What is ‘Pure O’ OCD?
‘Pure O’ is not an official diagnosis, but is rather a subtype of OCD that people experience. ‘Pure-O’ is characterised by intrusive thoughts, images or urges without any visible physical compulsions. Despite the name, people with ‘Pure O’ do actually engage in compulsions to alleviate their distress the same way as other OCD sufferers. The key difference is that the compulsions are done internally (i.e., in the mind), and therefore it doesn’t seem like a compulsion is occurring. Examples of such internal compulsions could be replaying events over and over again in your mind, silently repeating phrases in your head, becoming hyper-aware of normal bodily sensations, avoidance of thoughts — just to name a few. So how dow e treat “pure-o” and is it different to the way we treat other forms of OCD?
Though they can take many forms, the most common intrusive thoughts generally centre on themes of harm, relationships, sexuality, and religious or moral questions. These ideas and images can feel like an attack on a person’s sense of self, their values, and they often come with guilt and shame. Many people with pure OCD are scared of sharing these experiences for fear of being judged. It’s common for people with “Pure O” OCD to feel like they are the only ones dealing with this. Because their experience is internal, there often aren’t obvious visual clues an outside observer might notice to identify someone with pure OCD, but that makes it no less distressing.
Treating ‘Pure O’
Even though pure OCD compulsions are often not noticeable from an outside perspective, they are best treated like all types of OCD compulsions: with exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment, backed by decades of rigorous clinical research.
For pure OCD, a trained ERP therapist will be able to help you identify your mental compulsions and work with you to come up with the best course of treatment for exposure to them.
If you’ve ever tried not thinking about something, you know how difficult it is to control your thoughts (try to not think about a red-faced monkey for the next 30 seconds…see). ERP therapy takes the opposite approach: Instead of trying to make yourself stop your obsessive thoughts, you welcome them. In a way, many people with Pure O have built in exposure happening all the time, sine their intrusive thoughts are occurring daily, so that part of ERP is automatically taken care of. The difficult part of ERP for someone with “pure-O” is the response prevention aspect of ERP. This means that the resistance of internal compulsions is difficult.
When trying to resist internal compulsions, it can be really hard to resist the compulsion let alone recognise you’re even engaging in the compulsion. In this instance, ERP can feel frustrating. One thing to try in these instances is to engage in committed action that is in line with your values. This approach is very much in line with Acceptance and Commitment Therapy (ACT), a mindfulness-based form of psychotherapy that encourages you to ‘get out of your head and into your life’ by focussing on your values and then making decisions to live in accordance with them despite what shows up on the inside. This means that you choose to follow your own set of values as opposed to the values of OCD. An example of this would be to name the thoughts, feelings, sensations, memories, and urges, to sit with the distress, to lean into the distress, and to choose what you want to do in that moment (e.g., walk your dog, visit your friend, play with your kids, work on your novel, study for your exam, cook a nice meal, go to the gym, wash the dishes, mow the lawn…whatever it is that you want to do that takes you in the direction of the life you want). Living out your values is powerful because many people think they can’t live their lives whilst experiencing certain thoughts or emotions. But you can! Read though that list of activities again. Notice that you can do all of them even if distressing thoughts or emotions are happening inside of you. A thought in your head cannot stop you doing anything! It’s just a thought. So next time an intrusive thought appears, acknowledge it, and engage in opposite action (aka response prevention), and then keep doing what you’re doing as this promotes newer healthier brain pathways to develop and overrun OCD.
A Note About Distraction
Using distraction can be unhelpful when trying to get rid of OCD (because then I’m tacitly acknowledging that OCD is this big scary thing which feeds the belief that it’s scary). How do I know I’m not using committed action as a distraction?’
If you are distracting yourself using things that go against your values or the life you want to live (eg. Using drugs, blasting loud music, binge watching TV…) then yes, you are likely using distraction in an unhelpful way. If however, when an obsession pops up, you go to the gym, or go for a walk, or just keep doing what you’re doing, that is reasonable, and you are at the same time still leaning into the distress, and making room for the obsessions, then I would not call that a distraction. Additionally, it’s not a distraction if you acknowledge the thought. And remember, that in a very real sense, OCD and the compulsions are actually the distraction, because they are distracting you from life.
This blog was prepared by Nat Clarke and edited by Dr Celin Gelgec. If you or a loved one needs support with OCD please give our team a call on (03) 9882-8874.