Everybody experiences unwanted thoughts from time to time, but people with Pure Obsessional OCD (aka, “Pure O”) often feel completely overwhelmed by intrusive, distressing thoughts. Tom Corboy, MFT of the OCD Center of Los Angeles discusses Pure O and its many permutations.
When most people think of OCD (if they think of OCD at all), they think of obvious compulsive behaviors such as repeated hand washing or door checking. This is likely because they have seen television news reports about OCD that focus on these sorts of overt compulsive behaviors. Or perhaps they’ve seen films like The Aviator or As Good As It Gets or Matchstick Men that showcase characters doing these or similar compulsive behaviors.
But these obvious compulsions are really just the tip of the OCD iceberg. Many people with OCD exhibit few, if any, of these outwardly observable compulsions. Based on my 25 years of experience specializing in the treatment of OCD, I posit that the great majority of people with this condition actually struggle with what is colloquially known as Pure Obsessional OCD, or “Pure O”, in which their behavioral symptoms are more subtle, and often unrecognized as “compulsions” by anyone, including themselves. In fact, the great majority of calls we receive at the OCD Center of Los Angeles are from people who are struggling with Pure O. Which begs the question…just what exactly is Pure O?
What is Pure O?
First, let’s be clear in noting that there is nothing even remotely “pure” about Pure O. In fact, it would not be a stretch to say that Pure O doesn’t really exist, or is at the very least a significant misnomer. Every single person I have ever treated for Pure O has exhibited numerous compulsions. In fact, I would argue that it is the compulsions that really define the disorder.
Simply put, Pure O is nothing more than a widely-accepted slang term for the various subtypes of OCD in which the compulsive behaviors are less obvious to the outside world. Not non-existent – just less obvious. As anyone who has ever been “caught” doing their compulsions will tell you, hand washing, door checking, and other outwardly physical compulsions are quite obvious to just about anyone who is paying attention. In fact, it is this visual obviousness that makes these types of compulsions so appealing to screenwriters and tv news crews. Conversely, while people with Pure O may do these sorts of behaviors, their more painful struggle is generally with the three following types of compulsions, all of which are far less outwardly obvious:
- Avoidance compulsions – Avoiding situations in which you anticipate experiencing unwanted thoughts, feelings, urges, or sensations.
- Reassurance-seeking compulsions – For example, repeatedly asking others to confirm that you did or did not do something, or that something you did or thought was not “bad”.
- Mental Compulsions – There are various ways in which people with OCD do mental compulsions. Some simple examples include repeatedly reviewing a past event in your mind in an effort to prove you did not do something horrible, or purposely calling up a “bad” thought in order to check if it still causes you distress, or ritualistically praying in an attempt to eliminate “bad” thoughts.
It is important to emphasize here that Pure O is not separate from OCD, nor is it some sort of “new” or “special” type of OCD. It is simply shorthand for OCD in which the individual’s compulsions are more focused primarily on these three types of behaviors. And while these behaviors are more hidden than overt compulsions such as hand washing or door checking, they are done with the exact same intent – to quell anxiety related to the individual’s unwanted obsessive thoughts.
There are a number of OCD subtypes that are generally considered to be part of the Pure O spectrum, including, but not limited to, the following:
- Harm OCD – Obsessing that you have harmed someone, or want to harm someone. Common Harm OCD obsessions focus on the fear that one might purposefully cause harm, such as stabbing, suffocating, strangling, or shooting people, or on accidentally causing harm, such as running over pedestrians while driving or accidentally poisoning family members.
- HOCD, aka Sexual Orientation OCD – Obsessing that your sexual orientation is not what you think it should be. For straight people, HOCD focuses on obsessions that they are secretly gay or bi. Likewise, there are also people who are gay or bi who obsess that they are secretly straight.
- Trans OCD (TOCD) – Obsessing that your gender is not what you think it should be. For most people with Trans OCD, the fear is that they are secretly transgender. However, there are also people who are transgender who obsess that they are in denial and that they are actually cis-gender.
- Pedophile OCD (POCD) – Obsessing that you are secretly a pedophile. It is important to note that people with POCD are not pedophiles, but are consumed by the fear that they secretly are.
- Relationship OCD (ROCD) – Obsessing that you actually do not love your spouse or partner, or that you are secretly not attracted to them. In some cases, the obsessions in ROCD may focus on feelings towards non-romantic relationships such as friends or family members.
- Religious Scrupulosity – Obsessing that you are not living your life in perfect accordance with the precepts of your religious faith. Religious Scrupulosity can occur in people of any faith.
- Moral Scrupulosity – Similar to Religious Scrupulosity, except that the obsessions in Moral Scrupulosity focus not on religious faith, but rather on the fear that one is not living according to their personal moral beliefs and values.
