Pure Obsessional OCD (Pure O) – Symptoms and Treatment

Some individuals may suffer from “Pure Obsessional OCD” (sometimes called “Pure O”) in which they report experiencing obsessions without observable compulsions. These obsessions often manifest as intrusive, unwanted thoughts, impulses or “mental images” of committing an act they consider to be harmful, violent, immoral, sexually inappropriate, or sacrilegious. For individuals with Pure Obsessional OCD, these thoughts can be frightening and torturous precisely because they are so antithetical to their values and beliefs.

Symptoms of Pure OCD

Symptoms of Pure Obsessional OCD vary widely from person to person. Some examples of common obsessions seen in Pure Obsessional OCD are:

• recurrent intrusive harm thoughts or mental images of physically assaulting or killing one’s spouse, parent, child, self, friends, or others (sometimes called “Harm OCD“)
• repeatedly worrying that one has or will run over a pedestrian while driving a vehicle (sometimes called “hit and run OCD)
• excessive fears that one might accidentally cause harm to other people (i.e., burning down the house, unknowingly poisoning others, inadvertantly exposing others to toxic chemicals)
• persistent fears of molesting a child (sometimes called “pedophile OCD” or “POCD”)
• recurrent fears that one might be a homosexual, when in fact he or she is not (sometimes called “Gay OCD” or “Sexual Orientation OCD” or “Homosexual OCD” or “HOCD“)
• excessively worrying that one does not actually love his/her partner, or is not with the “right” person (sometimes called “Relationship OCD” or “ROCD“)
• repetitive thoughts that one has said or written something inappropriate, such as swearing at ones employer or writing hate-filled letters to a friend
• persistent intrusive thoughts or mental images that one considers to be sinful, sacrilegious or blasphemous, such as wanting to worship Satan or have sex with Christ
• recurrent fears that one is sinning or not living (or thinking) in a manner that is congruent with their religious, moral, or ethical values (sometimes called “Scrupulosity“)
• repeatedly thinking about benign somatic issues such as breathing, swallowing, blinking, eye “floaters”, ringing in the ears, digestion, where ones eyes are looking, physical sensations in a specific body part, etc. (sometimes called “sensorimotor OCD” or “somatic OCD)
• recurrent thoughts questioning the nature of the self or reality (sometimes called “existential OCD”)

However, it should be noted that the term “Pure Obsessional OCD” is somewhat of a misnomer. While it may at first appear that these individuals experience obsessions without compulsions, a careful assessment almost always uncovers numerous compulsive behaviors, avoidant behaviors, reassurance-seeking behaviors, and “mental compulsions,”. These behaviors are not as easily observed as other, more obvious OCD symptoms, such as hand-washing and lock-checking, but they are clearly compulsive responses to unwanted obsessions. Some common examples of compulsions seen in Pure Obsessional OCD include:

• avoiding numerous situations in which one fears the possible onset of unwanted thoughts
• repeatedly asking for reassurance that one has not and/or will not commit an act that one perceives as being “wrong” or “bad”
• compulsively “checking” one’s body in an effort to get evidence that one is not sexually attracted to someone who he/she considers inappropriate (especially in cases of POCD, HOCD, and ROCD)
• silently praying or repeating certain phrases in an effort to counteract or neutralize thoughts that one considers to be sinful, immoral or sacrilegious
• performing superstitious behaviors in an effort to ensure that bad things don’t happen (i.e., counting, tapping, knocking on wood)
• repeatedly confessing to people, even total strangers, that one has had thoughts which he or she considers to be unacceptable
• continually ruminating about obsessions in an attempt to prove to oneself that he or she has not done and/or will not do anything “wrong” or “inappropriate” or “sinful”

Treatment of Pure OCD

For many years it was thought that Pure Obsessional OCD was next to impossible to manage because there were no behaviors to treat, only thoughts. However, a specific type of Cognitive-Behavioral Therapy (CBT) known as “Exposure and Response Prevention” (ERP) has proven to be very successful in the treatment of Pure Obsessional OCD. Using ERP, clients learn to directly face their fears of specific thoughts, and to proactively challenge the compulsive and avoidant behaviors they have been using to cope with these thoughts. Another CBT technique that is extremely valuable is called “Cognitive Restructuring”, in which clients learn to challenge the validity of the unwanted thoughts that are causing them so much distress.

