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Pure O: Understanding This Subtype of OCD

Pure obsessional OCD refers to a type of OCD that consists of obsessions without observable compulsive behaviors. These thoughts, by nature, are distressing and unwanted. They create a significant disturbance, and they affect the individual's daily functioning.

What is Pure O OCD?

Pure O OCD is not officially recognized in the Diagnostic and Statistical Manual (DSM). However, many experts consider it a subtype of OCD.

Pure O refers to ongoing obsessions about feared situations. People with pure O experience unwanted, chronic, intrusive thoughts that feel distressing by nature. They find it challenging to discern their thoughts from reality, meaning that if they think about something, they believe it must be true.

How Does Purely-Obsessional OCD Differ From Obsessive-Compulsive Disorder?

The main difference between these disorders is that OCD sufferers experience obsessive thoughts and compulsive behaviors like hand washing, counting in specific orders, repeating phrases, or double-checking certain items. These behavioral compulsions act as a way to mitigate the extreme anxiety associated with obsessive thoughts.

People with OCD may engage in these rituals secretly. But if you spend enough time with them, you may start noticing the behavioral compulsions yourself.

Pure O OCD, on the other hand, refers to a combination of intrusive thoughts coupled with mental compulsions. People with pure OCD don't engage in the same ritualistic behavioral actions as someone with OCD does. Instead, they try to actively neutralize their obsessions through mental rituals like reassurance-seeking or fact-checking.

For this reason, Pure O OCD can be harder to detect. Unless someone opens up about their intrusive thoughts, others might not realize their full effect.

Pure-O OCD Subtypes

Pure O can be generalized, but many people experience specific themes when it comes to their intrusive thoughts. These themes fall into various clusters, and we'll review some of the common ones below.

Harm OCD

Harm OCD refers to having a fear of harming yourself or others. This is a common obsession in traditional OCD, and the individual having these thoughts often feels significant distress.

Here are some examples of HARM OCD obsessions:

  • You're cooking dinner and have an impulse to stab your wife with the knife you're using. You respond to this thought by hiding all the knives and assuming you're too unstable to safely cook.

  • You're driving on the highway when you think about swerving your car off the road and smashing into a guardrail. You pull over and try to flood yourself with positive thoughts to ensure you're safe enough to resume driving.

  • You are carrying your infant child down the stairs and have an image of dropping them. You start avoiding baby duties and delegating most of the caregiving to your partner, as you fear you will inevitably hurt your child.

This fear exists even if you have no history of hurting someone. Such thoughts of causing unintentional harm can be so jarring that you find yourself distancing from loved ones just to keep them safe.

Pedophilia OCD

Someone with pedophilia OCD may worry about their potential capability of being attracted to children. It's important to distinguish that this fear does not inherently mean they are pedophilic. It means they feel anxious about developing such unacceptable thoughts.

Here are some examples of pedophilia OCD obsessions:

  • You change your baby's diaper and panic that you have touched their genitals. You obsess over whether you acted inappropriately and find yourself avoiding any behaviors that involve touching them.

  • You notice someone on social media who looks attractive. You later discover they're not legally an adult, and you feel immense guilt and fear. You worry that your initial attraction means you are genuinely attracted to someone underage.

  • You hug your child and enjoy the close bonding moment. You then worry about this feeling indicating that something is wrong with you, and you experience obsessions about whether or not you are feeling a sense of sexual gratification.

People with pedophilia OCD experience immense distress about their fears. It's important to note that their fears do not indicate that they are harming children. People who sexually assault children often justify their behavior and use power and control as means of harming someone else.

Relationship OCD

Relationship OCD refers to intrusive thoughts about the relationship you share with your partner. These thoughts may consist of doubting their loyalty, continuous worrying about whether you're "right" for each other, concerns about compatibility, and fears about sexual desirability.

