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“Pure-O” OCD: Common Obsessions & Mental Rituals

Pure-O OCD Obsessions

The obsessions experienced by individuals with “Pure-O” OCD are commonly accompanied by mental compulsions.

As a follow-up to my previous post on Pure-O OCD, I thought it might be helpful to identify some obsessions that are commonly reported by individuals with Pure Obsessional OCD.  These same obsessions may also be experienced by individuals with non-Pure-O forms of the disorder.  Keep in mind that some of these symptoms are quite common (when experienced in a limited form) and may or may not represent an underlying psychological condition.  If you experience symptoms like these, consult with your doctor for clarification.  I am also available to conduct assessments and provide treatment if you’re located in South Florida (Palm Beach Gardens, Jupiter, West Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami).

Remember that most people who have Pure-O OCD actually perform compulsions.  These compulsions just tend to be mental rather than behavioral in nature.  Mental rituals are varied and include such activities as repeating certain words or phrases in one’s head, counting, reviewing/checking memories, intentionally thinking “positive thoughts” to counteract “negative thoughts”, pre-planning words before speaking, making mental lists of similarities between one’s own experience and others’ experiences, conducting online research to prove or disprove a fear, or repeating/restarting prayers due to distraction or worry that one’s prayers are not 100% genuine.

For some individuals, mental rituals also include complex cognitions.  Complex mental rituals often begin simply with one of the following statements or questions and then take on a life of their own:

OCD Mental Rituals

  • “I would never do that…but what if I do?…I don’t want to…but what if I secretly do?”
  • “Why is this happening?”
  • “When will this stop?”
  • “I can’t live this way…”
  • “I need to know…”
  • “I’ll never be strong enough to face this…”
  • “I wouldn’t be having these thoughts if I didn’t secretly want this…”
  • “Maybe I need to act on these thoughts to finally be rid of them and feel closure…”
  • “It’s always going to be this way…”
  • “I can’t take the chance, because if I did…”
  • “If I could just figure this out, I would be able to move past it and it wouldn’t bother me anymore…”

Such thoughts usually begin innocently enough, but in the case of mental rituals, they become repetitive, desperate, and counterproductive. The reason these thoughts are so seductive is because they have the semblance of being helpful.  People often feel that by engaging with these thoughts, they are somehow making progress in solving their own mental puzzle.  In some ways, this parallels the way that chronic worriers ruminate and prepare for every possible contingency (even remote ones that other people would consider unreasonable).

With OCD, you cannot get better by “figuring it out” in your head. This won’t happen today, tomorrow, or even a year from now. OCD does not yield to insight.  Overcoming OCD requires active non-avoidance and actually confronting the very things you fear.

See if you can imagine how the following obsessions might give rise to complex mental compulsions/rituals.

Pure-O OCD Obsessions


Harm-related obsessions (also called violent obsessions)
  • Fear of harming self or others (e.g., stabbing, hitting, shooting, suffocating, or poisoning)
  • Fear of wanting to harm self or others
  • Fear of hitting someone while driving (“Hit-and-run OCD“)
  • Fear of leading to someone’s accidental injury or death
  • Fear of assaulting or killing strangers
Religiously- or morally-themed obsessions (often referred to as religious scrupulosity)
  • Fear/doubt about one’s faith, fear that one might not truly believe in God
  • Fear of being damned or committing an “unpardonable sin”
  • Repetitive sacrilegious thoughts (desecrating religious icons, imagining nude images of Jesus/Mary/Pope/priests/rabbis or other religious persons)
  • Fear of being sexually attracted to religious figures
  • Fear of secretly wanting to worship the devil or becoming a Satanist
  • Excessive concern about past mistakes or previous decisions
Obsessions focusing on sexuality or romantic relationships
  • Fear of being gay (also referred to as Homosexual OCD, or “HOCD”), when the person is actually straight
  • Fear of being straight, when the person is actually gay or bisexual
  • Fear of being attracted to children (i.e., pedophilia)
  • Fear of being attracted to animals (i.e., bestiality)
  • Fear of being attracted to dead things or dead people (i.e., necrophilia)
  • Fear that one might cheat on his/her partner or spouse (infidelity-related)
  • Fear that one might want to cheat on his/her partner or spouse
Obsessions about acting on an unwanted impulse (also see harm obsessions above)
  • Fear of acting in a sexually inappropriate manner (e.g., exposing one’s genitals to others, flashing people)
  • Fear of shouting or screaming obscenities
  • Fear of committing arson
  • Fear of attacking police, taking firearms/guns from police and using them on self or others
  • Fear of accidentally talking about robbing a bank (while at a bank)
  • Fear of accidentally talking about terrorism/hijacking (while at an airport)
  • Fear of throwing important items (e.g., keys, wallets) in places where they cannot be retrieved (e.g., lakes, shredders, elevator shafts, public mail receptacles)
  • Fear of confessing to crimes (that one did not commit)
Obsessions involving health or bodily sensations (somatic obsessions)
  • Hypervigilance/hyper-awareness of bodily sensations/getting attention “stuck” on thinking/analyzing various autonomic processes (breathing, heart rate, swallowing, blinking, eye “floaters”, flickering of the visual field)
  • Persistent feelings of unreality, depersonalization, or derealization
  • Fear of having or developing a chronic, progressive illness (AIDS/HIV, ALS, Alzheimer’s Disease, cancer)
  • Fear of throwing up, also known as vomit phobia or emetophobia
Obsessions involving “mental contamination” or “emotional contamination”
  • Fear of being changed irreparably by exposure to certain ideas
  • Fear of physically or mentally transforming/turning into other people
  • Fear of changing or losing one’s sense of self due to direct or indirect contact with others
  • Superstitious fears regarding omens or signs of “bad luck”
  • Fear that if one sees a certain “sign”, one will have to take an unwanted action (e.g., commit a crime, kill self, murder someone)
  • Fear that one is destined to complete an unwanted action, and that exposure to certain stimuli will make this more likely to happen (e.g., fear that hearing about famous serial killers will make one commit murder)

Questions? Comments? Sound off below.

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  1. Dr. Steve,
    A partir de que idade se pode diagnosticar o Transtorno Obsessivo Compulsivo?

    • Hi Jane,

      OCD often begins in childhood. The youngest case I have ever seen personally was a 2-year-old child with fairly obvious symptoms. This is not typical and was a very unusual case. In many pediatric OCD cases, symptoms appear by age 10 and worsen when the child begins going through puberty. Other individuals develop OCD later in life (e.g., late teens/early adulthood).

      • Sir, I want to know the best medicine for Mental Compulsions. I have already tried Sertraline for 1 year. Thanks.

      • Hello Dr. Seay. My name is Sarah and I’ve recently become curious about a mental exercise that I constantly feel compelled to put myself through. I’ve done variations of this for as long as I can remember and am able to function well despite it, but recognize that it takes concentration and time that I would rather not commit to it. To breifly describe this “mental exercise”: I choose or feel drawn to either a word or (more often) a phrase that either comes up in a conversation or during a reading that sticks in my mind. I then sound out each individual letter in this word or phrase one time through. I then go through and repeat all of the letter sounds again, but this time with no two letters the same. For example, if I am processing the phrase “processing it”, I would sound it out as p-r-o-c-e-s-d-i-n-g a-t, replacing the secons s with a d sound and the second I with an a sound. I would then sound it out once more replacing the first s and first i, and then twice more with the second s and first i replaces, and the first s and second i replaced respectively. Once the phrase has completely individual letters, I repeat it through a few more times grouping the letters in segments by which the phrase is divisible. In this case, I would separate the phrase into 4 groups of 3, 3 groups of 4, 6 groups of 2, 2 groups of 6, and finally 1 group of 12. Words or phrases with 12 letters are the best since it is evenly divisible by so many numbers, although 6 and 8 letter words are acceptable. I know this process sounds complicated, and it can be quite time consuming with longer phrases that have several repeating letters.I’ve only recently viewed this habit as a peculiarity and find it hard to imagine what other people do with all the free time not dissecting phrases provides them. I’m simply interested in learning more about this seeming need to put myself through this. Once I feel the need to run a phrase through this process, I can avoid doing so but prefer not to as it makes me feel unbalanced and slightly…guilty? As if I am neglecting a duty. I’m not even sure if this would be classified as OCD, but any information you could give me would be greatly appreciated. Additional information: I am a 19 year old female and have been quite fortunate to lead a relatively trauma free life. Thanks again.

        • I have a similar compulsion

        • I read a word, remove all letters that have a pair or more and the re-read it. Also i count and group them etc. I also bear grudges and bear a feeling of been insulted and wronged which prevents me from being happy sometimes its an obsession about pride although i strive for humility. It is almost like my brain prevents me from being happy and content. Is there anyone else experiencing the same?

      • If you really care you’d try anything, mine isn’t so bad. A board certified psychiatrist in the State of Nevada cured me of a repression he didn’t report it to a medical journal because he didn’t cure all of the illness, I was experiencing OCD. Please visit my blog Steven j. Seay, Ph.D. Were not going to win with these mental issues until we address the subconscious properly. Thanks.

      • I have had both mental compulsions (pretty much every type here) and overt ones as well (about every known type as well. For 25 years. I have taken a 16 1/2 shower, washed my hair and face ( for 7 minutes with an outside hose), in air temperature of about 36 degrees, water couldn’t have been warmer than 40 degrees. I have done a lot lot lot more, I mean more than I will even summarize here, that were tiring and degrading. I feel beat to death most of the time, but I persist. As part of my core nature there is something I have not ever believed in, nor ever will, that is the cowardly act of giving up!

  2. Hi Dr. Steve,

    I am enjoying your insight on Pure O OCD which is what I struggle with. What do you recommend as the best strategy for dealing with the somatic obsession of getting stuck on thinking about swallowing (and hence swallowing much more than normal)? It is a very difficult obsession to get rid of. I am taking SSRI and a small amount of anti anxiety medication which helps a little but would like some ERP type strategies.

    • Hi Tanja,

      There are many different factors that need to be considered in this situation. In general, though, the basic idea is that your ERP should target your specific obsessional triggers. Some individuals are triggered by physical sensations in their throats, which might be addressed by wearing scarves, etc., during exposures. Others might feel more triggered around mealtimes, and useful exposures might include purposefully eating sticky, dry foods like peanut butter with (and also without!) an accompanying drink. All exposures should be conducted mindfully…you should purposefully pay attention to all the physical sensations you experience rather than trying to ignore or suppress them.

      Somatic obsessions are also associated with very different feared outcomes. Someone who is worried that s/he might choke should approach exposure differently vs. someone who is worried that swallowing might be the sign of a serious illness (e.g., Lou Gehrig’s disease) vs. someone who is worried that they will have to live the rest of their lives noticing every swallow. These fears should be addressed through CBT, as well as through imaginal and in vivo exposures.

      Remember, too, that ERP often involves switching up your goals. If your immediate goal is to reduce the attention you pay to swallowing and/or reduce the swallowing itself, you are likely to feel frustrated. Early in your recovery, these goals are unrealistic.

      Here’s a more appropriate initial goal: feeling less distressed when you notice your swallowing. If you adopt something like this as your goal and work on it through ERP, eventually you’ll reap the benefits of reduced attention to your swallowing.

      I would strongly encourage you to work closely with a therapist on these issues. It can be very tough to do it alone.

  3. Thanks so much for your detailed reply!! I am having therapy with a Mental health nurse here in country SA. I am worried I will never stop paying attention to my swallowing and will continue swallowing much more often than normal for ever or at least a very long time (because it is in the forefront of my mind).
    My therapist’s view of ERP is when I feel anxious because I want to swallow and feel like it is too soon, to just face it/focus on the anxiety, assess it etc. it and try to let the anxiety subside before swallowing. I wonder if there should be more to the ERP than this (i.e. some other type if in vivo or imagined exposures) because the desire to swallow is there for the greater portion of the day. It is also difficult to face/focus/resist throughout all of the day as I need to work and get many things done!
    Do you or anyone else know of any good psychologists with experience in pure O and somatic obsessions in South Australia?

    Thanks again, have a lovely weekend in sunny Florida, we are only on the third day of Spring and it is somewhat hot in SA!

    • Hi Tanja,

      It sounds like your therapist understands ERP, which is great. Many US practitioners aren’t very familiar with it. The fact that you are practicing mindful exposures and are waiting for the anxiety to pass before swallowing is very consistent with ERP techniques.

      One issue to clarify is the role that swallowing plays for you. Is it something that relieves the anxiety (i.e., a ritual) or something that triggers the anxiety? It sounds like perceiving the urge to swallow might be more of a trigger for your anxiety. Swallowing then temporarily relieves this urge (as a ritual would do), but this relief is short-lived.

      As far as general ERP principles go, I think it is very important to be proactive with exposures. Dealing effectively with intrusive thoughts as they occur is great; however, setting aside time to intentionally trigger the thoughts and then resist your rituals is also critical. I think this is where in vivo exposures can be helpful.

      Unfortunately, I don’t have any recommendations for good SA OCD therapists, but perhaps the International OC Foundation could help. Their website is, and you can also reach them by email at

      Best wishes as you continue to work on this. Let me know if you have any other questions. Your comments have been really insightful, and at some point, I’ll try to incorporate some of these ideas into a new blog post.

  4. Would you apply a fear of changing other peoples values or self a symtom of pure-o? Say turning a person who is good and forthright into someone who is bad and evil by them being around you.

    • Yes. This is often referred to as “emotional contamination” or “mental contamination.” It involves the fear of becoming “infected” with other people’s values or infecting other people with your own values. It can also involve the fear of acquiring (or spreading) unwanted characteristics, such as homosexuality. This is sometimes the case in HOCD. Another example is individuals who avoid hearing/reading about serial killers or child molesters, because they worry that they might take on the qualities of these individuals.

      Compulsions most often involve cleansing or resetting rituals, as well as avoidance of people with the feared characteristic. I talked a little bit about it here:

      • Hi Dr I have intrusive images of what my internal organs look like. Its very disturbing. Its all I can think about. Could this be some sort of pure o. I also fear that I am going crazy please help.

  5. Thank you, I read about it above but wanted some more information, i appreciate it. Is there any other information of yours I can read concerning pure-o???

  6. Hey Steven I believe I’ve been suffering from HOCD for a couple months now. I can’t stop wondering if I might be gay. I just recently turned 20 and cannot stop thinking about this no matter what I do. It is causing me severe depression and anxiety that is preventing me from wanting to go to work, go hangout with my long time pals, or really do anything social at all. When ever I see a guy I think am I attracted to him do I think he is good looking? but the thought of having gay sex or even kissing a guy is totally repulsive to me and that I know that for sure. I’ve never engaged in homosexual acts but did experiment when I was a lot younger which only adds to my anxiety. Would anti-depressants be a good option? How does one rid them-self of these unwanted thoughts?