In each of these OCD subtypes, the individual may perform a certain amount of obvious OCD compulsions, such as washing or checking. For example someone with Harm OCD may compulsively check that the stove burners are turned off for fear of causing a gas explosion that would potentially kill their entire family. Likewise, a straight person with HOCD might feel compelled to wash after driving through a gay neighborhood. But people with Pure O will likely be far more impacted by the hours of less obvious compulsions they perform, most or all of which will be completely unnoticed by others.
Furthermore, even obvious compulsive behaviors such as repetitive hand washing and door checking are often done as a response to unwanted, highly distressing Pure O thoughts. For example, some people who compulsively wash their hands do so not out of fear that they themselves will get sick, but rather for fear of transmitting some horrible disease to others. In other words, their handwashing is often a function of Harm OCD in which they fear being responsible for harm coming to other people. Ditto for the door checker whose compulsive checking is often done with the intent of ensuring that they are not responsible for leaving the doors unlocked, through which someone might easily break into their home and kill their family.
Room 101…or Why Pure O is So Devastating to Sufferers
Anyone who has gone to high school in the US over the past 50 years is likely to have been assigned to read George Orwell’s dystopian novel 1984. In that book, the thought police have a special room – Room 101– that they use when trying to break the will of people who dare to think freely. It is in Room 101 that the thought police use people’s biggest fears against them. As described in 1984, Room 101 is where “they threaten you with something – something you can’t stand up to – can’t even think about.” The main character in 1984, Winston Smith, is terrified of rats. In order to get Winston to turn on his lover, the thought police put two rats in a small cage, and then place the cage over his face. The only thing separating the rats from Winston’s face is a small door inside the cage. Faced with his biggest fear, Winston completely gives in. He turns on his lover rather than face the rats.
Essentially, Pure O is Room 101. It is your mind acting as the thought police and threatening you with your worst fear. For Winston, it was rats, so the thought police put rats in a cage and put the cage over his face. For people with Pure O, it can be any thought you don’t want. Murder, pedophilia, sexual orientation, eternity in hell – whatever you “can’t stand up to – can’t even think about”.
Over-Attending, Over-Valuing, and Over-Responding
In Pure O, the fear of the thought itself is the motivator for the compulsive behavior. After all, what is Pure O but unwanted thoughts (i.e., obsessions) that we“can’t even think about”, along with our over-reaction to said thoughts (i.e., compulsions). Seen this way, Pure O is basically a phobia of your own thinking – a fear of your own mind and what it might come up with next.
In Pure O, there is a three-step process by which your personal internal thought police are using the fear of your own thoughts to make you miserable:
- Over-attending – People with Pure O pay way too much attention to their thoughts. They actively monitor their thinking to see if they are having thoughts that they don’t think they should be having. This occurs in two different ways. One is by monitoring thoughts that happen to arise spontaneously in their consciousness. A second way is that they actually go looking for unwanted thoughts. Countless clients we have treated over the years have reported that they will purposely dredge up their unwanted thoughts so that they can evaluate whether or not they are having an appropriate level of disgust or discomfort in response to those thoughts. This is rather like poking a stick in your eye to see if it will hurt, and invariably leads to the next step in this maladaptive process.
- Over-valuing – It is quite reasonable to evaluate the world. It’s what the human brain does, all day long. But evaluating your thoughts to determine whether or not those thoughts are “ok” or “acceptable” or “accurate” is problematic. If you focus on evaluating your thoughts, you will start to believe that all of your thoughts are actually important and worthy of evaluation. But the truth is that much of what we think is completely and utterly unimportant. It’s just mental static that does not warrant your time or attention. Your brain keeps churning, 24 hours a day (yes, even when you are sleeping), and most of what it comes up with doesn’t merit attention or evaluation. Most of your thoughts are not good or bad – they are just present in your consciousness, with no particular importance. They just pop into your mind unbidden and do not automatically indicate anything whatsoever about your character or intent.
- Over-responding – Unfortunately, after spending so much time and mental energy paying attention to your thoughts, and evaluating them as being bad and unacceptable, it is only natural that you would respond to them. We humans naturally want to solve problems, especially problems that make us uncomfortable. And if you have determined that your thoughts are a problem, you are likely going to be anxious and uncomfortable with those thoughts. You are going to want to try to find a way to get rid of them, or to at least minimize their impact. This is the compulsive side of OCD, and it is a trap. Whether you try overt compulsions, avoidance, reassurance-seeking, or mental compulsions, you are merely going to make your OCD worse. Every second that you spend trying to fix or eliminate your unwanted thoughts, you are reinforcing the belief that they are important, and must be controlled. But you can’t control your thoughts, and in trying to do so, you are doomed to failure. You are digging the ditch deeper and deeper, and pretty soon, it is going to be very difficult to climb out of the hole you have made for yourself.