Here are some examples of relationship obsessions:

  • You are planning your wedding, but you keep doubting that your future spouse is "really the one." Even though you feel happy in your relationship, you worry that you're missing out on someone better.

  • You are at the gym and notice someone attractive working out next to you. You assume your feelings of attraction must mean you aren't really devoted to your current relationship, and you feel upset because you thought you loved your partner.

  • You dislike your partner's new haircut, and you wonder if it means you're really attracted to them. You search for other reasons that confirm whether you actually value your relationship.

Relationship OCD often causes immense problems within relationships. Partners may become frustrated by your difficulties with commitment- or your inability to trust them.

Sexual Orientation OCD

Someone with sexual orientation obsessions experiences immense anxiety about their sexual orientation. Sometimes, this is also referred to as homosexual OCD, as the fear is often around being gay or becoming gay.

Here are some examples of sexual obsessions:

  • You see part of your same-sex friend exposed while they're changing in the locker room. You keep wondering if you found their body attractive, and you keep scanning your own bodily sensations to determine whether you're turned on.

  • You wear a favorite outfit, but wonder if it will cause other people to think you're gay. You spend the day obsessing about what your friends might think, and you wonder how others judge your physical appearance.

  • You are married, but keep having a nagging thought that you might be gay without realizing out. You subconsciously avoid gay people because you fear it may trigger distressing thoughts.

Sexual orientation OCD can stem from internalized homophobia, and it can also be a form of anxiety. You want a level of complete certainty, and you may engage in time-consuming, reassurance-seeking behaviors to try to meet that need.

Treating Pure O OCD

All types of OCD are treatable, and you can lessen the intensity of your repetitive thoughts or repetitive actions. If you think you are struggling with these symptoms- even if you don't have visible compulsions- it's important to seek help.

Biopsychosocial Evaluation

A qualified healthcare professional like a doctor, therapist, or psychologist will evaluate your pure OCD symptoms within the context of your overall health. Biopsychosocial evaluations assess your current level of functioning, family history, and medical details. This information helps your provider make an accurate OCD diagnosis.

Exposure and Response Prevention Therapy

Exposure and response prevention therapy (ERP therapy) is a specific type of cognitive-behavioral therapy that focuses on confronting obsessive thoughts. It's currently considered one of the gold-standard treatment options for OCD.

ERP entails desensitizing yourself to your fears through gradual exposure. You will work with a qualified mental health professional to sit with distressing thoughts without acting on them. Over time, this makes the thoughts feel less compelling.

ERP treatment starts with creating a fear hierarchy. You will work through less anxiety-provoking situations to build confidence and mastery. As you get more comfortable with the work, you will move on to facing greater fears.

ERP focuses on consistency and repetition. There's a sense of mindfulness attached to it, as you must learn to sit with the urges related to your obsessive thoughts.


The FDA has approved selective serotonin reuptake inhibitors (SSRIs) to treat OCD. These medications are typically prescribed in conjunction with psychotherapy.

Co-Occurring Considerations

Many people with pure O OCD also experience other mental health conditions, like depression, anxiety disorders, or substance use disorders. The combination of these symptoms can undoubtedly wreak havoc on your daily life.

The best treatment approaches must take all presenting mental health symptoms into consideration. For this reason, it's important to be honest with your provider about your past and present difficulties.

Support Groups

Support groups can be beneficial for people with pure OCD symptoms. Psychoeducational groups, in particular, can help you learn more about your symptoms and ways to cope with uncomfortable thoughts. Peer-led support groups offer a sense of validation and connection for a condition that often feels isolating.

Final Thoughts

If you experience pure O OCD symptoms, you're not alone, and you're not a bad person. Even though these mental images may scare you, remember that your thoughts do not indicate reality.

The right treatment can help you overcome your obsessive thoughts. It can also help replace toxic repetitive behaviors with more positive habits.

At Resurface Group, we provide custom support for individuals and their family members. We are here for you during every step of your recovery journey.

Contact us today to get started!

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