    • Hi Bob,

      Gabi asked a very similar question recently, and I responded to her question here:

      Because there is no way to prove your “true” sexuality to your OCD (it will always ask, “What if…?” and “How do you know for sure…?” questions), your treatment goal should focus on learning to live with the doubt. Working with an ERP-trained therapist is likely to be very helpful in your recovery. Many people with OCD can also benefit from medications like the SSRIs. While SSRIs don’t “cure” OCD, the right medication may help reduce the frequency or intensity of the thoughts. Please note that you need to be on these medications for about 3 months before they begin helping with your OCD. They are also sometimes given at doses that are higher than what people typically take to treat their depression.

  7. Hi Steve,
    I have been suffering with Pure OCD for about 6 months, at first i was terrified I would hurt someone or myself and I was having panic attacks basically all day because it made me feel so out of control. That is still kind of there but now it has moved onto constantly questioning reality, the world does not look real and i have obsessive existential thoughts like ”what if everything is in my imagination” ”how can all of this be real” & being scared of really strange things like the night sky when the stars are out or trees? i’m scared of them because they look so unreal & my brain tells me there not real but i know they are & it makes me panic and makes me feel like iam losing my mind.
    I am so worried i’m developing schizophrenia or psychosis or i’m going to lose control of myself and just go completely insane. It’s stopping me from going outside as much as i use to. I’m currently waiting for CBT, is this still OCD? or has it turned into something more?

    • Hi Danny,

      Many people have symptoms just like you’re describing. Those symptoms are sometimes referred to as “depersonalization” or “derealization.” It’s important to recognize that avoidance maintains your symptoms and can even make them worse. Your best strategy would be to find a therapist who can help you develop a hierarchy around your feared thoughts/symptoms. Some of the exercises used in CBT for panic will also likely be quite useful. These include physical activities like spinning around in circles or staring at the sky. Because these activities can induce scary and/or unwanted symptoms, they’re actually considered exposures. Exposures like these that induce unwanted physical symptoms are often called “interoceptive” exposures. In addition to exposures based on physical symptoms, it might also be helpful to build a separate hierarchy around the harm-related thoughts (assuming that these are still problematic).

      Best of luck in your recovery!

      • Thankyou so much for your advice Steve, it means alot!.

  8. Dr. Seay,

    I am 39 and started having panic attacks when I was 19. That’s also when the pure O started. I feel embarrassed that I have been dealing with this for 20 years and still do not know how to handle it. I live in a rural area, and it is hard to find a therapist who knows about ERP. My big “worry” right now is about religious post on facebook. I feel like I have to repost them or God will be mad at me. Then, I worry about what other people think about me for reposting them, which leads to concern about what God thinks of me for worrying. I’m just not sure how to stop the cycle. Any suggestions?

    Thank you,

  9. Hi Dr Seay,

    thank you for this article I have found it very useful. I have a history of pure obsessional OCD. I had a very traumatic childhood…constant emotional and physical abuse and neglect from my stepmother. I believe that some of the traits of OCD began when I was young i.e I used to often think the thought..”if I perform this action then something good would happen”. I also used to “touch wood”often. As I got older though, the illness worsened and I began suffering severe panic attacks. About ten years ago I had a breakdown in which I started thinking harm thoughts. I was terrified of knives, and sharp objects. I would hide them and put them out of my sight. I also developed a morbid fear that I would become schizophrenic. As I studied a bit of pyschology at university I am aware of the syptoms of schizoprehnia and so I would become obsessed that I would develop the symptoms…for example when I watch tv I think to myself..a schizophrenic would think the people on tv are sending them personal messages and are talking to them directly…so then I would feel terrified that the people on tv are talking to me…even though I know they aren’t….I would not stop thinking the thought…and so I avoid watching tv now. I would also become paranoid that people can read my mind…even though my rationale mind knows they can’t…I keep thinking the thought…that I might be schizophrenic and so I become very anxious and become afraid of people and I was agoraphobic for some time. Anyway, after taking meds and instigating some major lifestyle changes I recovered for about 6 years. The illness returned again…when I had another relationship breakdown. Once again, I started taking meds and recovered. This third time my illness has returned as I have just had a baby. Whle pregnant I came off my medication. At the moment I feel terrible anxiety and panic. I started having thoughts that I would accidently drop my baby, or step on him. As time went by these thoughts got worse and worse and then I started having the fear that I would go mad, and hurt him intentionally. I see knives and the horrible image of hurting him flashes through my mind…though I have no intention to hurt him…I am terrified of these thoughts. I have sought help and it was quite traumatic for me..The mental health nurses come visit me and I felt I wanted to open up about my thoughts so I told the nurse who visited me about these thoughts. She left my house and ten minutes later returned and said I had to be committed to hospital. I had no choice but to leave with them. My poor partner who had no idea about my illness…as I felt too ashamed to tell him about it…had no idea what was happening. THe nurse turned around and said to him “it’s one thing to be afraid of dropping your baby and another thing wanting to throw him down the stairs”. He was horrified. Anyway, I went to hospital and spoke to the head psychiatrist who told me about a woman in America who drowned her baby…I felt sick and horrified..the whole thing has made me feel absolutely depressed and anxious. The chilld protection services have been called too, but at this stage I don’t know what’s happening with that. I begged the dr to let me go home and she has allowed me to go home as long as my partner is with me all the time. The thing is, I don’t want to hurt him at all…I have these images that make me feel sick. As you can imagine my partner is very confused about what is going on…and asked me why I wanted to throw our baby down the stairs…and I had to explain it to him…that it’s not what I meant. Anyway, I feel absolutely awful right now….and now I feel like I keep getting theses repetitive thoughts…like…what if my baby is evil…it’s soo absolutely horrible…as of course, he’s not..he’s just a baby…but the thought goes through my head and I feel so sick and traumatised. I have started meds as they helped me before. I will also be starting to see a psychologist soon. Can you please give me some tips on how to combat these terrible thoughtts and the repetitive sentences that go through my head about ‘evil’ stuff. Please I would really appreciate it. I will do anything to get better. I want to get better for my son.

    • What challenges you’ve faced! Your story illustrates the unfortunate point that OCD remains misunderstood by many, even those within the medical community. I’m sorry that you’ve had to go through this; managing OCD is difficult enough, without all the added social complications you’ve had to face.

      Regarding recommendations, I think it’s best that you find an OCD therapist to guide you through treatment. You cannot do anything to stop your unwanted thoughts (see… Recovery from OCD is not based on thought elimination but rather on acceptance. This makes sense if you understand that the OCD cycle is maintained by fear and anxiety.

      As you learn to accept your unwanted thoughts, you’ll feel less anxiety when you experience them. With consistent practice, this will make the thoughts less newsworthy, which will (in turn) ultimately lead to less frequent thoughts.

      Best of luck with your recovery!

      • Thank you for your feedback Dr Seay. I agree that there is very little known about this illness even amongst the medical community. It has been a tough road, but I agree with what you say and I understand that it is the only way to make me better, that is, I can’t stop the thought being in my head but I can stop the amount of energy and anxiety I attach to that thought. It is really hard work though and I have to combat the anxiety all day long. I do have hope that I will get better. I have started SSRIs and they are very slowly helping me with the anxiety and panic…though i really am constantly reminding myself and reassuring myself that it is just my illness creating the thoughts, which helps ease the anxiety somewhat. One thing I have found is that my ocd thoughts often evolve so that if one type of anxious thought stops another will replace it. It is a very ongoing process of trying not to give the thoughts energy. It’s very difficult. I have heard something about plasticity before….and was hoping that this might help me…that if my mind gets stronger at not feeling anxious that it will actually rewire my brain to not feel anxious anymore…I don’t know much about it though.
        Thank you for your website. There is so much useful information and I also read symptoms that I have…but never even realised that they were a part of my illness. It helps me learning as I know that is the first step to my recovery.

        • I know it’s tough, but keep up the fight and things will improve. RE: plasticity, OCD is associated with hyperactivity in specific neural circuits. Practicing good ERP causes this hyperactivity to diminish to more appropriate levels.

    • I have had the exact thing u r going though. i went through it 3 years ago, got it under control and now its back. id love to talk more and discuss this stuff w you because its reasdurring to me that i am not the only one out there.

      • hi mum of 3

        Yes. Let’s write to eachother. You can write to me
        Look forward to hearing from you

  10. Hi Dr. Seay,
    I have recently stumbled upon this diagnosis stemming from the discovery of my having a form of OCD. I have been suffering with POCD for almost ten years now. The fears began with AIDS, and pure obsession over being infected from mosquito and scratches on other people. i would get tested several times a year even when not sexually active. this then formed into full on hypochondria. eventually this went away, the aids thing still creeps up, but not so much anymore because i’m married, and we’ve been tested. since the time is coming up for me to think about having kids my pocd has become increasingly worse. i am terrified of having kids for fear i may hurt them, physically. giving baths, changing diapers, it terrifies me to the point of tears, i feel uncomfortable. i have never been around babies before, maybe this is why but i fear that i may abuse my kids, so i don’t think i should have them. finally, i fear sometimes that i could be a danger to society, if i’m standing on a rooftop, i think what if i jump, or what if i pushed him over, i never would but the thought is enough to paralyze me. i’m sick of living in fear of my own thoughts. i am obsessed with criminal shows, so maybe being so impressionable, i should stop watching them? i am a very strong person, and function very well on a daily basis, have two jobs and go to school full time to get my graduate degree. so this is not a debilitating feeling for me, but i fear the children aspect will be the end of me. i’m scared and not sure what to do. i don’t have health insurance, so seeking help is out of the question…any suggestions on this?

    • As many parents with OCD can attest, fear of harming your kids can be a particularly frightening symptom. It’s actually great that you recognize that this is a symptom of your OCD. Many parents go undiagnosed for many years, and in the intervening years, experience significant guilt and distress. Just as with any other form of OCD, it’s important to tackle your symptoms through ERP.

      Since you don’t have kids yet, you might consider developing a hierarchy that is based around interacting with other people’s children/infants. This will give you some practice in parenting-like activities. You might volunteer for babysitting, bathing, diaper changing, etc. It will be important for you to spend time alone with kids, rather than doing all activities alongside your wife (which will likely provide indirect reassurance). This will be challenging, but exposure is the only way to habituate to these fears. Despite your financial situation, I would strongly recommend getting professional assistance with this. Without assistance, you may be likely to fall into self-reassurance or other subtle rituals, which will undermine your progress.

      Another sticking point involves selecting an appropriate goal. Having 100% certainty that you will be a good parent or that you will never harm your kids is impossible. Instead, your goal should involve learning to live more comfortably with doubt and uncertainty. To put this in perspective, you might want to look over my other posts on thought control, unwanted impulses, and doubt/uncertainty.

      Best of luck with your recovery!

  11. This is very helpful information. Thank you.

  12. Hello, Dr. Seay
    I often have these fears that make me think that I’ve killed, stolen, or done something horrible in any form. To fight those thoughts, I write down or tell myself that I wouldn’t do such a thing. It worked for two years until recently when I thought that I disobeyed one of my writings. Right now, I’ve never been worse. I think I’ve stolen or killed and I’m actually believing it. And I can’t get over it. I tried ignoring it, but it won’t go away and it makes me feel so scared and tense. I fought against the thoughts by trying to recall memories and insisting that I would do no such thing, but the line between reality and the bad thoughts are blurring. Is that a common symptom of Pure-o? And do you have any advice on what I must do?

    • Hi Demi,

      Thanks for your message. The fear of doing something “bad” or “unacceptable” is a very common symptom of OCD. Unfortunately, self-reassurance strategies like the ones you’ve described (writing down or telling yourself that you wouldn’t do these things, reviewing memories) are not helpful for beating OCD in the long run.

      In fact, these behaviors are actually rituals that tend to increase symptoms over time. I’ve talked about ways of addressing these types of symptoms in other areas of this website. In general, your strategy is to work on accepting these unwanted thoughts without ritualizing. Find a psychologist who specializes in OCD to help guide you, as it can be tricky to do this on your own.

      You might also want to read my two recent posts on checking. Pay special attention to “Part 2” which talks about mental rituals ( A list of all the articles on my website can be found here:

      FYI, I’ll be publishing a post on harm obsessions (fear of killing, harming, etc.) soon.

      Wishing you the best with this!

      • Also, I am afraid of having been harmed by someone I care about. It makes me think that I was harmed by this person and I will ruin his reputation. Is that a form of pure o as well?

        My OCD seems to spike up when my monthly period is nearing. normally, I can ignore the thoughts. But during that time the thoughts dominate my entire day.

  13. I am SO what is described here. I am diagnosed as OCD but I believe I am Pure O. I had my husband read this article thinking it would scare the you know what outta him, but he said he already knew this is how I was! We have been married for 19 years! It scares me to read it even though I struggle with it daily. It scares me for other people to know, but I am blogging about it and finding a peace in that. It is amazing how many people really suffer yet we know nothing about them until we share of ourselves. Thanks for all your info on Pure O. I think it is right on target and I definitely can relate to it. By the way, I do see a psychiatrist and I do take meds, which help immensely! Thanks!

    • Thanks for reading, Shannon! Some of my favorite blogs are written by people with OCD. OCD can be so isolating and confusing…it is often liberating when you read about others who share your symptoms and realize that you’re not alone. Keep up the great blogging! 🙂

      • Dr. Steven,

        I have been suffering from OCD for over half my life and was diagnosed at McLean Hospital in Massachusetts. I am on maximum dose of medication SSRI and physically dependent on benzodiazepenes. I have learned to cope with my symptoms and very vocal to people in my life so they understand my disorder and how sometimes things go over and over in my brain and won’t stop and certain things I do to counteract them which are frustrating. My question to you is do you feel there will be any progression in being able to see if someone has OCD via MRI? I have read several articles on this. I am obsessing over having this disorder for the rest of my life and being on medication for the rest of my life and I want proof that this is exactly what I have, any thoughts?

  14. Hi Dr Seay,

    I’ve been looking around trying to find a label to put on the anxiety I’ve been feeling since I was a young teenager (now 21). Your post is very interesting, the way I feel sounds a lot like the pure O you describe except I don’t obsess over the kind of things you mention but really trivial things, such as my ‘to do’ list for the day or the items of clothing I’m wearing, I make a mental list and have a compulsion to keep going over it and over it in my head, and I don’t understand why. I think it might be a control thing. I was just wondering if you would think that’s a different thing or could it still be pure O type behaviour? I appreciate you don’t know all the circumstances but if you had any thoughts I’d be really grateful, I think I should see the doctor soon because it’s really starting to get in the way of my daily life.


    • Hi Jane,

      It’s certainly possible that your symptoms are OCD-related, as list-making/reviewing is a common compulsion. Whether or not it would be diagnosed as OCD would depend on the specific thoughts/fears that are driving the behavior. Regardless, if it’s taking up a lot of time or causing distress, you should definitely have your doctor check it out.

      Wishing you the best with this!