The bottom line is that the great majority of your thoughts do not need to be monitored, evaluated or responded to. They are just the idle chatter of the thinking machine in your head. A far better way of addressing Pure O thoughts is to just let them exist, without attending to them, or valuing them, or responding to them. Just let them exist unanswered. They are just thoughts.
Confirmation Bias in Pure O
Another way of viewing how Pure O wreaks such havoc is through the lens of “confirmation bias”, which is a term in cognitive science for “the tendency to search for, interpret, favor, and recall information in a way that confirms one’s preexisting beliefs or hypotheses”. (Plous, Scott (1993), The Psychology of Judgment and Decision Making, p. 233) Put more simply, confirmation bias is the all-too-human trait of cherry picking information that supports and confirms what we already believe, while ignoring and rejecting evidence to the contrary. It is because of confirmation bias that people with Pure O blindly over-value unwanted thoughts that are backed by little or no evidence.
For example, a 57-year-old man who has had Harm OCD for 40 years may have recurring thoughts about stabbing his grandchild. When he experiences these thoughts, he immediately thinks, “See, I am a monster who wants to kill his own grandchild”. But in jumping to this baseless conclusion, he is over-valuing the thought about stabbing his grandchild as being “meaningful” and “accurate”, while ignoring the fact that he has had these kinds of thoughts for 40 years without ever acting on them. Because of confirmation bias, he views the “bad” thought as being more important, more meaningful, and a more accurate indicator of his character and intent than all of the 40 years of evidence that indicate he is not a killer despite having these unwanted thoughts.
Ego-Dystonic Thoughts vs. Ego-Syntonic Thoughts
To fully grasp the concept of Pure O, it is necessary to understand the difference between ego-syntonic thoughts and ego-dystonic thoughts.
Ego-syntonic thoughts are thoughts which reflect our true values, beliefs, and intent. For example, if I were to have the thought, “I like ice cream”, that would be an ego-syntonic thought because…I really, really like ice cream. Conversely, if I were to have the thought “I want to kill grandma”, that would be an ego-dystonic thought, because I really don’t have any desire or intent whatsoever to kill my grandmother.
The difference between ego-syntonic thoughts and ego-dystonic thoughts has nothing to do with any objective definition or measure of what people see as “good” or “proper” or “healthy”, but rather is based entirely on the subjective values of the individual. Basically, ego-syntonic thoughts are consistent with how we see ourselves, while ego-dystonic thoughts are inconsistent with how we see ourselves.
For example, some individuals like the idea of sex with people of the same gender, while others do not. The issue is not sexual orientation in and of itself, but the individual’s subjective values and beliefs about him/her self. So if a person sees him/her self as “straight”, yet has repeated, unwanted thoughts about being gay, those thoughts are ego-dystonic. Likewise, if a person sees him/her self as “gay”, yet experiences repeated, unwanted thoughts that they are secretly straight, those thoughts are also ego-dystonic.
People with Pure O get stuck precisely because of how they react to their ego-dystonic thoughts. For example an individual with Relationship OCD may have the unwanted thought that they do not actually love their spouse. They see themselves as someone who loves their spouse, and are quite distressed that they repeatedly experience thoughts that they do not. They over-attend to these unwanted thoughts, compulsively monitoring them in an effort to discern how they “really” feel. They also over-value these unwanted thoughts by assuming that these thoughts are important and meaningful. Confirmation bias kicks into gear, leading them to notice these thoughts more often than all of the many loving thoughts they have about their spouse, and to give these thoughts much more weight than all of those loving thoughts. They then over-respond to these thoughts, doing all sorts of compulsive behaviors that are designed to alleviate their doubt, but which actually make it much worse. In fact, in most cases, the only “evidence” they have that they don’t love their spouse is the presence of the unwanted thoughts, which is really no evidence at all.
Pure O and Denial
Often, people with Pure O obsess that they are in denial about their true self. They spend much of their time locked in an internal battle with themselves trying to determine who they really are and what they really want. It’s as if they see themselves as a Russian nesting doll in which there is a “different” self secretly hidden inside their allegedly “fake” outer self. But this is nonsense. There is no secret deep-seated self that you have been keeping hidden from the world all these years through an elaborate and unknown process of denial. There is just you and your values and your choices. As the ancient Roman philosopher Seneca said, “You are your choices”. I don’t recall any philosopher ever saying anything like “You are your unwanted thoughts”.
The bottom line is that you are not responsible for the unending stream of thoughts that pop into your consciousness. Thoughts just happen, and many (most?) range anywhere from unimportant to ridiculous. If you were to keep a running log of all of the thoughts you have in a given day, you would quickly discover just how few are actually meaningful or important.
