We all have times when we may become hyper-focused on the details of things: our days, a hobby, or a particular subject. However, that period passes, and our focus shifts elsewhere. Yet, in cases of obsessional OCD, this is a complication that interrupts their day-to-day flow and can make living with it cumbersome.

Throughout this article, we’re going to explore pure obsessional OCD and find ways for those with this little-known manifestation of OCD to cope with it. At the end, we invite you to ask further questions.

Pure Obsessional OCD Defined

Pure obsessional OCD is a form of obsessive-compulsive disorder (OCD) in which the sufferer has compulsive thoughts but doesn’t act on them in the usual outward and ritualistic manner.

In other words, it has common OCD components, such as intrusive and unwanted thoughts or feelings. Not to mention, these thoughts can even be violent or disturbing.

However, the coping mechanisms that are common in OCD behaviors aren’t as prevalent in obsessional. ¹

Common OCD Behaviors & How PO-OCD Differs

OCD is a cyclical pattern of ruminations becoming obsessions that manifests into compulsive actions. OCD is present through anxiety, stark environmental changes, and overwhelming stress. Most OCD behaviors resemble routine or pattern actions. Common OCD behaviors for coping can look like this: ²

• Washing and rewashing hands in a compulsive manner.
• Checking the time, double-checking locks, or repacking bags are all borne out of anxiety that if it’s not done something bad will occur.
• Organizing things, events, or activities in a particular or precise way.
• Can’t control thoughts or behaviors, even when they’re recognized as excessive

While it is true that both OCD and pure obsessional OCD both have obsessions, the difference comes in how the sufferer copes with these thoughts.

For those with pure obsessional OCD, the release from these thoughts isn’t going through pattern-based behaviors. Instead, such thoughts release through mental review, mental rituals, and reassurance seeking.

Subtypes of Pure Obsessional OCD

Most times, those with pure OCD find themselves falling deeper and deeper into a spiral of discomforting thoughts and may have different reactions due to the type of obsessions they are experiencing. There are four common kinds of obsessions that those with purely obsessional OCD experience. Those four obsessional subtypes are: ³

• Harmful Obsessions relate to concerns over causing harm to oneself or to others. This can also relate to inflicting sexual violence towards romantic partners as well as children.

• Pedophilic Obsessions are those that relate to sexual thoughts toward children. These are often combatted by attempts to neutralize said obsessions through ritualistic practices such as praying to a higher power or distancing oneself from activities or events involving children.

• Relationship Obsessions are intrusive doubts relating to the sufferer’s attraction toward their romantic partner. This kind of obsession may also relate to their own attractiveness or sexual ability.

• Sexual Orientation Obsessions refer to fears that perhaps the sufferer isn’t aware of their true sexual orientation or that they may secretly be homosexual.

Symptoms of Pure Obsessional OCD

The responses to these subtypes are not typical of OCD in that they don’t usually have an outward expression. Most responses to pure obsessional OCD are internal and rooted in self-conscious rumination: ⁴

• Mentally replaying events over and over.
• Mentally monitoring your verbal and physical behavior
• Silently asking yourself questions about your identity and actions

However, the outward symptoms of pure obsessional OCD are generally subtle and may seem to others as a need for a confidence boost or ways of isolating oneself from others:

• Asking others for reassurance (i.e. constantly asking a romantic partner if they are attractive or ensuring that they are not gay)
• Avoiding people, places, or situations that are related to obsessions (i.e. those with pedophilic obsessions not attending a friend’s child’s birthday party.)
• Using rituals or behaviors to “protect” themselves from the obsessive thoughts (i.e. praying to oneself, replaying days events, or adjusting natural reactions to come across as “normal” or “straight”)

Causes of Pure Obsessional OCD

The causes for pure obsessional OCD follow closely to the causes of typical OCD. While there is no singular cause for OCD, researchers believe causes are genetic, trauma, and brain function abnormalities.

Genetics and family history are great predictors of who may develop OCD. It stands to reason that those with a familial predisposition for a particular mental health affliction may very well receive it through their genealogy. Environmental factors and trauma play a part in the formation of OCD development. ⁵

Those who have had distressing life events, as well as reactions to illnesses, can be more prone to developing OCD. One such cause of OCD in early childhood is PANDAS. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), is a type of OCD that occurs in childhood following the body’s reaction to infection. PANDAS happens very suddenly and can be detrimental to the development of a child’s growth both socially as well as mentally. ⁶

Pure Obsessional OCD Diagnosis

Diagnosing pure OCD is actually more complicated than diagnosing typical OCD. This is due to the fact that pure OCD is primarily an internal mental illness.