  15. Hello Dr.

    I’m a 16 year old who first started struggling with Pure O when I was 14. At first it was the wondering if I was gay and stuff. That bothered me but after a while I got over it. But anyways, I used to be terrified that I would somehow get HIV or Rabies. And I had fear of hurting my parents. It kills me because I love my parents more than anything. But anyways I went through treatment and over time, I felt so well that I almost forgot I had OCD. I stopped taking my Zoloft like 5 months ago and everything was good until about 3 days ago when all of a sudden it just came back. But this time it was mostly just the violent thoughts. It’s been a horrible couple of days and I’ve just been crying my eyes out. I hate having these thoughts. I love my parents and I never want to hurt them. But anyways, I started taking Zoloft again and idk when it will start to help. I haven’t been able to sleep hardly at all or eat. I feel like I’m going insane. I hate this. 🙁 But anyways I’m probably going to go back to therapy but is there anything I can do to help cope with the anxiety and terrible thoughts while I’m waiting. I can’t get in to the therapist for at least 2 weeks. Please help me with some advice. I’ll do anything. Please. 🙁

  16. Hey, good overview of Pure O, well written. Although I’ve never been formally diagnosed with Pure O, it has become increasingly apparent to me that this is the condition i’ve been suffering from for the past nine years (i’m now 25). I’ve been diagnosed with depression, generalised anxiety and once had the possibility of regular OCD mentioned. Now-a-days the obsessions are not as extreme as they used to be (because of the realisation that it’s a condition), I am not a generally anxious person, and I don’t feel depressed (though I do get down sometimes when there is an obsession). My obsessions have taken different forms over the years including dying in a plane, getting testicular cancer, committing an unpardonable sin and contracting HIV – they often morph between one another, when one locks in place the others dont bother me. My symptoms include pretty much everything written above in the mental rituals list, as well as constant online research and avoidance techniques, believe me I do not say this arrogantly but I would consider myself an expert on the subjects that surround the various obsessions :). I have found the best approach to coping with these thought came from the various techniques and spiritual teachings taught in the Power of Now by Eckhart Tolle and I also pray. It is not possible to reason with these thoughts, they are obsessive and never ending, one answer always leads to another question, and a question always needs an answer, and an answer is never good enough because there is always a reason why it may not be valid. It’s almost as if the brain is locked and cannot function in respect of the particular obsession; therefore the only strategy is to observe the thoughts as the silent watcher and to have faith in the fact that they are not me, they are OCD. Thank-you

    • Thanks for sharing. You’ve provided a very thoughtful, well-written description of what many people with Pure-O experience. Mindfulness practices can certainly be helpful for managing certain types of thoughts. As Hayes would say, it’s the difference between “having” a thought and “buying” a thought.

  17. Hello dr Seay thank you for posting this! i have been suffering from magical /superstious ocd thinking and evil ppl superstious beings and i get bad thoughts like exp..”ur going to be ugly and everyone will see u ugly “And it says the name of jesus enemy, and then i have to repeat the name and say “no everyone will see me pretty “. It sometimes says and makes my mind saying that i want to go be posessed and let me have bad luck then i have to repeat saying let me have good luck !!!! What can i doo?? ??Please help me i need advice i am going crazy :((

    • Hi Maria,

      It sounds like you’re experiencing a lot of distress. I would recommend that you consult with a psychologist to get individualized help with these symptoms. You might want to visit the website of the International OCD Foundation to locate providers in your area. All the best…

  18. do you have any insight on how to cope/treat/deal with ROCD pure o? This is what i have but i havent sought treatment

    • Hi Angelica,

      I haven’t written any posts specifically on ROCD yet, but I will at some point. ROCD exists in many different versions: fear of being in the wrong relationship, fear that you should have pursued a previous relationship, fear of cheating, fear of your partner cheating, etc. Response prevention is obviously critical no matter how ROCD manifests. I would recommend reading my post series on checking (especially the mental checking article), which is often a part of ROCD symptoms. Response prevention involving confessions may also be important. Exposures are then tailored to one’s specific symptoms but will always involve getting practice with doubt induction statements. Good luck!

  19. Hi Steve. Thanks for this information. It’s offered some insightful ideas on pure O. In fact this website is the only one i’ve come across so far that seems to talk about my specific problem: “mental contamination” or “emotional contamination”. Would you have more information and advice on this? Many thx

    • Hi Dave,

      I talked about it briefly here:

      That article also links to another article on the IOCDF website. In general, emotional contamination/mental contamination is treated the same way as traditional contamination through ERP (i.e., exposure to unwanted ideas and/or characteristics while resisting urges to ritualize).

      All the Best!

  20. Hi!

    Do you know why we get Pure O? Are we born with it? OCD runs in my family heavily – is it hereditary?
    I have Harm OCD, Religious OCD, Relationship OCD and Contamination OCD! I constantly seek reassurance that my medication is still working and that I am not going to go crazy and off the deep end lol.
    Do you know why we have such an extreme fear of the unknown?
    I have been through so much with this disease from having it since I was young and not knowing it because I was too scared to tell anyone what I was experiencing and feeling/going through. I always used to think that I was a paranoid psycho because of all the things I was feeling. I was especially terrified of suicide (never thought about doing it or wanted to – just really scared of it), terrified of someone kidnapping and killing me, terrified of cooking for fear of poisoning someone I love, terrified of watching a scary movie or show and turning into a killer, terrified of the highway, terrified of hurting someone I love, afraid to settle in a relationship because there might be something better out there, terrified of touching something that someone else touched and getting high or getting a disease, terrified of knives and scissors, terrified of guns and weapons, and the list goes on and on. When I write it all out and read it, it kindof sounds so silly…so why can’t I convince myself that it really is silly? I am now 33 and have just learned a few months ago that this Pure O is what I have and not just “anxiety”. I also learned that wishing it away will not make it go away and it is ok to take medication for it – just like someone who is diabetic or something. I can’t seem to grasp the ERP though…like my brain is fighting it or something. I am doing better day by day after reading a really good book for Pure O, but I guess am trying to learn as much about this disease as I can since my 4 year old has just been diagnosed with severe anxiety (I see the ocd in him) but for now just anxiety.

    Thank you for listening!
    Nichole =)

    • OCD isn’t thought to be directly inherited (as some conditions are). However, there are certainly genetic factors and learned factors that do contribute to the development and maintenance of the disorder. There are some good resources out there to further educate yourself. You might start with the recommendations here (Dr. Jonathan Grayson’s book is one of my favorites for people with Pure-O):

      ERP for Pure-O can work wonders, but it can be confusing if you have multiple symptom areas. If you’re struggling to do it alone, you might consider getting the help of a therapist to get you started.

      Best wishes in your recovery!

  21. Hey, I’m 17 and I think I may have pure o the doctor recently diagnosed me with anxiety but I did question him about ocd which he said I didn’t have. Since I was about 12 I would have contamination fears I would feel as if my hands were dirty from doing the simplest tasks and have to wash them many times a day. I also would think people had spat on me whilst talking to me and have to wash that area, I later developed a fear of cervical cancer at around aged 14 which stopped after I received the jab after that I started to have a fear of hiv and would think that people had jabbed me with needles and also anything red I saw I would be convinced was blood and sometimes think I had touched it and that it would infect me. I also ask sexual partners over and over again about their sexual health when receiving the answer I start to worry that I might of heard it wrong and start to think they said something else than what I heard which makes me keep asking over and over again.I have also worried about having throat cancer due to swallowing over and over trying to figure out if I felt pain which in turn I think led to the pain. These days my mind is stuck on the fear of hiv and I have even had intrusive thoughts of having sex with people in public who I definitely do not want to. And in turn contracting it. I also worry about hitting myself and injuring an internal organ so have kept constant track of my arm movements so I don’t just suddenly do it. I even sometimes convince myself that I have hit myself when I haven’t.

    • Hi Claire,

      Your description sounds very consistent with the types of symptoms reported by people with OCD. You might want to schedule a follow-up with your doctor to discuss your symptoms in more detail (in case something didn’t come across clearly). You might also consider getting a second opinion if your second consultation isn’t helpful.

      As with all types of OCD, your symptoms are likely to respond to a combination of exposure and response prevention (ERP) and medication. Check for therapists in your area.

      Good luck!

  22. My ex boyfriend has OCD. He broke up with me because of his worries. Since then I have been reading about it (I should have read a long time before), and I see some symptoms in myself. And it is scaring me.

    I worry excessively about things. The worries drive me insane sometimes. And I have these thoughts that ‘dare’ me to do things. Like when I was 13 I kept thinking that I had to take a blade and slash my mom’s wrists and then mine just to prove that I could do it. These thoughts were there for a couple of months and they drove me crazy but they went away. A few years later I thought that I had to jump in front of a train to see if I would die. I used to and stand on a railway platform to see how close I could get.

    I also worry a lot about the environment. Last year the winter was too harsh and I was worried that the ducks would die and I would cry for hours by the lake because the ducks were not there. Also when there were floods in Pakistan. Last year my boyfriend and I were talking about shingles and 3 people I knew got them and I thought that it was because I was talking about it because I was the common link and that I should not talk about it at all. athe worries are not there every day but when they are there I cannot think straight. They occupy the whole of my brain and I just wish I could stop thinking for a while. I want it to stop. I worry about world hunger and that I cannot do anything about it and then there is despair. I worry about people being in accidents. I ask the same questions again and again. But these thoughts are not there all 12 months of the year. They are there but not enough to drive me crazy. The ones which are enough to drive me crazy come out when I am stressed about something.

    I also used to get these obsessive relationship doubts. If we would be happy, if I really was in love, if we would fall out of love, if God want’s this relationship. Though I would like to get back together with my boyfriend and I know he is so good for me, these doubts still tear me apart because they actually lead me to acting cold and then there really are problems.

    Does this sound like OCD?

  23. Dear Dr Seay,

    Thank you so much for this website, I think I finally have a name for it, although I have suspected for several years!

    I need guidance as to where I can find help from specialists in the UK, who can help with the Pure ‘O’ form of OCD.

    I remember when I was young (before 10) I repeated swear words, I think it was the same 4 words every time. This then changed and when I was at boarding school I worried continuously that I had appendicitis for about 2 years solid. Then at the age of 19 – 23 it really started to get a grip, I was terrified that I was going to harm my parents, that I had no control and that I was going to walk upstairs and kill them. At this age I had my first series of serious panic attacks. I went to see my Dr and said I think I need to see someone. This didn’t really help much and became obsessed with checking that I wasn’t going mad, I feared that I was and I was about to murder my parents!! I read news paper articles as to why people killed someone, I think I was checking to see if they were like minded individuals! My anxiety would build and build, I almost fed it – if it turned out the person did it for a reaon, like jealousy then my anxiety decreased as there was a reason. If it was because the person was a paranoid schizophrenic my anxiety would go through the roof because I viewed this as mad and that could happen to me!
    Things settled down for a few years until I had my first son 5 years ago at the age of 30, exhausted and still having the odd panic attack that I was nuts, when he was born he had colic. He screamed for 6 – 7 hours every night from the moment I got in the door from work. I then had huge panic attacks that I was going to throw him out the window – at this time the anxiety was way out of control. I was picturing it all the time, at no stage did I want it to happen just like I didn’t want to kill my parents, but I believe it was going to happen.
    I was so afraid I went to see my new Dr who put me in touch with a psychiatrist. He diagnosed me with depression, I said to him at the time that I didn’t feel depressed though. He prescribed me Citralopram. This was like red rage to a bull, I took the pills for 2 nights only, on the 2nd night I was having panic attacks in my dreams that I was about to run out my front door and commit suicide by jumping in front of a car. It felt so real, I believed it was going to happen, even though I was terrified and didn’t want it to happen. This has since taken over and I’ve been obsessed that I am depressed and depressed people commit suicide. The last thing I want in the world is to commit suicide and I’m terrified that if I get depressed, properly depressed in my life then the illness will take over and I will have no choice and lose my love for life. The anxiety is so bad some days that I do feel low for a day or 2 and I get this feeling of shear and utter dread and I’m terrified that I’m depressed and therefore suicidal. Since having this new depressed/suicide fear/obsession I have strange sensations in my arms, that at the height of the fear/obsession was a constant reminder. More recently this has turned to an internal tremor that has made me worry about Parkinsons disease!

    I am a little better now that I realise it’s Pure O and not me going mad and needing to be hospitalised, but I would dearly love to learn how to accept/control it so it doesn’t control me.

    Please note at no stage have I planned to kill my parents, child or myself – as much as it’s felt it’s just going to happen, I’ve not wanted it to.

    Any help/guidance on books, literature, do you help people over the internet with skype etc? I really want to beat this sucker once and for all.

    Many thanks


    • Wow, I feel the same way. When I went in, they asked if I had a “plan” which I know deep down I didn’t. Yet the thoughts almost switch around and say “oh yes, you DO have a plan, you’re just in denial”

      I have been reading about it online (shocker right? Lol) but there’s reassurance in the idea of it being said that if you are indeed suicidal then you wouldn’t care enough to stop the thoughts, but yet we are terrified at the idea of suicide so therefore we really don’t want to act on it.

      However my fear is WHY are these thoughts popping up in the first place? My mind says well it HAS to be because you’re depressed and that you want to die.

      Internal mind game happening right now, seriously.

  24. Do you feel that the average psychologist is skilled enough to recognize pure-o?

    For example, my OCD themes are constantly changing and I suffer mostly from the typical checking of stoves and appliances, but I also recently suffered a bout of “hit and run OCD”. I’m aware that my fear is irrational, but I keep checking my bumper anyway. I’m afraid that if I seek help for my OCD, I might end up with a psychologist who has never dealt with pure-O and may think I am actually capable of violence and will act on this idea. I’m afraid seeking help for my pure-O will ruin my career and my life and embarrass my family. I know I’m a good person who deserves to stop ruining her life, but I’m afraid the psychologist will not know about this form of OCD.

  25. Dr. Steve, I am so happy to have found this article (although I know re-assurance is a bad ritual). Since this is a fairly new article, I am glad to see that more people are recognizing what Pure-O OCD is.

    I myself was diagnosed only last year by visiting The Center for Cognitive-Behavioral Psychotherapy (Steven Phillipson, Ph.D. and his staff, i am sure you’ve heard of him)

    They have helped me tremendously with becoming more aware of my triggers (spikes) and learning how to not flag my thoughts through exposure. I can report back that the difference is amazing and therapy really does work. I have suffered with all of the obsessions listed and have done some really weird things to re-assure myself.

    Right now I am actively dealing with somatic obsessions, these are some of the hardest to overcome, especially since theyve been my habit since i was a little child. I now realize and remember that I have been OCD since I was a kid (repeating phrases so that bad things don’t happen for instance).

    I also deal with fearing that I might have some sort of mental illness that will grow and turn me into a “killer” i am not sure what this falls under, but its kind of like “fear of wanting to hurt someone” or rather “fear of turning into someone who won’t know what he is doing” as you can imagine the recent string of shootings have triggered me quite a lot, but I look at them as challenges and as practice to become better at managing my OCD.

    Please keep brining Pure O into the spotlight, i have a feeling a lot more people are affected than it is known.