Think of it this way – if our thoughts are evidence of our true character and intent, then just about everybody is a murderer, as most of us have at some time or another thought of killing someone, even if only while watching a movie or reading a book in which a murder takes place. Think of all of the people who have written books or made movies about killers. Are they all killers themselves? They have all clearly had thoughts about murder, otherwise there would be no way for them to have created stories about such things. Years ago, at the annual conference of the International OCD Foundation, there was a presentation entitled “If Stephen King Can Do It, Why Can’t I?”, the joke being that Stephen King took all of his thoughts about crazy killers and turned them into millions of dollars…all without having to kill even one person in real life!
Treatment of Pure O
Some people have the mistaken belief that Pure O is somehow “special” or “different”, and as such is unresponsive to treatment, but that is simply not the case. Pure O responds quite well to treatment, so long as the therapist actually understands OCD and has the proper training. The most effective, evidence-based treatment for Pure O is the exact same treatment that works for all forms of OCD, namely Cognitive Behavioral Therapy (CBT), with an emphasis on a specific CBT technique called Exposure and Response Prevention (ERP). Check back to this blog in the future to read our follow-up article on treatment considerations for Pure O.
•Tom Corboy, MFT is the founder and executive director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions. In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
Great article. I need to read stuff like this periodically to remind myself that my thoughts are just thoughts and not to give them value or weight. Thanks for the reminder.
Thanks for your kind words. Glad you found the article helpful.
Thank you so much for this article. It’s as if someone wrote it for me.
So glad to hear that you found our article relevant to your personal experience of OCD.
Ditto Ross – 42 years of Pure O on and off, really ON in my early years and even today this article grounded me after a few days of the “old” sh#@!%t returning for an encore. Funny stuff this Pure O.
I love what you wrote – Pure O is the same old shit returning for an encore. Everyone struggling with unwanted thoughts needs to remember that when these thoughts pop back up.
Hey, is it a symptom of pure OCD to believe that your actions were done in ill intent, even if they were originally harmless? For example, today I was driving and anoter car was turning ahead of me. I realized at the time that I could continue at the same speed and not hit it, so I didn’t slow down. I did not hit it, but my mind was telling me that my intent was to t bone the car ahead of me. Do distressing thoughts after innocent actions fall under the umbrella of pure OCD? Thanks you
The thought you describe sounds like a typical Harm OCD thought. As the article above notes, Harm OCD is a common variant of OCD that is generally conceptualized as a part of the Pure O spectrum.
You need to realize that your OCD mind is a liar. It is going to try to convince you that you have ill intent, when in actuality, you did nothing other than to drive your car normally. I encourage you to read our article about how the OCD mind lies to people.
Great article. Found the comments re denial and Pure O really helpful. The hook is often thinking the thoughts represent some deep inner belief that is being repressed.What a relief to read this is not the case.
Thanks for your kind words Joan, Especially happy that you found the points about denial to be helpful. I encourage you to read our article about the denial obsession in OCD.
Yup, my sentiments exactly. I forget sometimes that the thoughts are OCD and even question if they are indeed OCD, question if that is the truly correct diagnosis. Whenever I read something written by you or your staff, it is so reassuring because I relate so much to everything being described and I remember, “Oh yea, this is just OCD. That’s all.” So, thanks.
It is extremely common for people with OCD to question their diagnosis – remember that OCD has often been called “the doubting disease”. Reminding yourself that your doubt is a function of your OCD is a good starting point in addressing this pernicious condition.
Very useful article. Explained nicely and accurately in the goal. You can also send me useful articles. Thank you. Best regards, Angela P.
Thanks for commenting. Glad to hear that you found this article helpful.
You are doing an important job informing about this. I guess there are many sufferers out there who have barely heard of OCD. I feel so grateful that I managed to find my way out of it – in the process I read several articles by you. Keep up the good work!
Thanks for your kind words. It’s our honor to help people struggling with OCD and anxiety. Glad to hear you have been succeeding in your recovery.
Thanks for article but my problem is what is the SOLUTION
Thanks for commenting. As our article notes in the last paragraph, the most effective, evidence-based treatment for all forms of OCD is Cognitive Behavioral Therapy (CBT) with an emphasis on a specific CBT technique called Exposure and Response Prevention (ERP). You can read more about this at https://ocdla.com/cognitivebehavioraltherapy/.
I’ve been in ERP/CBT before and it helped with regular obsessions and compulsions, but NOT for mental compulsions (or Pure OCD). I can’t relate exposing myself to the obsession in my mental thoughts and feelings which are terribly complex. I need answers on “how” to apply ERP/CBT to Pure O or mental obsessions.
As the article above notes, Pure O is not special or different from OCD, but is simply a slang term for OCD in which the compulsions (such as mental compulsions) are less obvious. The best way to learn how to apply ERP to your specific Pure O symptoms is to seek treatment with a therapist who specializes in treating OCD. I have no idea from whom you have previously sought treatment, but I assure you that a qualified OCD specialist would be quite capable of helping you with mental compulsions.
