“PURE O” OCD: A MISNOMER
If you’re familiar with the term “Pure O,” then it might surprise you to read that it’s a bit of a misnomer.
It’s true: there are some helpful aspects to this term. For example, some people who experience OCD symptoms that tend to manifest mentally, have felt misunderstood by the larger OCD community (and even therapists and doctors at times). The term “Pure O” has helped people more quickly identify others with similar symptom manifestations, and more readily connect with others who “get it.” However, mental rituals and cognitive avoidance are more common in OCD than this term might imply.
Defining Obsessions
First, let’s give a quick refresher on the basic components of Obsessive Compulsive Disorder. A simple definition of an obsession is an unwanted intrusive thought that tends to create distress, anxiety, or discomfort—and reoccur. A basic definition of a compulsion is any form of avoidance or ritual—mental or physical—that a person does in response to an obsession (in effort to seek safety or certainty or reduce anxiety related to an obsession). It's important to note this key aspect of a compulsion: it can be mental or physical. Therefore, people who experience compulsions, rituals, and/or avoidance that is predominately mental already fall into what the DSM-5 describes as OCD. This is good news, because a lot of the helpful research on OCD also applies to people with primarily mental forms of avoidance to help treat OCD.
Common Mental Avoidance/Rituals:
However, there are some commonalities typically seen in people with predominately mental avoidance. For example, the most common obsession themes in people with OCD that primarily manifests with mental avoidance (also known as covert compulsions) are:
sexual obsessions
harm obsessions
religious/moral obsessions
bodily sensation obsessions
Relationship OCD (ROCD) is also common in people who experience predominately mental compulsions.
Additionally, forms of OCD that involve primarily mental acts of avoidance can often be mistaken for Generalized Anxiety Disorder or merely excessive worry, potentially leading to inappropriate treatment that might actually be harmful. There are two primary ways to prevent this. One, educate yourself. Recognizing common forms of mental avoidance that are often more subtle, and therefore go unnoticed, can help you to identify covert avoidance. Read the list of common forms of mental compulsions below to see if you can relate to any of them.
Examples of mental avoidance:
Body scans for physical sensations
Counting
Mental checking
Mental distraction
Mental repetition of words or phrases
Mental reviewing past events
Memory hoarding
Neutralizing thoughts
Playing out potential future scenarios
Repetitive, ritualistic prayer
Ruminating
Scenario bending
Seeking reassurance from others
Self-punishment
Self-reassurance
Testing reactions to compulsive flooding of feared thoughts
Obsessions with sexual content often involve mental checking, testing reactions, and body scans for physical sensations. Mental review of past events and playing out scenarios that might happen in the future often accompany harm obsessions. Unwanted intrusive thoughts related to religious themes or scrupulosity might involve ritualized prayer, reassurance seeking, or self-punishment. If you’re interested in additional reading, we often recommend the book, “Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty,” by Jonathan Grayson.
Two, working with a therapist who specializes in OCD can also help to lead to a more accurate diagnosis and the best treatment for you. An OCD specialist can help you to get a thorough understanding of patterns in your thoughts and anxiety to identify counterproductive avoidance that might exacerbate anxiety in the long-term. They can also teach you more about common forms of avoidance to help you catch them sooner. They’ll likely equip you with strategies to reduce unhelpful avoidance and better tolerate uncertainty, such as mindfulness. Most importantly, they should be experienced in providing Exposure and Response Prevention, the gold standard therapy for OCD.
Want to Learn More?
To learn more about distinguishing unwanted intrusive thoughts from more common negative automatic thoughts, check out our blog post. If you’re interested in reading more about therapy for OCD, then click the link.
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