  26. 25…i got pure o ocd wen I,was personalisation thoughts were,there.had agarophobia,for,some time…from an,excellent student to my academics came down…i nev s.gav up…felt like fightin wit d unknwn enemy n continued studies…got degree…in btwen I went to a psychatrist n he said I got ocd and started ob sertralin..aft cbt…i am better…but I am,not getting dat,full concentration,in,studies…some thought causing,anxiety comes but,less intense…how to get full concentration…i hav excessiv sexual thoughts…addicted to porn…is it,associated wit it…laziness also botherin me…help me
    and also sir can a day come wen I can b medication,free,and normal…

  27. hello dr im one from suffers i have 23 yrs old had an ocd since 6 yrs .i followed cbt and become challenge my illness but the last thought come to me lasts for 6 months i can’t concentrate on te thought but still with my mind(the thought as an oder”u r afraid from”afraid from any thing in front of me for example hen i watched film thought comes as u r afraid from seeing the second person on the monitor…………..when i study u r afraid from study this topic………when i sleep u r afraid from move from my side to another side on the bed ….etc despite i m not afraid …….i followed cbt but unfortunately the thought remain……..please tell me what should i do

    • Hi Ahmed,

      I’m not sure I understand your description. I would suggest consulting with a therapist to get individual help on these issues.

      All the best…

  28. Hi Dr! quick question. I am a 20 year old male and had Pure ocd for about 3 years now. Had a problem with Hocd but got over it after a few years. Now ive convinced myself im transexual. I start getting anxious when I look at my body, and have the thought that I shouldent do anything with my life cause no one can see me for who I really am. which scares me greatly thinking something like that. Can you have pure O about being transexual? it kind of stinks cause I feel like it can be similar. Ive never felt like a women before or at least I dont think I have

    • Sexual obsessions can target any sexual topic, including fetishism, transexualism, etc. If you’re concerned, consult with a local psychologist who can assess you.

  29. Hello Dr. Seay. Thank you for your previous info. Ironically, I am a psychologist, but work in the educational realm. I’ve always had OCD since a child, but a very mild form. Mostly Pure O. I’m noticing, however, that as I’m getting older(38) that my Pure O is more intense. I’ve been taking Lexapro for 2 years now for anxiety and the medication has helped tremendously. My question to you is in what ways can I deal with or stratigies to help with my pure o? For example, my wife and I watched a recent show on Dr. Phil about OCD. One guest had a severe case and mentioned something about his eyes blinking. I’ve never heard of that nor did I ever “obsess” about it. Now, since I saw the show, I can’t “stop” obsessing about it and fear I’ve now inherited an new, wonderful ritual. Thanks for any help.

    • Hi Chuck,

      There are many articles that have information about OCD treatment on this site. Blinking symptoms manifest differently in different people. They can emerge as sensorimotor symptoms or as Pure-O symptoms where they’re linked to preventing certain dreaded outcomes. Treatment differs depending on the nature of the symptom.

      The most effective treatment for Pure-O is exposure and response prevention (ERP). You could tailor an individual program for yourself based on one of the popular self-help books about OCD, or you could have a psychologist assist you. The goal is to learn to not be afraid of your unwanted thoughts. Most people with Pure-O over-identify and over-respond to their thoughts, which tends to exacerbate their symptoms over time.

  30. Hi Dr. Seay,
    I had been diagnosed with OCD a few months ago… mostly harm fears, some checking (e.g. “What if I ran over someone without realizing it?” or “What if I forgot to unplug x and the house burns down?”), and also fears of saying inappropriate things (racial slurs, insults, etc). Other than the harm fears, the absolute worst are the “WHAT IF IT’S NOT OCD?! what if i really have something else and that these thoughts mean i actually want them to happen?!”

    Lately I’ve also been struggling with seeing myself in the mirror or seeing pictures and thinking “I look weird” and then panicking that this must mean I don’t recognize myself. (which, of course, then morphs into “It must not be OCD! I must really be losing it!”)

    Is that common/related to the OCD??

    • The “What if it’s not OCD? / What if I’m crazy?” question is very common, especially for people with aggressive and/or sexual obsessions. Moreover, some people experience those types of symptoms as their main obsession. Perceptual issues that occur when looking in the mirror also occur quite often.

  31. Thanks for this awesome site. I am assured more than any time now.

  32. I was just diagnosed with OCD and I have trouble accepting it, I feel like I need proof or something, which I know I won’t get. My obsessions have ranged from the fear of being crazy to obsessions with weight loss and calories and obsessive self doubt about things, what happens is the thoughts take over my life and then I neutralize them with self talk which takes over my brain to the point where I am having imaginary conversations with people the entire day. I feel close to psychotic but I can’t accept this is OCD for some reason, I feel like I am doing this on purpose but I don’t know why. The doctor said I should be on medication and therapy but I feel like I don’t need medication as I need proof that I have OCD. I don’t hAve obsessions that fall into the categories I have seem defined so does that mean I don’t have OCD.

    • Hi Ginger,

      Symptoms of OCD often don’t cluster into tight, neat packages. This website has many articles about some of the more uncommon types of OCD, so hopefully some will be relevant to you. Recovery from OCD involves learning to live with doubt and uncertainty. For many, this extends even to uncertainty surrounding the diagnosis itself.

      If you’re struggling with your symptoms, I would recommend finding a therapist to help guide you through ERP.

  33. Hi, I’m 16, male and from the UK, I have never been diagnosed with OCD but I have realised myself that I most probably do, I have a few different symptoms/habits, some of which go back to an early age of about 7-8 and others which have developed more recently. The first habit that I can consciously remember was like I said around the age of 7-8, If I made contact with some form of object I would feel the urge to repeat the contact on the other side of my body, for example, my hand touching the back of a chair, I would then have to repeat it on the other hand, and if I didn’t, I wouldn’t be able to stop thinking about it until I did, but this habit went as far as one finger making contact with another which I would repeat on the other side, and then another habit developed from that one, where, I would make contact with my thumb and index finger and then take them apart while contacting my index finger and middle finger and then taking those apart and contacting the middle finger with the next finger and so on, and I would do this with both hands at the same time and I would then repeat this process but the opposite way round (from the little finger to the thumb) and then I would repeat that from the little finger to the thumb for the second time before repeating the first process from the thumb to the little finger, this is because, if you take the following values, the 1st process=4 and the 2nd process=3 and the 3rd=2 and the 4th=1, the order in which I completed the habit would add up to the same value (5 in each direction) but I would then do longer ones with 16 processes or even 64, but this quickly became a problem when I could not stop doing it no matter how hard I tried, I remember when I was 8, the teacher telling me off for doing it and she was telling me to stop but as she was telling me to stop I couldn’t stop myself until I had finished the full habit which often consisted of 64 processes, as you can imagine, at the age if just 8 not being able to stop doing something a teacher is currently telling me off for caused me some mental distress, after over a year of trying I did eventually break the habit but it just returned a while later and then I had to attempt to break it again, I have not had this habit for a considerable amount of time now but I do not doubt that it could still come back. This habit of repeating things on the opposite side also occurred in other ways, such as doing a full turn, I would then be forced to repeat the turn the opposite way round. Other obsessions are more mild and controllable which have developed throughout puberty, for example, being obsessed with tables being in the exact right place and not leaving any gaps between tables that are supposed to be together in a class room, just a year ago, I used to arrive to my religious education lessons before everyone else, not because I went out of my way to get there first, I was just let out if my previous lesson earlier, but when I got there I would go in and sort out all of the tables so they were parallel to the walls, but people were aware of my obsession so they went out of their way to move the desks so they would be incorrect just to annoy me. And although I am not obsessed with cleaning, once I start cleaning something, I find it hard to stop until it is perfectly clean. Another habit I have had is sort of grinding my teeth in a certain way to the rhythm of the syllables of what other people are saying or what I’m thinking in my head but I think I have possibly broken this habit but I’m not certain as I’m so distracted by the next habit I’m about to explain that I wouldn’t really know. The habit that I have developed most recently is entirely mental which frustrates me because I am unable to physically stop myself and it has continued to develop and change, it started in the summer by me typing things out in a keyboard in my head because I was board in the car because we were travelling a long way, but before long this had become another one of my in breakable habits, then the habit developed whereby I would have to press the same amount of keys with each hand for each individual word, if the word had an odd number I would include the space and the next word after it and I would repeat it again of the total was still an odd number, I even included apostrophes into the equation, this habit then developed further to a similar idea to the first habit I explained, the first character I press on the keyboard has the value if the total number of characters in the word and then the second would have one less than that number until the last character would have the value of one, I work out how I can bring the total two values as close to possible to the same value by pressing certain keys in the words with the left or right hand, I can always get the values the same or just one apart, if one hand has a total value of one more than the other, the next time i cannot match the values exactly i will make the hand with the higher value the opposite hand, therefore cancelling eachother out. I find this habit increasingly frustrating as I am struggling to concentrate on other things because I am constantly doing this in my head all the time, even if I’m having a conversation with another person I will pick up on words they say and put then through my keyboard habit, which as you can imagine is making it increasingly difficult to talk to people as I cannot concentrate on what they’re saying while I’m doing the habit. I have been trying very hard to break this habit but I have been completely unsuccessful. There was something you mentioned in this article about dwelling on small past events that could have been different, I often struggle to let go of tiny things that I could have done differently like something I said in a conversation even if it’s nothing bad I wish I had said something differently even if it’s something that the person most likely has no memory of anymore. I can think of one example which took place over Facebook, where I was talking to a girl and suddenly she said “night!” but out of the blue as if I’d irritated her, and I couldn’t stop thinking about it and how I should have done something differently, and then a while later I looked back at the conversation and she had said she was going to bed and then I had continued talking because her message didn’t come through until later and I couldn’t stop thinking about it, it still irritates me now even though this was about a year ago, and I wanted to explain to her afterwards but it was quite a while afterwards and she might not even have remembered it so I just left it. Sorry for such a long comment, I’ve never mentioned this to anyone before and I hate leaving anything out of an explanation, if you have any advice if you think this is a serious enough problem I’d be glad to hear it even if it’s just that you think I should see someone about it

    • Hi Jamie,

      Your symptoms sound very distressing, and it certainly sounds like you have OCD. Recovery from OCD can be challenging, but it’s a battle you can win. Whether you decide to fight back on your own or get assistance from a therapist, recovery from OCD will involve breaking OCD’s rules and setting your own rules for how to live your life. Treatment success will probably depend largely on response prevention, although you’ll also want to seek out exposure-based situations, which will give you additional practice with your response prevention.

      Wishing you the best in your recovery!

  34. Hi, I’m desperately in need of help, it feels like pure ocd is ruining my mind an changing me permenantly, I’ve had ocd as long as I can remember but now it has completely took over my life, 90% is rituals in my mind cancelling bad sick thought about children and replacing them with thoughts about women an then thoughts about family being ok, sometimes I can be doin a ritual in my head for hours, I feel the need to get the ritual perfect an of I don’t I hav to do it all again, I’ve messed my mind up so much I’ve lost my attraction to women, then I think to myself am I a pediphile even tho I know I’m not, if I was to explain everythin abt the way my mind works I would be here for hours, even though its all mental it’s takin over my day to day life, I really feel like giving up its too much an I find it hard to concentrate on things as I’m constantly sayin sentences in my head, memory’s seem to dissapear an normal thinkin disappears because my head is so messed up with this, I hav to mentally cleanse things if I’m going to buy them an I hav to mentally cleanse everythin in day to day life, I seriously need to know how to beat this because its killing me.

  35. Hi, I’m desperately in need of help, it feels like pure ocd is ruining my mind an changing me permenantly, I’ve had ocd as long as I can remember but now it has completely took over my life, 90% is rituals in my mind cancelling bad sick thought about children and replacing them with thoughts about women an then thoughts about family being ok, sometimes I can be doin a ritual in my head for hours, I feel the need to get the ritual perfect an of I don’t I hav to do it all again, I’ve messed my mind up so much I’ve lost my attraction to women, then I think to myself am I a pediphile even tho I know I’m not, if I was to explain everythin abt the way my mind works I would be here for hours, even though its all mental it’s takin over my day to day life, I really feel like giving up its too much an I find it hard to concentrate on things as I’m constantly sayin sentences in my head, memory’s seem to dissapear an normal thinkin disappears because my head is so messed up with this, I hav to mentally cleanse things if I’m going to buy them an I hav to mentally cleanse everythin in day to day life, I seriously need to know how to beat this because its killing me. I seriously believe I could help people because I understand my illness, I jus don’t know how to beat it, I would appreciate any help.

  36. Hi Doctor,
    My OCD is getting from bad to worse and it is affecting my quality of life. I have no money to consult a therapist so the only way out for me is to battle with it myself.
    My ocd does not involve physical rituals,it is in my mind. Everytime I feel this tingling sensation(kinda like what you feel when you have a headache) in my head, my level of anxiety will shoot up. I try very hard to just ignore it and then my anxiety will drop. However throughout the day, I will be reminded of that sensation(feeling always comes back whenever i think about it) in my head and the anxiety will come back again. Its like I am living in fear throughout the day although i am not performing any rituals.
    What can I do to help myself :*(?

  37. Hi Doctor,
    My OCD is getting from bad to worse and it is affecting my quality of life. I have no money to consult a therapist so the only way out for me is to battle with it myself.
    My ocd does not involve physical rituals,it is in my mind. Everytime I feel this tingling sensation(kinda like what you feel when you have a headache) in my head, my level of anxiety will shoot up. I try very hard to just ignore it and then my anxiety will drop. However throughout the day, I will be reminded of that sensation(feeling always comes back whenever i think about it) in my head and the anxiety will come back again. Its like I am living in fear throughout the day although i am not performing any rituals.
    What can I do to help myself :*(?

  38. Help me!!! I’m a 19 year old girl, who has a FEAR of being a pedophile, I don’t know where this came from BUT now I can’t be around kids without getting all tense and wondering if I’m turned on, even around babies!!! :'(
    I do NOT know what to do, I want to be a mother someday, I have a little brother….the sexual things I have thought about him, other children is NOT okay and the give me anxiety and I wake up at 3 every morning feeling sick to my stomach.

    How can I be a mother if I’m a monster? How?

  39. Ok so I have anxiety and panic attack problems. And I recently just went to a psychologists for it and she kinda diagnosed me with anxiety and hypochondrias. But lately I’ve been having panic attacks about something I have never even thought of. Like thinking what is life and examining my body like omg I have a brain inside my head and this is all just a body very weird thoughts and I’m thinking I’m becoming skitsophrenic or something crazy and it’s worrying me to death like I feel like I’m loosing grip on reality and I know that’s just a side effect from the panic. And I can’t get these thoughts out of my head It’s making me sick to my stomach almost like an ocd thing plz help me I’m only 20 I have a great personality I have lots of friends. Do you think in on the verge of loosing my sanity plz help me like I look at people and I’m like omg how were we made. What is this? Like an out of body experiance ?!? Plz help I tell my friends sometimes and there like nothing’s wrong with you. Your just freaking yourself out and I can forget about it for like 5 mins then I think about it again. I’m so scared help menplz and lately I’ve been feeling normal and then I go and wonder why was I feeling like that then bam those thoughts hit me again and another panic attack. Why can’t I just forget about it and go on with my life. And now I came across this site and wanted to post this and see what you guys thought

    • It’s great that you’ve taken the first step and found a psychologist to help address your anxiety and panic. Some of your worries do sound very OCD-like (e.g., the fear of mental illness, the fear of developing schizophrenia or “going crazy”), which may indicate that you might benefit from exposure and response prevention (ERP), a specific type of cognitive behavioral therapy (CBT). However, it’s also possible that your worries may simply be related to your panic. Talk with your psychologist, who should be able to provide some clarity.