What a brilliant article! I recognize myself in Relathionship OCD: I think you managed to sum up all of the traits of this “mental trap”. I usually get stuck when I think: do I really suffer from ROCD or is it just my relationship which has come to an end? Are my thoughts ego-dystonic, as you wrote, or do I really not like my girlfriend anymore? It’s like an enigma I can’t solve…
Thanks you for your very kind words. I am happy to hear the article has meaning for you.
Trying to solve the “enigma” of OCD is itself a compulsion. There is no solution, other than accepting the presence of unwanted thoughts, without over-attending to them, over-valuing them, or over-responding to them. These unwanted thoughts are just lies your brain is telling you.
I encourage you to read our article “OCD is Fake News”, as well as our article “Doubt, Denial, and OCD”. Hopefully these will be helpful to you.
Thank you, your help is invaluable. I’ll read them.
Thanks for a helpful article! And for all the good work you do on behalf of OCD sufferers.
Thank you! We are grateful for the opportunity to help.
Thank you for writing about pure o I have suffered with many of the subtypes during the past 50 years of my life. I have managed my OCD with CBT and ERP along with medication. I am now in a good place but I fear when my unwanted thoughts will take hold of me again. But reading your article has helped to reassure me that my unwanted thought are just my OCD. OCD is fake news!
Glad you found the article helpful in providing perspective towards your OCD. OCD really is just fake news!
Great article could identifywith all of it. Thank-you
I have pure o and a lot of these things sound very much like me in so many ways. my thoughts are like a room 101 and I feel trapped by them. I am always ruminating and it is a struggle every single day. glad to see it is coming more out there
Thanks for commenting. I’m glad to hear that the article resonated for you.
Know that you are not alone – many people with OCD feel trapped by their thoughts. But there is help. I encourage you to seek treatment with a therapist who specializes in treating OCD.
I really enjoyed this article. It felt nice to hear that is it not our fault these thoughts keep coming. I’ve had OCD for as long as I can remember. I practice meditation everyday, but they still just keep on coming to this day. It is so very true that we take our thoughts way too seriously. Thank you.
Yep – the thoughts just keep on coming! Unfortunately, many people with OCD have the mistaken impression that they can control what comes into their mind, and that the presence of any given thought in their mind means something important about their intent or values. But the reality is that we cannot control what comes into our mind, and that much of what we think is just nonsense.
A brilliant article!
You very accurately addressed what is happening in the mind of a Pure O.
My experience of living more than 28 years with OCD is that it is an ever-progressive disease. I controlled it several years ago for the first time, but from that time to now it has had several remissions. It’s like it crawls into the mind; it progresses silently and very slowly such that I don’t notify it’s back, until I find myself trapped again.
I took many notes while reading your brilliant article with the hope that they remind me time to time about the true nature of the thoughts and specially Pure O thoughts.
Thank you for your kind words. I am glad the article was helpful for you.
It is extremely common for OCD to wax and wane over time, with periods when one’s symptoms are more or less pronounced. When your OCD is increasing, it is helpful to remind your self that this is the normal progress of OCD – sometimes it is more active, and other times it is less active. If you can remind your self of that simple fact, it becomes easier not to over-react to your unwanted thoughts. They will likely still be present in your mind, but you needn’t take them seriously.
Thanks for your great work! Humanity needs people like you?
Thank you so much for your kind words. Glad that the article was meaningful for you.
Hi, great article! How does acceptance play a role in recovery in your view?
Acceptance is crucial to managing OCD. The goal is to accept the existence of all unwanted thoughts, without over-attending, over-valuing, or over-responding to them. That doesn’t mean accepting that your unwanted thoughts are true, or meaningful – only that they exist in your mind. Don’t make any effort to control or eliminate them – just let them exist without reacting to them.
I had a dream a few months back that triggered an intrusive thought.. I’m reading ‘Overcoming Unwanted Intrusive Thoughts’ and they mention that intrusive thoughts aren’t product of the subconscious like say “ a Freudian slip or dream are”.. now I’m terrified that I don’t have OCD and my dream was actually telling me something about a subconscious desire.
I have not read the book you mention, so I cannot comment on the authors’ intent. That said, I would argue that dreams are generally meaningless, and that they do not tell us anything about a secret self hidden in our unconscious (because there is no secret self hidden in our unconscious). We dream about all sorts of nonsensical things, and assuming that the content of your dreams is evidence of some “subconscious desire” is likely going to worsen your OCD.
