding certain places, people, or situations that trigger their obsessions, and can lead to increasing social isolation or impairment in daily functioning.


People with Pure O often become hyperaware of their thoughts, constantly monitoring their mental processes for any signs of distressing or unwanted thoughts. This heightened self-awareness can worsen anxiety and also contribute to a feedback loop of obsessive thoughts and compulsive behaviors.

Pure O OCD Examples

Pure O OCD manifests in a diverse range of themes. Examining some of the more prevalent presentations can be beneficial in determining if they resonate with your own experiences.

Violent Intrusive Thoughts

A person with Pure O may experience intrusive thoughts of harming their loved ones despite having no intention or desire to act on these thoughts. These thoughts can feel quite distressing and lead to acute guilt.

Contamination Obsessions

Individuals may obsessively fear contamination, leading to excessive hand washing or avoidance of certain objects or environments perceived as dirty or germ-ridden. Despite knowing the irrationality of their fears, they struggle to control their compulsive behaviors.

Sexual Intrusive Thoughts

Pure O OCD can present with intrusive sexual thoughts or imagery that are antithetical to an individual’s moral or ethical code. These thoughts may delve into taboo subjects or scenarios, leading to pronounced distress and feelings of shame.

Religious or Moral Obsessions

Some individuals with Pure O OCD may experience intrusive thoughts related to religion or morality. They may obsess over perceived sins or worry excessively about violating religious or moral principles, even if they have no intention of doing so.

Pure O OCD Diagnosis

Due to the predominantly internal nature of its symptoms, diagnosing Pure O OCD can present a unique challenge. Mental health professionals utilize comprehensive clinical evaluations to assess for the presence of the disorder.

It’s essential to differentiate Pure O from other conditions with similar symptoms, such as generalized anxiety disorder or depression.

Pure O OCD Treatment

Effective treatment for Pure O OCD typically involves a combination of psychotherapy, medication, and self-help strategies.

There are some common approaches worth learning about.

Cognitive-Behavioral Therapy (CBT)

CBT is acknowledged as the gold-standard treatment for OCD, including Pure O. This is especially true of a subtype known as exposure and response prevention (ERP) therapy.

ERP involves slowly exposing people to their feared thoughts or situations. At the same time, they seek to stop themselves from engaging in compulsive behaviors and gain more control over obsessive thoughts.

With enough sessions, this treatment helps desensitize people to their obsessions and reduces the urge to perform mental rituals.

Selective Serotonin Reuptake Inhibitors

A common group of antidepressent medications known as selective serotonin reuptake inhibitors (SSRI), which includes medications such as fluoxetine or sertraline, are often prescribed for those with OCD and similar conditions.

SSRI medication help regulate serotonin levels in the brain and reduce the intensity of obsessive thoughts and compulsive behaviors. While widely used to treat those suffering from OCD, SSRI medications alone tend to be less effective than when medication is combined with ongoing, supportive therapy.

Mindfulness and Acceptance-Based Therapies

Mindfulness-based approaches can include cognitive therapy, as well as acceptance and commitment therapy. These two strategies can help individuals with Pure O develop greater awareness of their thoughts and emotions without becoming ensnared in them.

These therapies emphasize acceptance of intrusive thoughts without judgment and focus on values-driven action.

Support Groups and Peer Support

Connecting with others who share similar experiences can be a valuable adjunct to therapy. Support groups, both in-person and online, foster a sense of community and belonging, thereby mitigating feelings of isolation.

Noteworthy Lifestyle Changes

To do even more to improve your general well-being and soften the effects of OCD symptoms, the impact of adopting beneficial lifestyle habits, such as regular exercise and maintaining a balanced diet, can’t be overemphasized. Results can be even better when you couple this with proper sleep and stress-reduction techniques.

Pure O OCD Deserves Treatment

If you think you have Pure O OCD, then you owe it to yourself to seek a diagnosis and get professional guidance on the best course of treatment.

You can always rely on the licensed team at Advanced Behavioral Health. Our empathetic professionals focus on obsessive-compulsive disorders, phobias, skin picking, and more.

We’re ready to assess your condition and come up with a tailored treatment course. Get started by reaching out to the Advanced Behavioral Health team now.

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