  40. Dr., my CURRENT obsession relates to hyperawareness, and constant monitoring, of my body movements – especially while walking or doing something with my hands. I’m afraid to do any movement too quickly – as if somehow that will provoke an anxiety attack. The only thing I know to do – in the area of ERP – is to simply AVOID AVOIDANCE, keep moving and stay active. And, of course, I’m trying not to indulge in any of those mental rituals. It is my hope that by staying active, and not trying to shove the thoughts out of my head, I can neutralize the anxiety. I’m also taking Prozac (and klonopin) now – so that may help too. Any other suggestions?

    • If possible, build a hierarchy of increasingly more active behaviors that cause you anxiety. Additionally, you could get practice with interoceptive exposures that create panic-like bodily sensations. You might also consider doing these activities while practicing the thought, “I am going to have a panic attack.”

  41. One Last Question: Would a positive mental counter-statement to your scary thought be considered an OCD ritual? Something like “this won’t kill me” or “it’s just an obsession – nothing more.”

    • These sound like good pro-coping statements to me, as long as you’re not having to repeat them excessively.

  42. I recently discovered that my husband has been watching bisexual, gay and shemale porn. He has also been paying for private webcam sessions. He watches a lot of porn and can’t seem to get enough. I think he is addicted. Anyway, he is writting I’m gay or fag. He refers to himself in the third person. He writes on clothes,cars,walls the floors anything he can. He has written his nickname on most of our clothes along with fag or gay. Help!!m. I need advise on what has brought this on and what to do asap! He has also going on craigs list and meeting people. OCD?? Or scitzophrenia……

  43. Hey Steven,

    I’m getting tons of unwanted thoughts about Suicide, I think I’m suffering from Pure O Suicide thoughts I tried to find your reply but I couldn’t how can I do some exposure for this?

  44. hey Dr!

    I have a questions regarding the response prevention part of my ERP . When obsessesion strike , in order to resist mental checking , Do I tell myself ”Im GONNA harm someone” or ”I MAY harm someone” . Do I have to believe it or just live with the possibility…


  45. Hello Dr,

    It is such a blessing to see a wonderful man like you create this helpful service to people who are struggling.

    I dont know if you classify this as OCD or not, or what kind of treatment is good for me. About 6 months ago, i woke up with virtigo and the room was spinning out of control. Went do the Dr. and they found out that i had crystals in my ear that needed to be relocated. Took about a month for my to get my balance back. Well, it terrified me, and i was so worried that it would come back. One morning i woke up with sever panic attack, and i was so worried that i would get that attack again. So for the past since then, i havent had a panic attack, but i do have anxiety all through the day. I hate the feeling of not being in control of myself and my thoughts. The one thing i am struggling with now is the thought of having anxiety through the day. It’s like a record player playing over and over and over again. I went to a psychiatrist and a physiologist down here in Coral Springs, FL. My Dr. slowly is getting me to 100mgs of Zoloft, because it has worked great in the past. And my “talk dr” wants me to accept my anxiety and welcome it into my life, and learn coping strategies to settle down the thoughts. I have been seeing him for about 12 weeks now, and i do feel better, but i dont at the same time. I have been practicing meditation a lot and have been working out in the morning. I feel the most comfortable when i am around my friends and family. It’s when im alone that is worst. I wake up in the morning and think to myself “am i having anxiety? am i going to have anxiety today? And this begins the cycle. What do you suggest for me Dr?

    I have also had harmful thoughts of hurting myself, wife and my dogs. Of course i would never hurt them, so the anxiety is not so high when i do think about those thoughts, because i see them as just thoughts. However they still do just freaking suck!

    • It’s good that you’re working on this, Chris. It sounds like the vertigo symptoms have contributed to ongoing worry about panic. Medication can be helpful, as well as psychotherapy, so hopefully the combination will be effective for you. The biggest current challenge sounds like it is accepting the possibility of having anxiety when you’re on your own and increasing your confidence in your ability to handle it. It may also be useful to identify any specific feared consequences associated with your anxiety (i.e., what’s so bad about having it, how does it interfere, what is its potential impact on other things, etc.).

    • Hi Chris, Wow. I am going through EXACTLY what you described two years ago. My anxiety/panic also started with a legitimate health concern and then transformed into full-blown Pure O (mainly harm and fear of anxiety/mental illness). Every morning, I wake up and think about whether I am anxious or not and that dictates my day. I would love to hear how you are doing today and what you have been utilizing for treatment if you indeed still check this site. Thanks!

  46. Hello Dr.

    You are truly an amazing man for answering peoples questions and trying to help them understand this illness. I have wrote you before explaining how i am seeing a Physiologist and Psychiatrist down here in Coral Springs, FL, who both diagnosed me with OCD “but more of the obsessing part”. It was brought on by a bought of Vertigo that happend about 5 months ago. And for the past 4 months, i have had constant anxiety that last all day long. It’s like a record playing going over and over in my head, i constantly check how i am feeling, emotionally and physically. About 10 years ago i thought i was gay, because someone called me gay once, and it just locked on. I didnt see a Dr or seek any help for that. It just finally went away. I once was affraid of throwing up, when anyone would have a stomach flu, i would get bad anxiety. And i also used to have thoughts of Hurting my family member, which finally just went away. This was all about 10 years ago. Now my battle is the anxiety and worrying if its going to come back (of course it does). However, my Dr. refereed me to a book called Brain Lock. I have read it, but its hard to use the methods. I talked to my Dr about ERP Therapy and maybe that would help. My Dr. I know exactly what ERP Therapy is, and honestly i dont think its good for you. He said hes never recommended it to anyone. He basically just wants me to work out every morning, eat right, learn relaxation practices like meditation. And visualize that you are on a ship and sometimes the storms are tough, but you can battle through them, that i have been through them before and i can get through them again and again and again. Do you think this is a good approach? And im also concerned that he doesnt want me to do ERP therapy, because i have been researching that’s the only way to beat this beast. Btw the harmful thoughts come into my head now, about hurting my wife and dogs, but it doesnt cause such horrible anxiety. I just let the thought stay there and it goes away. What do you think?

  47. Hello,

    OCD seems like some doubt about something that will never happen.

    But what if you actually have done something and have memories of that and get scared.
    I have over concentrated my mind, did experience a difference in understanding, perceiving, seeing things, acting faster, change in behaviour, random thoughts, analysing better, becoming more active…and later gave these up but am left with memories which prove that many things that I do in everyday life have come from that over concentration. The end results are nothing abnormal, actions and thoughts matches with normal people but their source is quite abnormal. The meories come back with examples and scares mes for long hours.
    It has features like a pure obsession but the things have really been experienced, they are not purely imaginary. It is not imagining what might happen but what I have actually done.

    Getting huge panick attacks.

    No one has this kind of OCD. even ERP will not help because the thoughts are not imaginary. Never seen another example like this on any site.

  48. Dear Doctor Seay,

    I had found out that the best solution for my OCD problems (mainly sensorimotor) is to focus on other issues. After some time of distracting I usually was forgetting about bad thoughts. But for one month, I have been being obsessed with blinking. And when I have my eyes opened it is not possible for me to focus on important issues. For example, I am creative person, but now when I want to use my creativity or when I want to analyze something, it is not possible, because immediately I start thinking about blinking. I tried exposure technique but when I make it, after one day of trying, I realize that I can not really do anything else apart from these exposures. Doctor, have you met such case? Do you maybe see any solution for that?

    Thanks a lot for creating the whole website and best regards.


    • I’ve exactly the same problem : constant focus on my eyes blinking and I would like to get free of this. But I don’t know what to do !
      By the way, I’m French, sorry for my English.

  49. Hi Dr. Seay, I’m an 18 girl and I think I may have Pure O OCD. I don’t really worry about physically hurting others. I think I used to have HOCD, but then I discovered I’m bisexual. From the time I was ten I would worry if I liked girls, and I thought it had something to do with bisexuality, but now I think it was POCD. I don’t really do this now, but I used to become really aware of my blinking and notice every time I blinked and try to force myself to stop noticing it but couldn’t. I don’t really do that anymore though. I constantly worry people are going to assume I’m lying. So I go over recent events I want to tell my friends about in my head to ensure I don’t miss any facts that would lead them to think I was lying. Another big obsession is whether or not I’ve emotionally hurt someone. Things, mistakes I guess, I made years ago that hurt someone or might not have hurt someone but also may have hurt someone, I think about those over and over again. I never thought I was OCD because I’m not really compulsive, except for the computer mouse. If I’m reading or watching something online, the computer mouse has to be perfectly aligned with lines on the screen and be equally distant from sides of the side of the screen and the lines. Sometimes, maybe often times, when I go to the store with my mom and I stay in the car while she goes in to get whatever, I start thinking/worrying about what would happen if someone went into the store and committed armed robbery and then came out and stole the car while I was in it. When I was a little kid I used to stare myself in the mirror and tell myself horrible things about myself. All my handwriting has to be perfect, and I have memories of being in kindergarten and learning how to write the letter “s” and being very unhappy with my s’s lack of perfection. I definitely have a “fear of being changed irreparably by exposure to certain ideas”. I’m an atheist, always have been, so I don’t have any religiously motivated obsessions but I have some very christian friends and sometimes when I’m around them I worry they’ll change my atheism. But now I worry that I don’t have OCD and I’m just thinking this stuff and posting this because I want the attention, and I’m just thinking stuff is wrong with me because I’m a drama queen. But I haven’t told anybody about these worries. Sometimes my friends will notice certain peculiar compulsions. Like I was at a friend’s house and I had to organize the pins on her billboard by color. Or I once I was playing a board game and I was using my game card to perfectly align the my game pieces in a perfect formation that was parallel to the edge of teh board game. My friends got silent, even though I didn’t notice, and I heard one of them say “Look, it’s Monk!” and I looked up and he was pointing at me and only then did I notice what I was doing. When I was little kid I would make pretty designs with the refrigerator magnets but it all had to symmetrical. If I put a squiggly line one the left, I HAD to put it on the right. I also wonder if I have depersonalization because sometimes I just kind of go blank and I find myself staring off into space with no thoughts. I recently went to a debate tournament and they post a paper on the wall that lists of people with who you’re debating and in what room. I would check that paper once and then I would have to recheck two or three times because I worried I got the information mixed with someone else. So, I really just want to know what you think of all this and if I do have POCD or if it seems like I just…want attention for nonexistent problems.

  50. Wow, its like you walked into my brain and described everything thats going on in there. I thought I was just a horrible person for all of these thoughts. I have to admit I feel like a huge weight has been lifted knowing that its all just brain issues and that I’m not actually just terrible. lol Thank you for posting this article!

  51. I often have HOCD and ROCD. I will suddenly obsess about what if I don’t love my boyfriend. How do you stop mental rituals? I’ve heard that agreeing with the thoughts is the only way to get past this.

  52. Okay. I’ve always thought I was pretty “normal.” But I do ALL those “OCD Mental Rituals” listed above (ALL of them!) and an awful lot of those obsessions listed below. (You can leave out the screw kids, animals and dead things ones – I don’t recall those; but the religious ones? Yeah – pretty much every one of those when I was religious…) All in all, I have lots of obsessions that have no related compulsions and lots of compulsions that have no (apparent) related obsessions. Am I a “Pure-O” and a “Pure-C?” — or — am I saved by the fact that they come and go over time? Perhaps I’m just a nutter who’s displaying all the symptoms ‘cos I read the “drugs insert?”

    I’ve certainly never been diagnosed an OC… but that might just be because I’ve never seen a shrink. And while it all used to bother me – I’ve grown older and now I’m comfortable with me. … One day I decided to “like me” and once I got that right the batty obsessions and compulsions that seemed to rule my every waking moment stopped bothering me. They’re still there – kinda like an old friend.

  53. Hi Dr.,
    I recently developed a heart condition about 2 years ago as a result of getting really sick that makes it were randomly my heart rate goes really high, when this happens I noticed that I get Pure-O OCD. (without heart rate problem I’m normally fine and just get some minor OCD when it comes to things be even or orderly. With this Pure-O the symptoms change versions depending on what is around me. Luckily I have a fiance who is amazing that I can talk to about the thoughts and then they go away(though as stated above,will switch versions of my heart is still acting up). I also naturally started doing the exposure thingy since I found that helped alot and also running helps because my heart rate goes down. What I’m wanting to ask is, do you know of any other cases like this?(where tach. triggers it and the thoughts aren’t a specific thing because I’m able to “conquer” them(through actually proving wrong using logic-exposure, talking out with fiance helping prove wrong, or finding source of fear then proving wrong etc.) so they change).

    • I noticed I forgot to explain that my heart rate goes up before going down after running. Felt the need to clarify that so as not to confuse you. Sorry about that.

  54. This page was very helpful. My son is 9 and has every form of OCD. The “O” is the hardest to deal with. He has 3 doctors and all say something different and keep changing meds, this is the first I’ve heard about the pure O and honestly I’m so glad he’s not going crazy. My question is if I should keep trying medicine or actually travel to a treatment center that specializes in this issue? No one in this toledo area seems to be able to help me. All comments welcome.

  55. First off, people who have Pure OCD normally also have above average intelligence. If you have Pure OCD, you can feel good about this fact. Pure OCD is really a problem of dealing with an extremely bothersome thought -to that person with Pure OCD (whatever the bothersome thought is, it really makes no difference). Trust me, whatever it is that is bothering you is normally the exact opposite of what is reality and what is your true self. The troublesome thought actually becomes a question that you feel the need to be answered with absolutely no doubt in your mind. People with Pure OCD are unable to come to a definite answer to the question inside their head and this becomes so very bothersome and upseting to that person. The thought that bothers any person with Pure OCD is the problem, because there is uncertainty. You just need to accept the fact that there is no possible way to find a definite answer to the question that is bothering you. This is okay. To beat Pure OCD, understand that the thought that is bothering you makes no difference. Tell yourself:
    “I may never know what it is that is bothering me I recognize this and therefore I will not try to figure out exactly what it is that is bothering me. Rather, I’ll just be comfortable with the unknown. When my mind gives me the troublesome thoughts and I feel the need to combat those troublesome thoughts I appreciate the help, but I’ll just be comfortable with the unknown. If my brain chooses to give me thoughts or opinions about this thing that is bothering me I appreciate the help, but I’m choosing not to engage in the debate”.
    The real problem is trying to come to a definite answer in your mind. It is not important to do this. In reality, you will see that you can say to yourself maybe the troubling thought is true. Again trust me, whatever the thought is that is bothering you is not reality and it is not the real you. By not engaging in the debate you will not continue to ruminate (which means think over and over about these troubleseome, really stupid thoughts that are bothering you) and go back and forth in your mind engaging in this debate. Pure OCD is treatable, and you can feel free from the distressing thoughts and feelings this problem has given to you. The real problem is continuing to engage in the debate you are having in your own mind. Just tell yourself I will accept the fact that there is uncertainty, and I will not engage in this stupid debate I continue to have in my mind anymore. My days debating this ridiculous question in my mind are over! You can beat your troubling thoughts and beat Pure OCD!