Internal mental illnesses are those that don’t have an obvious outward presentation. The difficulty of course lies in the fact that there are very few physical manifestations of symptoms. Observations from a mental or medical professional which lead to proper diagnosis are extremely limited. 

The most common way that pure OCD is diagnosed is through self-monitoring and self-reporting by the patient themselves. It requires that the patient be vulnerable about their struggles with a trusted mental health professional. Those with purely obsessional OCD are often diagnosed through a typical three-step assessment: ⁷

Psychological Evaluation

An initial psychological evaluation allows for a mental health professional to gain all the necessary background information of the patient. This may include the mental and physical health history of the patient, an account of symptoms, and a timeline of how the potential mental illness developed.

Diagnostic Criteria Inquiry

The diagnostic criteria inquiry is the most important and distinctive method for making a secure diagnosis. The criteria will be more precise due to the answers received by the patient. 

Overall Physical Exam

A physical exam allows us to rule out any other possible distinguishing factors that may point to why a patient is feeling a particular way. 

Diagnostic Criteria For OCD & Pure Obsessional OCD 

For typical OCD a diagnostic criteria inquiry usually includes the following: ⁸

• Persistent thoughts urges or images that are experienced, sometimes said experiences are unwanted, intrusive or disturbing. 
• Attempts are made to ignore or suppress such disturbances
• Repetitive mental acts are performed internally to quell said obsession, or according to the rules that must be applied rigidly.
  • Mental acts aimed at preventing or reducing distress. However, these are not connected to a realistic way to neutralize or prevent such occurrences.
• The obsessions are time-consuming or cause distress or impairment in functioning in a professional, personal or social manner.

While OCD is difficult to diagnose, pure obsessional OCD is even more difficult to try and distinguish. Due to this, those with pure obsessional, often receive an initial diagnosis of typical OCD.

Pure Obsessional OCD Treatment

Treating pure OCD involves coaching the patient to intervene in the rumination process. However, this is far more complicated than just putting a stop to obsessive thinking. If it was that easy, then every pure O sufferer wouldn’t have an issue, to begin with. 

No, this kind of treatment is actually retracting the brain’s ability to process thoughts, emotions, and actions. Cognitive behavioral therapy (CBT) is a form of talk therapy in which a mental health professional speaks with a patient about their experiences. Due to these discussions, methods to recontextualize thoughts and reprogram behaviors start to ease symptoms.  

For pure OCD symptoms, a CBT method called exposure and response therapy has shown great promise. ⁹ Exposure and response therapy encompasses an element of exposing the patient to the triggers that cause obsessive thoughts and counteracts them by providing different responses that are coached in order to better cope. ¹⁰

There exist medications for those with typical OCD in order to better cope with their symptoms. However, these medications might not be comprehensive in treating pure obsessional OCD-specific symptoms. As with any medication, it’s best to consult a mental health provider. 

Final Word

OCD alone can be a challenge, the compulsions, intrusive thoughts, and unavoidable behaviors, of OCD, can make life burdensome.

However, for those with purely obsessional OCD, the same struggle exists but it’s a silent struggle. In a paradoxical sense having pure OCD can be more difficult due to the symptoms being in the interior of the mind. It may seem as though those suffering aren’t getting the attentive care that they may desperately need.

The only resource for those suffering is to speak up, to throw their hands out for help and hope that those that respond believe that they are actually struggling. 

This is how we end this kind of suffering: by identifying rarer forms of larger and more well known mental health complications and understanding them.

Your Questions

Do you still have questions about pure obsessional OCD?

We invite you to ask them in the comments section below. If you have any further knowledge to share – whether personal or professional – we’d also love to hear from you.

Reference Sources

¹ Mind UK: What is ‘Pure O’?

² National Institute of Mental Health: Obsessive-Compulsive Disorder

³ Made of Millions Foundation: Common Pure-O Subtypes

⁴ GoodRx: How do I know if I have pure O OCD?

⁵ International OCD Foundation: Causes of OCD

⁶ National Library of Medicine: Clinical Characteristics of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Childhood Obsessive-Compulsive Disorder

⁷ MayoClinic: Diagnosing OCD

⁸ National Library of Medicine: DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison

⁹ Cambridge University Press: Controlled trial of exposure and response prevention in obsessive-compulsive disorder

¹⁰ International OCD Foundation: Exposure and Response Prevention