Additionally, a variant of ERP has been developed that has also been found to be extremely effective for the treatment of Pure Obsessional OCD. This method, called imaginal exposure, involves writing short stories based on the client’s obsessions. These OCD stories are then used as ERP tools, allowing the client to experience exposure to situations that cannot be experienced through traditional ERP (e.g., killing one’s spouse or molesting a child). When combined with standard ERP for the above-noted compulsions, and other cognitive-behavioral techniques, imaginal exposure can greatly reduce the frequency and magnitude of these intrusive obsessions, as well as the individual’s sensitivity to the thoughts and mental images experienced in Pure Obsessional OCD. To learn more about imaginal exposure, click here.

One of the most effective CBT developments for the treatment of Pure Obsessional OCD (“Pure O”) is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with Pure Obsessional OCD (“Pure O”), the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with avoidance behaviors, reassurance seeking, and/or mental rituals. To learn more about Mindfulness Based CBT for the treatment of Pure O, click here.

Using these CBT tools, clients learn to more effectively respond to distorted, unwanted thoughts, and to resist the urge to do compulsive and avoidant behaviors. If you would like to learn more about Cognitive Behavioral Therapy for the treatment of OCD, Pure Obsessional OCD, and related anxiety-based conditions, click here.

Individual Therapy for the Treatment of Pure O

The OCD Center of Los Angeles offers individual therapy for treatment for adults, children, and adolescents with Pure Obsessional OCD, with a strong emphasis on Cognitive Behavioral Therapy (CBT). We have 14 therapists on staff, and our offices are open six days a week, including evening and Saturday appointments. If you would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.

Group Therapy for Treatment of Pure O

In addition to providing individual Cognitive Behavioral Therapy (CBT), the OCD Center of Los Angeles also offers six weekly, low-fee therapy / support groups for adults with OCD, Pure Obsessional OCD, and related conditions. Research has shown that group CBT is extremely effective for the treatment of all types of OCD, including Pure O. All groups at the OCD Center of Los Angeles are led by our professional staff therapists, and use the same CBT treatment protocol as our individual therapy program. Please note that all of our groups require an assessment prior to participation, and are open only to adults over the age of 18 with OCD, Pure Obsessional OCD, and related anxiety based conditions. Also please note that all groups meet at our Brentwood office in Los Angeles. To learn more about our weekly groups for adults, click here.

Online Therapy and Telephone Therapy for the Treatment of Pure O

The OCD Center of Los Angeles also offers online therapy and telephone therapy to clients around the world suffering with OCD, Pure Obsessional OCD, and related anxiety conditions. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our office, and for those in remote areas who cannot find specialized Pure Obsessional OCD treatment close to their home. Telephone and internet therapy have repeatedly been found to be safe and effective in numerous research studies, and have been legal in California since 1997. If you would like to learn more about our telephone and online therapy program for Pure Obsessional OCD, please click here.

Intensive Treatment for Pure O

We also offer intensive Pure O treatment for adults, adolescents, and children. This program is designed to meet the needs of those for whom standard outpatient Pure O treatment is either unavailable or insufficient. Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective Pure O treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about our intensive outpatient treatment for Pure O, click here.

About the OCD Center of Los Angeles

The OCD Center of Los Angeles is a private outpatient treatment center specializing in Cognitive Behavioral Therapy (CBT) for the treatment of OCD, including all variants of Pure O. We have 13 therapists on staff, all of whom are either licensed or registered, and all of whom specialize in CBT.  We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays.

Our Southern California office is located in Brentwood.

If you are experiencing any of the above Pure Obsessional OCD symptoms, and would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.

Please note that the above is not meant to replace a complete and thorough evaluation by a licensed cognitive-behavioral therapist or other qualified mental health professional. Some individuals with OCD may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between OCD and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in our area. Furthermore, it is imperative to make the distinction between OCD and other medical conditions. For this reason, a medical examination may be a necessary part of Pure O treatment.