  56. I just wanted to say, for anyone who was like me looking on websites for help dealing with this, that I had an exorbitant case of POCD, that began with the fear of good luck/bad luck, and progressed to me feeling I could not be myself so long as certain thoughts or feelings were in my head as opposed to feelings or thoughts that had a stimulating effect of making me believe the impediments to myself were gone, a kind of elaborated case of the “just right” feeling. Until May eleventh, i constantly ruminated on literally hundreds of different minor spikes a day, and also felt impeded by obsessions I believed to still be affecting me for weeks, months, and sometimes years regarding my ability to act as myself due to the fact that i felt I had not yet fixed them and to alleviate myself from their grasp, I must figure out a way. I went through countless new ritualistic practices I believed to be the sensible solution for ridding myself of these thoughts, however they were just another manifestation of the POCD’s compulsary nature, thinking that to get over the OCD I had to rid myself of these thoughts and feelings. It was so bad that I had to take a complete year off of college to address it. The good news is, on May eleventh of this year I finally began, for the first time, using techniques like ERP, Mindfulness CBT, in essence letting the thoughts be there, realizing they could not be reasoned with or eradicated, that they were normal processes of the mind which was now acutely fine tuned to flag as well as create these thoughts given my fifteen year history with the POCD. Writing this now, on August twenty eighth, almost four months into my self treatment, I would like to say that although I, as anticipated, still have spikes, still have anxiety from the spikes, have seen a resounding positive change in my life. I no longer let the OCD control my life, I am no longer a slave to these thoughts, it has truly worked wonders for me. So my message is, after being in the deepest depths of suffering from POCD, that although it takes time, and it difficult at first, the outcomes of using these techniques is too spectacular for words. Lexapro also assisted me in making it easier to commit myself to this therapeutic recovery. In the end, following classical conditioning models, I do not see a way this therapy would not help anyone suffering with POCD or just OCD recover to leading a normal life. Just let the thoughts be there, recognize what your compulsions are, usually those things you feel you have to do otherwise the internal feeling of anxiety won’t go away (though it always will and does), and make sure not to do those, but most importantly become comfortable accepting that these thoughts are in your mind, and paying them no further attention, because no matter what they will always be there, however they do substantially reduce in severity and quantity as time goes on. Keep your head up.

  57. Hi I have just found this site after So much googling I have always had obsessive thoughts has far back as I can remember I am 28 now when my daughter was born 4 years ago I suffered so bad with harm thoughts I didn’t even wanna be in the same room as her I was scared I was gonna hurt her I went to see my doctor and broke down to her and told her how I felt she said I have a severe anxiety disorder and put me on fluxoetine after this I managed to get my life on track but Inbetween then and now I have had months of obsessive thoughts about having every cancer you can get kept going back to my doctor but now I have got another obsession and I’m suffering so bad at the moment I watched a program about somebody with schitzophrenia and now that’s started a big obsession with me i convinced myself I was gonna get it I read all the symptoms for it and all the delusions they think and then started thinking what if I think people are watching me etc… All these delusional thoughts keep going round in my head its there from the time I get up to the time I go to sleep I just want these thoughts to stop all I do is google looking for things to say I haven’t got it I’m doing all the tests online.i do get very good support from my parents has my mum suffered with this for years hers started after my brother passed away so it’s so good to have somebody to talk to who understands my dad I can also talk to he don’t suffer with it but was there for my mum I can’t say the same for my partner who doesn’t understand and makes me feel so much worse by the things he says I tried to explain it to him before but he said there’s something not right with you and I thought omg I’m deffinatey losing it I just want these thoughts to stop

  58. My name is James Risoli. I will try to make this as quick as possible as I am sure you are extremely busy and honestly I want to say beforehand that any insight or help would be immensely appreciated. Ok…I was diagnosed with O.C.D. back in 1999 by a therapist I was seeing at the time for some other things I had going on in my life. My OCD started when I was very young and before I technically even knew it was a thing or existed and involved the common hand washing and counting to specific number type rituals. However, over the course of my life it evolved and really took on a “purely obsessional” form when I was a teenager. I had my first panic attack at 16 after smoking marijuana and then after experimenting with ecstasy I had a thought that “I was rolling” go through my mind for 7 months constantly like a loop tape. This thought lasted my entire senior year until I went off to college. This was right around the time of my diagnosis however I didn’t know what it was because we didn’t really cover much. Anyway, in college it moved on to constant worry about my sexuality then guilt and the need to confess to my girlfriends any and every type of thought or indiscretion possible. I have suffered from POCD as well where I was convinced I was a pedophile for a time. Long story shorter, After college and in the last 3 years or so I have since gone to see a new therapist that my wife and I decided on because her brother and sister saw him for some things OCD related as well. Over the last 3 years we have made strides but to be honest OCD isn’t his specialty although he isn’t unknowledgeable either. He helped me with most aspects and for a while I saw a major decline in the last two years which has made my wife happy as well because my confessing was hurting her. I am on Lexapro and take Xanax when needed along with a medication for my thyroid. Starting about a month an a half ago I had a really bad dissosociative (sorry spelling) state that lasted a good few hours and was brought on after a yoga session. Since that day, November 11th to be exact, I have felt really off. I have had constant and I mean constant thoughts about existence and whether or not I exist at all. I have questioned whether or not I am real as well as the people around me including my family and wife. I have wondered if what I think is happening is really happening or if it’s even possible. Those three question in my head have been with me almost morning to night. I haven’t had too much relief and this is probably the worst I have felt since high school honestly. Normally my OCD drives me crazy and brings me down but goes away after at most a week or so after I work through it or let it pass through techniques. This however has been constant, although slightly better, it has been scaring me and has me really feeling down in the dumps. With that being said….is it possible this is just OCD still or something else? Not much talk about this kind of OCD. Also, can depression cause these questions and feelings? I have been out of work for some time now (laid off) but start a new job in January so…I don’t know…My therapist and I have hit a wall and I terribly miss my old fun confident self. Thank you so much for any advice you can give. I really appreciate anything at the moment!

    Sincerely and with thanks,


  59. hello dr. steve, thankyou for your help and guidance through a terrible disorder…it helps people like myself greatly. i’m on 20 mg lexapro and it’s helped tremendously since my diagnosis about 2 months ago but sometimes I feel a sliding back effect especially during hormonal weeks….I guess my real question is will I ever feel better?? I was basically normal and without most pcs symptoms for 10 years. i’m 25 now and just having such a difficult time it’s hard to even think about my future. thankyou if you ever get to answer this I appreciate it. -erin.

  60. Dr. Steve,

    My Mom is 70 years old and she is indulged in excessive TV watching speacially at night and keeps on wtahcing TV through out the night, sometimes till 3/4 in the morning. She is sometimes half sleepy or really sleeping in front of TV and in between wakes up to watch TV, This really disturbs her entire life and schedule as she can;t wake up in the morning and is tired through the day and eats at totally off times such as dinner at midnight and lunch ad 3:00 PM. We have all tried to explain to her that she is ruining her body like this and her body needs rest at night but she is not willing to understand and vehemently opposese us and says that TV is something which gives her pleasure and that she is not neglecting her daily tasks so no one has any right to tell her to stop watching TV the way she watches. It is going worse and worse and her body suffers and her Arthritis has increased. What could be the cause of this behaviour and what is the cure for this? Your suggestions will be very much helpful as we are just helpless. Thanks.

  61. I just have a small question… I recently went to postpartum depression ocd, that was 6 months ago I feel I have gotten over the OCD but now I feel weird like I no longer know how to be myself because I spent so long analyzing everything I thought and said because of the OCD I feel weird like I am in a haze , my vision has also changed I had a fear of going crazy for a couple weeks do you still think I am going through this? am I all better but maybe going through depression? Your advice would be awesome 🙂

  62. I have a private practice in Southern New Hampshire that specializes in spectrum anxiety disorders which includes OCD. I have worked with Michael Jenike, M.D. and Lee Baer, Ph.D. which were the founders of Exposure and Response Prevention. I have a question about a client who seems to have difficult symptoms to work with and wondered if you have any suggestions. He has mental counting which causes distress and is continuous throughout the day. He states he tries to stop or divert his attention but explains that it is almost impossible. He has no reason for his counting and states he has done this for as long as he can remember. We have tried relaxation techniques to decrease the physical anxiety when he counts. We have tried counting in a different order, different languages, random numbers, letters, etc. to no avail. His parents are not willing to put him on medication at this time because he is only 12 years old. Do you have any suggestions?

  63. I have recently been diagnosed with HOCD and I am very curious if I have always displayed pure o ocd symptoms. I’m wondering what you mean when you say “pre-planning words before speaking”? I have a tendency to think about conversations I might have with people I know I will see later that day. I find this really annoying but can’t help imagining these conversations. Is this part of ocd?
    Also, I went through a period where I felt like God had abandoned me, as though I had lost my connection with him. I’m not a religious person but I do believe, for the most part, in God and Jesus. I felt like I couldn’t pray to God because he wasn’t there for me. When I was in my teens I remember I would have intrusive thoughts like “I love the devil.” Then I would counteract this thought with, “No, I love God and Jesus!” Is that ocd?
    Something else that I’m really curious about is this – a few years ago the carbon monoxide detector in my parent’s house went off. I begged my parents to call the fire department and hydro to get things checked out. They were a bit reluctant to do so as they didn’t think the carbon monoxide detector was working properly. It turned out there was a carbon monoxide leak. The problem with the furnace was fixed and all was fine until next time the detector went off. My parents called hydro to come out and there was another leak. For the next two years, even during minus 40 weather, I slept with my window open every single night because I thought it would ensure that we wouldn’t all die from carbon monoxide poisoning. My dad eventually threatened to nail my window shut so I couldn’t open my window at night during winter. I became very upset with my dad and threatened to kill him (I would never do such a thing but I was on prednisone (a few weeks at that point) at the time and it was making me extremely nuts and verbally impulsive) (my fear of carbon monoxide poisoning began well before being on prednisone, just to clarify). I no longer sleep with my window open at night, but I will occasionally check the detector to ensure that it’s working. Can this be related to ocd?
    I’m sorry for all the questions, I just really want to understand this and I don’t want to ask my therapist because I feel like I’m already monopolizing his time with my hocd.

  64. Hi there,

    I have been having vivid instructive thoughts about self harm (mainly with knives for some reason). I get severe anxiety, knowing that I don’t actually want to act on these impulses, and I even find myself leaving the house if it becomes too much.

    I recently dealt with being left by my partner of 4 years and started having these thoughts about a week after. I went in, got evaluated and they said it was due to lack of sleep and exhaustion. After being prescribed sleep aids, the thoughts lessened in severity and almost seemingly went away, and when they did pop up… It didn’t phase me in the way it did prior.

    However the thoughts are popping up again in the last few days and have been really intrusive.

    I also know that I am super sensitive to my body. I often think the worse case when it comes to something that doesn’t feel “normal” (ie; heart palpitating, I assume I have a heart condition, short of breath and I assume I have COPD because I smoke, yet I’m only 28).

    I’m trying to figure out if it indeed is ocd acting up or if I’m dealing with depression over this? Depression I know is normal after dealing with a breakup.

  65. I was wanting to ask if anyone has had thorough and proper thyroid testing done. Then I saw James’ recent post. He apparently is on meds for his thyroid. I really, really think that more research needs to be done on a connection. Current lab ranges are still including sick people, so thyroid disease is continuing to be undiagnosed or poorly monitored. I have Hashimotos’s, and suffered many years before diagnosis. Interestingly, I also dealt with some level of OCD and anxiety. I can related to many posts on here. I thought I had AIDS, I constantly was a checker, I had tapes of thinks go over and over and over in my head, I feared germs and washed my hands over and over and many other compulsions and obsessions. I am unsure of whether the thyroid disease caused OCD or if it just exasperated it. Right now, my anxiety and OCD type thoughts have greatly diminished. I am, however, very, very diligent about stabilizing my thyroid condition, knowing all the progressive treatments, and recognizing my body cues that I am getting too hyperthyroid or hypothyroid. I can tell when I am hyper because I get anxious and have the “fear of death” creep over me. It’s similar when I am hypothyroid, but I find that I start getting hung up on germs and contamination, irrational thoughts. Anyway, I really wish I was in the medical field because I would do a study on this correlation: thyroid disease and OCD.

  66. Is positive self talk OK or counter productive?

    For example if I am going through a hard time is it ok to tell myself “you’ll be ok, you’ve dealt with this before and came out ok you can do it again.” Or “you can handle this.” Or “embrace uncertainty.” Or simply noticing when you are making progress and giving yourself a little confidence boost.

    The reason I ask is because I have OCD about OCD right now. And getting my therapy “right.” I am afraid if i do anything wrong that I wil llose all my progress and actually make my condition worse. I am not sure if positive self talk is actually just building up trust in myself that I know resides in me or if it is a form of ritualizing.

    • Hi Joy!

      I’m struggling badly with “OCD about OCD” for quite some time now.

      I see that your post is quite old. Do you have a better understanding about this now?

      This seems to be quite a rare form of ocd…

      I wish u all the best,


      • OCD about OCD is not so uncommon. It often is driven by perfectionism or the fear of not getting better and is best treated via ERP (just like most other types of OCD).

    • In my opinion, self-motivating statements are okay — just as long as they’re not used ritualistically or used to manipulate changes in feeling states. If they become repetitive, or are used to escape from anxiety, they’re probably skewing toward rituals. OCD about OCD is sometimes addressed through intentional mistake practice which challenges perfectionism around treatment. This keeps treatment from becoming an anxiety-driven process used to escape or reduce anxiety.

      • Hi there,
        I am also dealing with OCD about OCD. My question involves whether or not I am engaging in an obsession or a compulsion – I am hyper aware of when I am not obsessing, am being “Normal” and my OCD recognizes this and I am pulled right back in. It is as though I am trying so hard to be normal and not have OCD that I am hyper aware of my inner state. Is this awareness a mental compulsion and how do I deal with this? I try not caring, but within seconds my brain notices I am not caring and I am pulled back into the loop again. This is my day, over and over again. What would be the best way to deal with this? Thank you so much.

        • Sometimes internal checking is the compulsion. Are you monitoring if you’re feeling “normal” or not? Without knowing the specifics of your OCD, it’s hard to guide you. You might consider consulting with an OCD specialist to get specific guidance. Some people overcome this by putting post-it notes everywhere that read, “Normal?”. This allows you to practice being non-reactive to the awareness (in a more concentrated way).

  67. Hi! I’ve developed really strange one, not sure whether it is ‘Pure-O’OCD or what. I was scared one night from a panic attack, feeling as if I’m in present or better to say vacuum, and there is no past no future. Very wierd feeling. Perhaps, was some kind of ‘derealisation’ symptom.