I have suffered for 35 years from what I have finally come to realize is OCD. It has resulted in major depression, hospitalization, excruciating pain. I obsess about the most important thing to me and that is my faith. It’s similar to relationship ocd in the way it’s described. Constantly asking myself if my religion is the right one and always comparing, seeing all the negative, etc. its like my faith is locked inside a fortress and I can’t get to it. I can’t see it through the walls no matter how hard I try. When I’m depressed I know my thinking is off. It’s when I’m not feeling depressed that my thoughts scare me and I think they must be real because I don’t feel depressed. But then I get depressed. Vicious cycle. That’s the worst part.
Obsessions related to religious faith are quite common in OCD. I encourage you to read our article Scrupulosity: Where OCD Meets Religion, Faith, and Belief.
Thank you for the article, Tom! What about thoughts that have no rhyme or reason? Like you find yourself counting words when you speak or if other people speak. My guess is it’s as frustrating as the other parts of pure O but is that treatable as well?
Many thoughts that humans experience “have no rhyme or reason”, and there is nothing special or different about OCD thoughts. This is true regardless of whether the thoughts are about the types of things noted in this article, or if they are about counting or whatever. Compulsive counting is a common OCD symptom, and it responds quite well to a type of therapy called Cognitive Behavioral Therapy (CBT), especially a type of CBT called Exposure and Response Prevention (ERP).
I sent it to my psychologist.
Glad you found the article helpful.
Could my Retroactive Jealousy be a type of Pure O?
If not, I am not sure what explains my intrusive thoughts about my wife’s sexual past.
I practice avoidance, and seek reassurance from my wife not infrequently.
Retroactive Jealousy can be conceptualized as a variant of OCD that falls into the Pure O spectrum. That said, don’t get too caught up in finding the right box into which to put your symptoms. If you have repetitive intrusive thoughts, and use avoidance and reassurance-seeking behaviors in an effort to ameliorate your anxiety related to those thoughts (and it sounds like all three of those factors apply), then you likely have OCD, regardless of what “type” it is.
I am so grateful for your articles, this one in particular, and for the OCD Center of LA. I had OCD for over 20 years before I figured out that it was OCD. Finding your website and getting treatment has been liberating beyond words. When I read articles like this one, I am reminded of how incredibly thankful I am to finally understand that I have OCD. I am kind of speechless and simply want to say THANK YOU!! Thank you for writing articles like this one and for founding the OCD Center of LA. It has turned my life around.
Thank you so much for your incredibly kind words!
I obsess about an incident that actually happened in the past. I have struggled with this for years now. Feel very alone with it as feel not many others have this. Would you say the treatment is the same as the other types of pure O you talk about?
Yes, as the article notes in the last paragraph, the treatment of choice for Pure O is “the exact same treatment that works for all forms of OCD, namely Cognitive Behavioral Therapy (CBT), with an emphasis on a specific CBT technique called Exposure and Response Prevention (ERP).
I found this really helpful to read in the middle of a bad day – it reminded me of the basics and helped me reframe some of the intrusive thoughts I was having. The bit on confirmation bias was particularly useful. Thank you!
Thanks for commenting. I’m glad to hear that the article helped you get some perspective on your unwanted thoughts.
Thank you very much for this article. Its great to see that you included obsessions and fears about being trans, which is an understudied ocd subtheme.
Trans OCD (TOCD), is a fairly common variant of Pure O. It has become more recognized in the past few years as trans issues have had more media exposure.
The article re: Pure O was so well put together. You’ve captured the experience with words and detail so perfectly it is as if the article was written about me. I took the test as a reminder of how Pure O took over my life during the early 1970s and how I am in 2019. Mindfulness and CBT have freed me from agonizing thoughts. I received one on one counseling in early 2015 during a patient aftercare program in Brampton,Ont. Canada. Prior to that I was looking for a magic pill type treatment. Anything to avoid explaining what exactly was the source of my angst. I read of surgeries and other successes. I wanted the supposed quick fix so badly. I finally realised that their is no magic pill anywhere. Claire Weekes summed it up in a few sentences long ago. To rid yoursel of extreme anxiety dont react to any thoughts and let the thoughts float away. Trying to ride out the anxiety was excruciating. I went back to ritualistic or compulsive thinking. I was introduced to mindfulness and CBT. I found that letting the thoughts come and go without reacting became easier as months went by. I was freed of Pure O finally. Thx to the OCD of LA. for indirectly helping me.
Thank you for your comment. I’m glad you found it to be personally meaningful. And thanks for the Claire Weekes quote. It is right on target.
This article came at the perfect time for me. I’ve been dealing with Pure O for 10 years, but for the past year and a half, I’ve been dealing with it relatively well. I had surgery about a week ago, though, and ever since then my Harm OCD has been incredibly intense. Of course, the thoughts are as unimportant as ever, but for some reason after the surgery, my confirmation bias is very strong and I haven’t been able to deal with the thoughts rationally. This article has helped to remind me that this is just OCD and I’ll get through this rough patch as I’ve done for the past decade.