    After this PA, I felt detached, then eveyrthing was normal for sometime. But a bit later I’ve started thinking more and more about this case, having PA from time to time. Ended up developing high anxiety 🙁

    It scares me once I start thinking about past, where all goes, imagining that I’m not able just relax and live present moment. I doubt it’s ‘derealisation’ but just intrusive thought that makes me panic. Plus, I’m 35 weeks pregnant which makes it all very upsetting


  68. Hi,

    I have been having Pure O for a little over a month now, and it is really debilitaing my life. My fear is the fear of being a cannibal. It first started when I woke out of my sleep with the fear of killing my daughter, and I had a complete full blown panic attack for hours until I finally was able to calm down. It was theme pure ocd at first. It went from fear of hurting others, to fear of cannibalism, fear of wanting to have sex with dead bodies, and a then even to the fear of being a pedophile ( which I remember reading about and said at least I didnt have to fear that…but then that happened too.) Those went away. The one I fear the most, and the one that stuck is the fear of being a cannibal, even the fear that I may seceretly want to be one. I keep having what I call the “paper plate scenario” where a tiny truffle size piece of (meat eww, or whatever you want to call it) is presented to me, and I keep thinking over and over what would you do? Do you want it? NO!!!!! Then I keep thinking if I did, it would only be b/c I want to get over this damn fear, or sheer curisoity. I couldnt eat meat for over a week. The entire idea completely grosses me out, and I desperatly hope Id never participate in any of it, in any circumstance. It horrifies me, and in fact, Id rather die than do any of it. I keep bringing every scenario up to test myself in hopes that I wouldnt. I even put myself in scenarios of picking the worst of two evils…. meat or living spiders (whih I have a fear of) or cutting off my own leg rather than eating a piece, Or jumping off a building. This is completly insane! I read a horrible story about a a cannibal, child molester and killer when I was about 11 and then heard about Jeffrey Dahmer not too long after. I think this is a huge reason for this fear. Everytime I can remember hearing about this subject, or wacthing a movie, I have been really scared and grossed out. But then i think maybe I have an interest in the suject b/c why’d I read that article,( when I was 11, I cant remember how I found it, or why I read it for that matter, and I went back and read it again. I think to process it or something, or b/c I was in such disbelief.) or why did I watch that movie on Jeff Dahmer? ( just curisoity maybe? Ive heard of him a million times, saw the movie on netflix ,and WASNT scared of all this when I watched it. Now I wish I hadnt…. I try to just look at it in a nuetral way now. Thinking to myself, thanks, but not thanks, not for me, but I can understand a little why some cultures, etc would see it as appropraite. But then I always get anxiety. Its the constant need to be absolutly certain that I am not a cannibal, and more importantly that I dont WANT to WANT to be a cannibal….This damn Pure O has me so confused I cant tell if I do or I dont anymore. All I know is that I dont want anything to do with it, ive always been scared of it, never had any desire to eat a perso or even the thought of it, and I have never had these thoughts or fears until a month ago. When I was a kid I had OCD for a while during hard times in my childhood, but then it went away completely. The rest of my life was fine. My husband comitted suicide with a shotgun and I found him ( I was 4 months pregant at the time as well) and during the next 2 years or so I had noticed regualr OCD things occuring, but not enough to really bother me. But this literally came out of nowhere. I largely blame it on that, as I know the difference of the past few years. I am very spiritual person, love the earth,I am a pagan, and I also am an avid hiker….so all this completely goes against what I feel in my heart. At times I am even scared of meditating and hiking and absorbing myself in nature, b/c I am scared I will adaopt the mindset of pro-cannabilsm. Serisouly???


  69. Hi,
    Is the fear of being transsexual can be a OCD obsession. I cant seem to shake the thought off and I constantly think and try to disprove it but sadly it just don’t stop and it make the future seem so unpleasant and depressing. Sadly i always been arroused by the tought of wearing woman clothe, making the tought even harder to ditch and make me fear that I just allways been in denial. I constantly think about this and i feel so disconected from the world and the people arround me. Do you think it could be caused by OCD? I always been a very anxious person, younger I had a constant fear of vomiting keeping me from enjoying live and I feel it could have been ocd too.

  70. Hi Ive been dealing with intrusive thoughts since I was 15, I’m now almost 19 and they are still here. They were really really bad when I first got them and I ended up going into therapy for them and was diagnosed with GAD. I would worry constantly that i would harm my family, my cats, or that i was a pedophile. After awhile they went away and werent even in my head anymore. But theyd still pop up at random times but I can usually just ignore them but a few weeks ago they popped up again and havent left. Ive read up on so many articles about intrusive thoughts, anxiety, ocd and I know that they are not me. I would rather kill myself than EVER EVER commit these things. I’ve always wanted to be a mom in my future, and Im so scared that I will hurt my future babies 🙁 and it makes me physically sick to even think that. Ive always loved little kids and having a family has always been important to me. Im also a psychology major so you’d think id be able to realize that the thoughts are just thoughts, but every time i start to feel better, the thoughts come back and i worry that ive just accepted that i am my thoughts 🙁 At my job Im also always around kids and i worry every night before because im scared Im gonna lose control and hurt someone. hurting others in any way and especially people who hurt children are horrible terrible people and i would never ever be one. i have such a hard time sleeping and the thoughts are just always there and i dont wanna deal with them anymore, i just want them to go away. im constantly questioning myself and telling myself that they arent me, and now im starting to feel a sense of depersonalization because my brain is so tired from all this overthinking and worrying. i watched a lot of law and order svu and criminal minds as a kid but now i cant watch it at all because i find it so disturbing, idk if that couldve contributed to my fears. i have a friend who feels the same way i do and she also watched those types of shows when she was young. does this sound like pure-o to anyone? or just intrusive thoughts?

  71. Hello Dr. Seay,
    Thank you so much for your website. I’m pretty sure I have some level of Pure O OCD, though I haven’t been officially diagnosed. Your website as it has brought me much comfort as I have learned more about this condition. I do have a question though that I can’t really seem to find an answer to when it comes to Pure O. Does someone with this condition have to have it on a daily basis? I don’t have it everyday and actually feel like I can go for weeks at a time without a terrible thought. I do seem to spike on a monthly basis though, but not necessarily in line with my monthly cycle. Is this common? Can you have Pure O on a party-time basis or is it an all or nothing thing? Sometimes, as crazy as this may sound, I feel like if I had it everyday I’d feel better knowing for sure this was what I have. Instead, I’ll feel “cured” for a few weeks or a month and then it will sneak back up and leave me very discouraged. What are your thoughts?
    Thank you so much.

  72. I had some very successful therapy following diagnosis for Pure O many years ago. As I am sure you know OCD hangs on, and changes, even when things are improved. I have had a few of the symptoms you mention above but therapy allows me to negate many of them.

    However, my persistent worry is that of being ‘judged from above’ for my thoughts, words and behaviour, and then worrying that my face will change (as in become ‘uglier’) as a sort of punishment or consequence, linked to these issues. Have you ever heard of this concern in others with OCD? Some days I can beat it, other days I feel wretched.

    • Paul, this persistent worry you have from “above” that you are being judged for your thoughts, words and behavior and your face might change is not real. I am sure you actually realize this is the case, but the pure OCD is what is bothering you. I know how bad pure OCD can get. The truth is you are being bothered by something that is the exact opposite of the real you and the exact opposite of reality. Your thoughts, words, and behavior are those that a really good, smart person has and does. People with pure OCD have troubling thoughts that go against the very core of their true selves, The problem is that uncertainty exists in life. Just let the troubling thoughts be there without arguing with them when they enter into your head. Do not try to reason with them. The real problem is that we try to argue against the troublesome thoughts. The thoughts then hold power over us. Just try to say okay so maybe my thoughts or words or behavior are bad and my face will change. Your face will not change. Trust me. It is such a ridiculous thought and I bet you really know it is not true, but when you ruminate try to argue and prove it can’t be true, the OCD gets worse and worse.It is not easy at first, but do your best to just let this stupid, ridiculous thought be there when it enters into your head without arguing with it. Paul, you are a good guy, really. Your face isn’t going to change and get “uglier”. That is a ridiculous belief. I am trying to help you. I want you to see how crazy it sounds. It is just your OCD talking to you. Do not argue with it do not try to reason with it. The OCD will lose power over you. Eventually these troubling thoughts you have will not bother you anymore. Best wishes, Paul. Again, the truth is people with pure OCD will be bothered by thoughts that are in reality the exact opposite of their real selves and the exact opposite of what is true. The truth is your thoughts words and behavior are not being judged from above and you are a good guy. You’re a good looking guy, too, whose face will never change because you are being judged from above. Those troublesome thoughts are of course not reality, it just the pure OCD talking. You can and will beat the pure OCD

  73. A way to beat OCD is to not9 f

    • Paul, this persistent worry you have from “above” that you are being judged for your thoughts, words and behavior and your face might change is not real. I am sure you actually realize this is the case, but the pure OCD is what is bothering you. I know how bad pure OCD can get. The truth is you are being bothered by something that is the exact opposite of the real you and the exact opposite of reality. Your thoughts, words, and behavior are those that a really good, smart person has and does. People with pure OCD have troubling thoughts that go against the very core of their true selves, The problem is that uncertainty exists in life. Just let the troubling thoughts be there without arguing with them when they enter into your head. Do not try to reason with them. The real problem is that we try to argue against the troublesome thoughts. The thoughts then hold power over us. Just try to say okay so maybe my thoughts or words or behavior are bad and my face will change. Your face will not change. Trust me. It is such a ridiculous thought and I bet you really know it is not true, but when you ruminate try to argue and prove it can’t be true, the OCD gets worse and worse.It is not easy at first, but do your best to just let this stupid, ridiculous thought be there when it enters into your head without arguing with it. Paul, you are a good guy, really. Your face isn’t going to change and get “uglier”. That is a ridiculous belief. I am trying to help you. I want you to see how crazy it sounds. It is just your OCD talking to you. Do not argue with it do not try to reason with it. The OCD will lose power over you. Eventually these troubling thoughts you have will not bother you anymore. Best wishes, Paul. Again, the truth is people with pure OCD will be bothered by thoughts that are in reality the exact opposite of their real selves and the exact opposite of what is true. The truth is your thoughts words and behavior are not being judged from above and you are a good guy. You’re a good looking guy, too, whose face will never change because you are being judged from above. Those troublesome thoughts are of course not reality, it just the pure OCD talking. You can and will beat the pure OCD

    • hi Dan, reading your post here is like finding what I knew had to be the truth but don’t have the confidence to have the trust in myself to believe. I am sure that I am a pure-o since late childhood with on and off worries. I had hocd during my adolescence, but now know it’s not true. Right now I’m having a horrible rocd, and I wanted to know where you got your information from? Did a psychologist tell you this? How can I know for sure that this HORRIBLE new worry I have is not what I secretly want? What if it is what I want and I don’t want to accept it? Please write to me, I hope it’s not too late for you to see this post.

      • Hi, Susan. I am sorry for not getting back to you sooner. I hope you are okay. I just read your message now. What I am writing is true. People with pure OCD normally have above average intelligence and, YES, your distressing thoughts are NOT REAL. I did see and get this information from a leading specialist treating people with pure OCD, Dr. Steven Phillipson and his team of doctors in NYC. Here is the phone number (see end of this message) to his office. He has a team of highly qualified and very caring specialists who work at his OCD center in NYC. Good luck to you. The annoying, horribly distressing thoughts that bother you are not real. Just accept that you cannot ever prove it with absolute certainty, because nothing in life I is truly 100% certain. Uncertainty exists in the world and what we do is seemingly need to be able to prove in our own heads that the distressing thoughts are not real and can’t possibly be true. If you just let the thought be there and say to yourself okay maybe it’s true I realize it is a stupid completely unrealistic thought because there are so many things that make the exact opposite the truth however I will not continue to argue with this distressing thought. Please do your best to limit ruminating,and stop ruminating. I know you can do it! You can beat pure OCD. You are an intelligent and caring person who is bothered by something because it is really the exact opposite of the real you. Again, good luck and best wishes to you.
        Dr. Steven Phillipson (NYC)
        Phone: 212.686.6886

  74. A way to effectively combat pure OCD is to not “argue” with the distressing thought. Do not ruminate which means to continue to think about the ways this distressing thought must not be true. Just say to yourself okay maybe this distressing thought is true. Don’t continually argue in your own head trying to arrive at that definite answer that proves the distressing thought you have is wrong. If for instance, your distressing thought is that you may be a child sexual predator and want to hurt children. Well, wait I am nice to children, I am around children and don’t hurt them, I love my little niece and nephew, etc., but I think I might really be a sexual predator because when I was little my uncle… or whatever… ridiculous reason you have that lets you know you might be a sexual predator – do not argue with that distressing thought. It does not mean the distressing thought is true. It does not even mean the distressing thought might be true. It is not true. The opposite is true. Trust me. People with pure OCD ruminate about something that is the complete opposite of their true selves – the complete opposite of reality. When the distressing thought is in your mind – Oh my God, I think I really am a sexual child predator – do not argue with that thought. Let it be there. In this way the distressing thought loses all power over you. Do not argue with it. YOU CAN BEAT PURE OCD. What happens is the distressing thought loses “power” and importance to you. You will say, Okay maybe I am a child sexual predator. The reality is of course you are not, but if you ruminate, continue to argue with these stupid, annoying, horrible, terribly troubling thoughts, continue to try to reason with them they hold power over you. I swear to God, these troubling thoughts you are having are not true. People with pure OCD have troubling thoughts that go against the very core of what they really are. The thing is in life uncertainty exists. We with pure OCD need to be aware of this. It sounds crazy, but people with pure OCD are normally above or well above average intelligence. What is bothersome to the person is this uncertainty. That is all it is. It is not real. You are NOT a child sexual predator. Trust me. The problem for us is there really is no way ever to absolutely totally prove it. Nothing in life is absolutely, positively certain. You can beat it. Let the troubling thoughts be there and don’t argue with them. They will lose importance, lose power and you will say yeah so maybe I am a child sexual predator. The troubling thought loses its grip on you. The time will come when the troubling thought does not even bother you anymore, and it will no longer even enter into your mind as a troubling thought anymore. Please do your best to not ruminate – do not argue with the troubling thought, reason with the troubling thought, etc. The problem is not really even a problem it is just that nobody can ever prove in their head for certain I am not a child sexual predator, for instance. Don’t continue to try to absolutely prove it in your own head. This stupid, ridiculous thought that you are a child sexual predator will lose its power over you. You really can beat pure OCD. The troubling thoughts and ruminating goes away. This is true with any type of troubling thought. Any kind of pure OCD. Do not argue with or try to reason with your troubling thoughts. They are not real, anyway. They will lose all power over you. Eventually, the troubling thoughts will no longer be there, anymore. Youcam beat pure OCD.

  75. Best wishes to all out there. I know how terribly troubling pure OCD can be for a person. Please do your best not to ruminate, do not argue with, do not try to reason with this troubling thought. You are smart. Uncertainty exists in life. The troubling thought is not real. In fact, the truth is that the troubling thought is the exact opposite of the real you. The problem is that people with pure OCD are trying to know with absolute certainty the troubling thought is not real. When it enters into your head, do not continually argue with it, do not continually try and reason with it. Let it be there. It will eventually lose all power over you.