Thank you very much for the work you do, as you’ve helped me more times than I can count.
Thank your your comment and your kind words. So glad that you have found this article helpful
Keep in mind that it is quite common for OCD to spike when people are under stress. You just had surgery, which would be stressful for just about anyone. And not just due to the surgery itself, but also to the disruption in one’s life that surgery causes.
Be patient with yourself and with your OCD. As you note, your OCD thoughts are unimportant, and you’ll get through this rough patch.
Great article, description and explanation of Pure O.
The people I have treated are so deeply distressed by these unbidden and overvalued thoughts. Just knowing others suffer from these same intrusions begins to give them (hesitant) hope. This article should be shared widely to reach as many people who live in unnecessary self-fear as possible.
Thanks for your kind words. Glad you found the article meaningful.
Thanks for the article, it’s very enlightening.
In my case I suffer from ROCD (also I suffered HOCD for two/three years), or at least I have been diagnosed of rOCD by two different therapist, because my mind keep always telling me I don’t have rOCD.
And it comes to a point where my thoughts are not thoughts anymore but real feelings… I’ve been there for a long time now, just “feeling” and even thinking that I *really want* to break up with my partner, with no anxiety. Or even feeling that I’m exhausted. That is the real fear of this OCD.
It is common for people with any of the variants of Pure O (such as ROCD and HOCD) to over-attend to their thoughts so much that they begin to conceptualize those thoughts as “feelings”. It is worth noting that “I want to break up with my partner” is a thought, not a feeling.
That said, I think it is pointless to analyze your thoughts and feelings, and in your case, counterproductive to differentiate between thoughts and feelings.
As for your brain telling you that you don’t have ROCD, I encourage you to read our article about doubt and OCD.
Tom, this is an excellent article & I feel I have taken key pieces of information from it.
I am definitely guilty of placing too much value on ego-dystonic thoughts & it is extremely distressing & upsetting.
At the moment, I am struggling largely with distressing thoughts relating to my relationship & it’s affecting me hugely.
I am due to get married in a few short months & I love my partner with my whole heart. The presence of these thoughts are bothering me so much & affecting other parts of my life, sleep, work…. I have a lot going on in my life recently, big shake ups in my work whilst also being relatively new there, preparing for our wedding & building our own first home together. I am trying to be patient with myself, working on my mindfulness practice & trying so hard to allow the thoughts to be presence without reacting but it’s extremely difficult not to engage them all of a sudden the thoughts have snowballed into catastrophe! I have also dealt with other forms of obsessive thoughts in my past incl. fear of harming others & paedophilia & schizophrenia. Can this occur in times of stress/pressure? Thanks again for the insight.
OCD symptoms frequently increase at times of stress. Getting married is a common stressor for many people, and we have had numerous clients over the years who have reported that their anxiety and OCD went through the roof when they were getting married.
Began a meditation practice a month or so ago. Guess, what? My old friend Pure O decided to join in. Probably been there, just not heard or listened to. It never goes away, I accepted that long ago and honestly that’s fine. I noticed I started to give it importance or started to fear the feelings/thoughts. This article was a reminder of how ridiculous it is, how much Pure O lies and how many other “randomly crazy” other thoughts I have that don’t create that special anxiety I know as OCD. As meditation teaches and as you write, let them come and go and just notice. This will be great for my practice. Thanks OCD:)
These are great insights you offer here on Pure O. Unwanted thoughts don’t go away forever, and giving them importance never helps. Accept them when they appear, don’t take them seriously, and don’t react to them.
Thank you so much. A hard day made better by reading this. I especially related to the confirmation bias bit.
Thanks for commenting. Glad to hear that you found the article, especially the section on confirmation bias, to be helpful.
Thanks so much as well. I am actually rereading this to remind myself that my brain is doing the OCD thing again. My brain can produce thoughts where I question accepted things around me, like—why is working the right thing to do? Why is loving others right? Why should I take care of myself….? With every one of these thoughts questioning what I have pretty much always accepted as true, I feel panic that I shouldn’t relax and trust my previous beliefs. Does this sound like OCD?
Also, can OCD piggyback off of feelings? As one who has struggled with depression, I find that if I have had depressive feelings at any time in the day, I can’t let go of it mentally later and almost keep worrying about the feelings returning.
A few thoughts…
1) OCD is often exacerbated at times of emotional distress. And depression is quite common amongst people with OCD.
2) On a related note, obsessions about unwanted feelings returning is quite common for people with OCD. Those can be any feelings – sadness, guilt, anger, etc.
3) I love what you wrote here – “My brain is doing the OCD thing again”. I encourage you to remember that when you have unwanted thoughts.
Thanks so much! Would ERP be helpful for fear of experiencing times of depression?…I check my feelings and for any hopeless thoughts so often.
Do you have any medicines you suggest for Pure O sufferers?
If your obsession is “what if I am depressed” or “what if I become depressed”, then ERP should theoretically be helpful. That said, I encourage you to discuss this with a therapist who specializes in treating OCD so that you can determine if you are actually struggling with depression, or just having unwanted thoughts about the possibility of becoming depressed.
As for medicine, you should discuss that issue with a physician.
This is very good Article on pure O. I am happy you included Trans Ocd. As this is my latest theme the last few years.( for obvious reasons.) i have had a number of Themes over the last 40 plus years. Including some of the ones mentioned in the article. It still frustrates me at time the things I can Obsess about.( Ridiculous Things ) Especially if I am feeling Tired from lack of sleep.Then i have to be prepared for the intrusive thoughts to be There most of the day. and not give any energy to them. Which is Difficult. Just my Brain doing its thing. Great Article Tom. Thank You.
Thanks for your kind words. I am glad the article was meaningful for you. I suspect many readers resonate with your statement that “It still frustrates me at times the things I can obsess about”.
Great article. I have taken the recommended test for possible HOCD and the conclusion is “high probability that you have HOCD”. I feel that I can confirm that finding. I had been obsessing about my sexual identity and could find no relief or peace until the day that I mentally surrendered and accepted that I am gay. So far l have stayed with this conviction and have been free from the compulsion. I am now reassured by the findings of the test.
The goal of treatment is NOT to accept that you are gay, but rather to accept that you have unwanted thoughts about being gay. Those are two very different things.
Of course, if you ar actually gay, and have been obsessing about the possibility that you are secretly straight, then my statement above should read “The goal of treatment is NOT to accept that you are straight, but rather to accept that you have unwanted thoughts about being straight. Those are two very different things.”
Would you consider health anxiety a form of pure OCD?
Health Anxiety is a separate condition, but is very similar to OCD. The treatment is essentially the same as the treatment for OCD. You can read more about Health Anxiety on our website at https://ocdla.com/hypochondriasis.
I have struggled with intrusive thoughts since I had my first one at the age of 6 when I was on top of a mountain with my father and the thought of, “What if I pushed him over the edge?” popped into my brain. Suffice to say I never told anyone about it and was highly distressed to have had such a thought.
I’m now 44 and my OCD thoughts have run the gamut throughout my life, mainly of the harm variety, but also relationship, gay, pedophilia, religious scrupulosity, and pretty much any other topic you can think of. Oh, and health. That’s always a big one.
I found this site a couple years ago when the OCD was really pounding me and all I can say is I wish I had found it sooner. It would have saved me a lifetime of misery because I had no idea what was “wrong” with me. Turns out nothing was “wrong” with me, other than I was giving my thoughts way too much value and attention.
I still get all the thoughts I used to, but they don’t bother me anymore. You can beat this thing, I’m proof and I’m grateful for sites like this that provide the information people like myself need to overcome our obsessions.
Thanks for all you do!
Thanks for your comment, and for your kind words. It is really gratifying to hear that our website has been so helpful to you.
You are right on target when you write that the key issue in OCD is giving too much value and attention to thoughts. So many struggle because they believe that having an unwanted thought means something about their character and intent. It’s crucial to remember that thoughts are just thoughts, and EVERYONE has unwanted thoughts.
Where do OCD specialists stand on intrusive emotional states? Or would you say that intrusive emotional states are in the same vein as intrusive thoughts? My current understanding is that behind every intense emotion is a cluster of thoughts that are producing the emotional response. Is trying to figure out what causes your intense emotions worth the time or is it making them more likely to appear in the future. Should you just ignore all your emotions? How do you know when a feeling, emotional state , or thought is worth your time? I’m confused.
You ask some questions, specifically…
Q) “Would you say that intrusive emotional states are in the same vein as intrusive thoughts?”
Q) “Is trying to figure out what causes your intense emotions worth the time or is it making them more likely to appear in the future.”
A) Analyzing thoughts and emotions is complete waste of time. It is an even bigger waste of time to attempt to discern the difference between thoughts and emotions.
Q) “Should you just ignore all your emotions?”
A) Don’t ignore them – experience them. But do not analyze them.
I have intrusive and negative thoughts that tell me to kill myself. I have a family that counts on me and I love dearly. I love my life and all that it has given me. Why on earth do I keep ruminating about death and what life would be like without me? None of them are real I refuse to believe it. I keep thinking this is the end, I’m not safe. I’ve never cut myself or plan on hurting myself yet I spend 8 hours a day ruminating about my death and all the people I’d disappoint. I would love any feedback thank you so much and God bless you all.
While I cannot provide you with a diagnosis via this blog, I can say that the symptoms you describe sound very much like OCD. I encourage you to seek treatment with a therapist who specializes in treating OCD.