  76. hi,

    I had a lot of intrusive and obsessional thoughts ( and before that ” normal ” ocd ) can we have paranoiac intrusive thoughts which attacked people you love ex: ” don’t trust your mom, she will kill you ! ” but i love my mom.
    Please help and thank you

  77. Hello,
    My boyfriend struggles with OCD, and if anyone could help me it would mean the world to me!
    He has been dealing with OCD since he was a child, but he cannot talk about it very much or else he will have an “OCD attack” and need some time to fix everything in his mind. He has told me that I know more about the symptoms of his OCD than anyone else in his life, but I still know very little and it hurts me to see him suffer. I’m very afraid that I will accidentally trigger his OCD and that terrible things could happen. Here is what I know:
    He went to a doctor for his OCD a few years ago, and started taking medicine. It made it very difficult for him to eat, so he had to stop taking it. He told me that the medicine did help with his thoughts though.
    He used to go to therapy, and that helped him as well. He had one on one sessions with a doctor, and even then he couldn’t explain all of his symptoms to the doctor without triggering an attack.
    His doctor passed away a while ago and now he refuses to go see a new doctor.
    He has trouble walking, opening/closing doors windows etc, and even typing or plugging things into ports. He has trouble with these things because he “sees” little white bugs in these areas and he is afraid of hurting them, so he has to make sure that he is very careful. He knows that the bugs are not real.
    Whenever he hears a certain animal make a sound, he must stop everything and think only about himself, or else he is afraid that the people he thinks about will die. He will stay silent anywhere from a very short time to a long time.
    He cannot hear or see the words “god” or “OMG”. If he sees/hears these words, he will automatically insert the words “f***” or “f***ing” in his mind. He will then need to be silent and apologize to God in order to be sure that his loved ones are not killed. He is Buddhist if that makes any difference.
    He also talks a lot and needs to over explain himself because he is afraid that people don’t understand what he is saying. If he wants to say something, he must. If he doesn’t understand a word or phrase, he must get a fast explanation or he will start swearing at God inside his mind, and he will need to fix it. If he wants to do something (eg watch a movie) he must at somepoint or he will get another “OCD attack”.
    He struggles a bit with depresdion and has had thoughts of suicide. He has said that he tried to kill himself when he was younger, but he can’t say anything else about it.

    As you can see, he is clearly suffering a ton on a day to dday basis. I’m constantly terrified that I will say or do something to set him off. I struggle with deppression and am recovering from an eating disorder. I have found that music helps me, and I am trying to make a playlist for him when he needs to calm down… if anyone could help me identify his type of OCD (since he won’t go to the doctor) and give me any ideas on how to help him or get him to go to the doctor,I would be SO thankful. And if there is a way to identify more things that trigger him without him telling me, please let me know! Thank you so much for reading this!


  78. hello dr
    i am suffering from ocd (mainly perform mental rituals ) but some times once in 2 weeks time some kind of action but all the time fight negative thoughts with positive thoughts ) my problem is that i faced so many thoughts from past 3 and a half years that i got so tired after 1 and a half year that i found a way to live in a calm and slow way in which time seems to be elonged . what i did was that i entered a peaceful place in my mind bounded by certain rules which would help me overcome specific thoughts and the rest of the thoughts would stop coming because of avoidence of rest of the things in life this is what i define as a stste of mind,anything not relevant to it would cause large disturbance ,now ican overcome that disturbance by counciling myself by saying that now things are this much better now (comaparing with past situations ) and wont go wrong .. i have phobea and depression too,so while living in this state of mind i wont feel anything that i dont want to feel even if it is of gr8 value in my life and i will attend the colleege and tutions in a particula state of mind and in that i will be reminding myself of my self made state of mind to face situations , f i let go of the state of mind i would end up in a very fearful place where every thought is allowed to come and i will have to ignore it to do my work because they were less in the beginning but after some time they increased tremendously in number and till today i cant face all of them at a time . even writing this generates thoughts so i would either ignore them ( which after some time would become extremely difficult ) or i would write this if the state of mind i m living in has no fear for this writing or i would set a balance betwwn the two stuations thus causing me to phase out a bit from the stste of mind and then after finishing it again returning to it . i have done a lot of fight but i am losing energy can u please guide me with some behavioural advice .then is that i cant feel sad , ihave to feel happy so that i can perform a task while dealing with thoughts otherwise in sadness i wont be able to do anything.i have a lot of cocern with what peope think of me and i think telling everything to someone is nott a good thing i should have patiece,sometimes in v tough situations i council myself tht everything will be okay , and i dont let myself deal with the darkness or mourn over the lossesi would simply face them with a happy heart stamina and strenghth but at the same time wont let go off what i didnt get i would work on it and the biigest thing would be that i will get it some day and if not i will sit at home and enjoy life there will be no midway ,either i get what i want or i will continue life living happily
    i run from hopelessness because i will never recover from it and to move on i have to create a state of mind full of happiness

  79. And for nineteen years I thought I was just “unique” and “crazy”… I have been plagued by bad and fearful thoughts since I was a kid and I would try to think the opposite in order to stop thinking about the bad thoughts which I feared if I thought about them too much they would come true. I don’t know if this a symptom of OCD but I feel the need to do certain things in my head or behaviorally in order to feel safe. My fear of being hospitalized with an illness has driven to the point where I have had suicidal thoughts. I have worried about sexual immorals appealing to me and I had no idea that was part of OCD.

    On one hand I’m glad to know I’m not the only one but on the other hand this distresses me that other people have to face what I have to face everyday.

    • 3

    • Anon, it sounds like you may be experiencing pure ocd. It is not a pleasant feeling. I know. However, you can feel better and those distressing thoughts will not bother you and will eventually leave you. You can really feel better. Do a search for doctors who treat pure ocd in the area where you live. I am including a link that describes pure ocd. Certainly, if you can relate to this, a doctor (or trained therapist) who specializes in pure ocd can help you.

  80. I would like to add category that you missed and that I find particularly unsettling. I mostly have sexually themed obsessions that I feel I am finally coming to terms with. I thought that nothing could be worse. But, every once in a while I get “philosophical” OCD. This one feels like the very fabric of reality is caving in lol. This can take on many subjects : what is art? What is music? Political philosophies, existential angst, etc. Fortunately it is rare for me and goes away in a couple of days. It’s usually started by something that overwhelms me intellectually and I become fascinated (for me this is the real cause if OCD – it’s the caring disease. I doubt lots of things – it’s the doubts that seem to have meaning for me that crank the hamster wheel) OCD then kills the rational intellectual curiosity and turns rational thinking into anxiety. I’m well aware that the questions either don’t make sense or are too complicated even for your average phd. In some ways they feel like neutral obsessions (hate em) because they are somewhat nonsensical and meaningless. The very question is the obsession. Ex. Is there an element of fascism in certain pop musical forms? Is punk rock fascist or socialist in nature? These questions are indeed valid under certain circumstances but it’s the obsessional fear that I won’t be able to stop asking deep questions about the nature of things – thus the neutral obsession sensation – what if I get stuck on the letter “I”, what if I won’t be able to stop thinking about my guitar, etc. It is devastating because I pride myself on my rational thinking skills and OCD attacks the very essence of that.

  81. Dear Dr. Seay,

    Thank you very much for this post. About six years ago I suffered terribly from pure o ocd for over a year. It took over my whole life and was quite frankly unbearable. With medication I was able to over come it.

    However six years back it is back to haunt me. In the past I was obsessed about obsessing, now I cant stop thinking about blinking (its hard to explain to others cause it all sounds silly). My fear is that I will again be stuck the way I was six years ago, and quite honestly I just cant face that again. Do people with pure O get over it? I am worried because I am on medication… but it is not working in this instance. I have set up an appointment for CBT but I dont want to have to battle my brain 24/7. Thank you for your insite

    • Hi MGB,

      Did you receive therapy for your obsessing about obsessing? That is my issue right now and it is unbearable. Any advice you can offer for that? I am also on meds but am in the beginning days of it.
      Thanks so much.

  82. Hi there,

    So I think I have a kind of “worry-contamination” fear. I kind of noticed that, for a lot of my obsessive thoughts that bred visible actions (let’s just say, fear that I’m clicking my mouse too loud — I know, really silly) when other people noticed this they would start doing it too, and it would kind of affect them, and now I’m scared that either every bad/fear-driven thing I do will “contaminate” other people, or that I’ll notice someone else doing a “fear-driven” thing and I’ll start doing the same thing as well. Like, I know it’s kind of silly when I really think about it, but then why did other people start copying me when I did worry-driven things? I’m a kind of expressive person, like you can sort of read my face easily, so I don’t know if that has anything to do with it…? I really don’t want to be affected helplessly by other people!

  83. I have never been diagnosed with OCD by a professional (but I have a brother who has been, and my mom said I display many of the same symptoms), but I think I have Pure-O. I have and have had intrusive thoughts that have plagued my thoughts for varying periods of time. One time, I had been obsessed with the fear that I would harm myself. One night, I went to my mother and told her about these fears because I was so afraid I would actually do it. I had been plagued with those thoughts for months. Other times, I would obsess over the death of a loved one and what I would do if that did happen. I also doubt many simple things about myself, such as my sexuality, my belief in God, etc. I keep asking myself, “Is this even normal?” It scares me, but I’m too disgusted at myself to talk to anyone about these thoughts. I normally just do my best to push them aside by thinking positive thoughts. Any advice?

    • Those are all common OCD content areas — it’s very possible that you might have OCD. If so, the most helpful treatment would consist of exposure and response prevention (ERP). You could pick up a book to learn more about ERP, or you might benefit from working with OCD specialist to help guide your efforts. Regardless of which option you choose, treatment can make a tremendous difference.

  84. Thankyou for this article. You have excellent insight and far more than most psychologists. At the moment I am suffering from obsessions of a past decision to only have one child. I am constantly checking my memories going back and forth on how I could of done it differently. I did not realize this was the compulsion. I am also researching it a lot on the net comparing myself to others. Looking for statistics etc. I realize this is also a compulsion. I am trying to actively engage in ERP to combat it. It is very difficult to get the mental energy to fight. Great work.

    • Mental review, online research, and mental analysis can all be types of compulsions that prevent symptoms from improving. It’s great that you’ve been able to identify that. Incorporating response prevention (in addition to your exposure) should make a big difference in your recovery. The RP may also help the exposure to be less exhausting. Hang in there, and keep working at it!

  85. I have a loved one who has an obsession based on the fear of turning into someone else. It’s very bothersome. Although he’s nearly 20 now, he first had this obsession at age 13, so it is not “new.” He has many obsessions and is a highly artistic and intelligent person. He has very few obvious compulsions.

    One problem is that therapists in our area are totally confused by this. They aren’t experts on OCD or Pure O and confuse this symptom with other psychiatric conditions. It’s so easily confused, it’s dangerous to talk about.

    (Only one psychologist, 350 miles away, seems to understand.)

    What’s the best long-term treatment option for these very sophisticated and complex fears? He’s on fluoxetine and lorazepam but no therapist. I want to help but don’t know how.


    • This type of OCD is often referred to as “emotional contamination.” Treatment tends to be similar to other forms of contamination OCD, in that you would typically build a hierarchy around exposure to “contaminated” people. For some people with emotional contamination, there may be particular types of people who are especially triggering. Treatment of emotional contamination involves reducing avoidance and directly facing the fear, as the avoidance is what causes this fear to persist. Response prevention (for mental rituals) — as always — is necessary for the exposure to be effective. Treatment of emotional contamination wouldn’t necessarily be long-term — it would just involve taking the right steps. The problem is that most people with emotional contamination don’t easily find their way to a provider who understands the condition. FYI, writing more about ERP for emotional contamination has been on my to-do list for quite awhile, so keep your eyes peeled for a post on that topic.

  86. Dr. Seay I have learned that I suffer multiple thoughts of Pure O. I have weird thoughts about little kids which I don’t know if that extends into the realm of pedophilia. I drive by parks which makes me nervous and swimming pools when I was at my local community center. I also have thoughts of hurting my son with suffocation from a pillow and my neice with a blanket I have the anxiety and fear of those thoughts in my head. I also suffer from HOCD. I question my sexual orientation because I have been hurt by women and my mind thinks that women aren’t attracted me anymore. I have an issue where I repetitively have to tell my mother about the thoughts to relieve the anxiety but the thoughts have become to frequent that I’m constantly telling her them. I can’t live the house and when I do my mind is always looking for something new to fear or worry about. I tell mother men are cute even if I dont really mean it. It’s like I’m having a nervous reaction so I have to say something. Sometimes I feel that I cause the thoughts to come on purpose to see if I can face them or maybe to get attention. My body is constantly feeling anxiety and I have become sorta bed-ridden do to psychosomatic symptoms like migraine headaches, I feel like my chest is heavy, gastrointestinal problems, bowel problems, spasm of the appendages like uncontrollable jerking movements. That’s just some of the problems. I had a genetic test down telling me that the drug Anafranil is toxic to my body. How long does it stay in your system could it be amplifying my Pure O. I am back on Zoloft but haven’t felt any benefits yet I dont know. Everyone in my area hasn’t heard of Pure O and no one specializes in ERP. I have trouble with CBT, so I don’t know if my therapist is doing it right. I live north of Palm Beach. I don’t know what to do anymore. They want to start me on medical marijuana. Will that help. Have you ever dealt with the things that I have written about because I feel alone in this.

  87. I always thought that OCD was just someone repeating things over or having an immaculate home. I read your article and it really describes how I have been feeling I notice i have numerous symptoms, not just one. About two years ago I was diagnosed with Generalized anxiety disorder. I had compulsive thoughts and never told my doctor because i felt she would think I was insane. After a bunch of research I finally see that many people suffer like I do. I just wish there was a cure. My question for you Dr. Seay is why do I go long periods of time without symptoms? My anxiety is always there though but I can go months without having compulsive thoughts.

  88. Hi Dr,

    Some of these compulsions or fears really resonate with me, but I am old enough that I feel like this sort of thing would have been diagnosed already, and so I am not sure about my self-diagnosis (which I already know is dangerous).
    Also, I tend to get lost in thought arguing with myself about an issue – sometimes without worry, and sometimes with a lot of it. I have yet to see a definition of OCD where this is present, and I was wondering if you have any insight?
    I know it has been a while since this article was published so this may be a shot in the dark, and please do not worry if you don’t see this for a long time.

  89. Hello, I was wondering if one can come back from ocd causing them to believe their fears? Im suffering for several years from, 5 years, what if I created the world with my imagination and nothing is real/im alone. I feel like I believe this! Its horrible…. I know I cant solve it, or know for sure. But can I at least get to a point where im not buying into it like im doing now? Not have it here constantly? I just need some hope…

  90. Hi Dr. Seay,

    I am struggling with hyperawareness of my breathing. I am not sure what compulsions are keeping it around. My attention to it seems completely out of my control. I am not sure what I am doing that is keeping the attention there. My fear with breathing is that I don’t know how to breathe normally anymore and it will never go back to normal. Any advice? Thank you.

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