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Pure-O OCD (Pure Obsessional OCD): Hidden Rituals

Pure-O OCD & Hidden Mental Compulsions

Pure-O OCD (Pure Obsessional OCD) is associated with hidden mental compulsions that interfere with treatment effectiveness.

“Pure-O” OCD, or Pure Obsessional OCD, is a relatively less common form of OCD that seemingly differs from classic presentations of the illness.  What distinguishes Pure Obsessional OCD from classic OCD is that in Pure-O OCD, symptoms are predominantly obsessive (rather than compulsive) in nature.  Although individuals with Pure-O OCD frequently experience intense and distressing obsessions, they typically report few (if any) overt compulsive behaviors.  However, in almost all cases, pure obsessionals do engage in a variety of rituals.  These rituals  just manifest as mental compulsions rather than behavioral compulsions.

Unfortunately, most psychologists haven’t been trained in how to ask the types of questions that are necessary to identify these “hidden rituals.”  As a consequence, these rituals often go undetected.  Because effective treatment requires consistent response prevention, a failure to recognize and resist mental compulsions makes true exposure and response prevention (ERP) impossible.  Treatment then proceeds in an ineffective and haphazard way, with neither the patient nor the therapist any the wiser.

Not surprisingly, treatment for Pure-O OCD often fails.  However, treatment failure occurs not because the patient is an ERP non-responder, but rather because the most important part of treatment (i.e., response prevention) was unknowingly omitted.  Sadly, many individuals with OCD wrongly get labeled as being treatment refractory (treatment resistant), even though they have never undergone a single course of response prevention that appropriately targets their very real mental compulsions.

Remember, not every ritual consists of an observable behavior.  Learn to more effectively fight your OCD and become a mental ritual detective by considering a few of the following “hidden” rituals that I assess when treating individuals in my South Florida (Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami) psychological practice:

Pure-O Mental Compulsions

  • Trying to “figure out” why you’re having a certain thought.
  • Trying to counteract, neutralize, or balance out negative thoughts with positive thoughts.
  • Trying to forcefully control an obsessive thought.
  • Trying to “figure out” what type of person you are (e.g., questioning your own morality).
  • Avoiding certain situations, people, or activities so that you don’t have an obsession.
  • Reassuring yourself (e.g., telling yourself, “I’d never do that.”).
  • Postponing certain behaviors or thoughts until “the right time” or until “they feel right.”
  • Repeating thoughts, phrases, or words in your head.
  • Repeatedly praying or asking for forgiveness (in a way that is not typical for others who share your faith).
  • Getting stuck in an OCD doubt/reassurance loop.
  • Asking questions and seeking reassurance from others.
  • Over-analyzing one’s own behavior or body and trying to do things “normally.”

Questions? Comments? Do you engage in mental compulsions? Sound off below.




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67 Comments

  1. Excellent post which clarifies a lot of misconceptions people have about Pure-O. Thank you!

    • Even today, Pure-O remains one of the most under-treated forms of OCD. This is not because effective treatments don’t exist but rather because of the challenges inherent to properly recognizing it and addressing it.

      • Good afternoon, I have read many articles and this one is the closest one I could find to summarize what I go through on a daily basis. I have been diagnosed with anxiety and obsessive thoughts and was started on remeron just about a week ago and take clonizepam to help me sleep. I have been in a relationship for just about 3 weeks and I do not want to lose her as I want to be with her. However my thoughts will not stop telling me to break up with her. To leave her. That I do not have feelings for her. It’s extremely over whelming as I do not want these thoughts I just want to be happy with her but I cant stop my mind. Please help me ASAP

        • hi, it sounds like you have relationship ocd!

          • What is the best way to go about managing relationship OCD with out sabotaging my relationship? What techniques or medeciation or therapy ?

        • Ignore the thoughts. I have OCD, and my relationship with my boyfriend has been at the forefront at times. There were times where I’d be sitting next to him on the couch and my brain would consistently tell me to break up with him; I just had this urge to say it even though I didn’t really want too. Over a year ago now I had a serious break down because I had no idea whether I loved my boyfriend or not, if I wanted to stay with him, and how to know if I should break up with him or not. All I could do was test myself over and over again by imaging what my life would be without him to the point where the pain was so bad I wanted to throw myself through a wall. At my lowest point I learned to accept the negative thoughts, I learned that the only way that I knew I wanted to be with him and that I loved him was to know that I didn’t want to spend my life without him – that it hurt too much to think about. You have to ignore the thoughts and go with what your “heart” says.

  2. Excellent, Healing, thoughtful Help.

    thank you so much

  3. Thank you very much. Reading this helps me to understand myself so much better. I hope i find a suitable professional to work with.

    • It can be hard to find a qualified OCD therapist, but if you’re in the States, the International OCD Foundation is a great place to start. IOCDF also has listings for some therapists abroad. Good luck with your journey!

      • My son struggles with Pure O. He is a student at FSU in Tallahassee. Is there a provider trained to help him retrain his brain in that area? I don’t see anyone closer than Pensacola.

        • Have him look into therapists who practice EMDR (eye movement desensitization and reprocessing). It is amazing.

  4. Thank you Dr. Seay,

    I have a question: do OCD sufferers start to believe/identify with their thoughts about harming others?
    For e.g., someone may start off having recurrent thoughts of killing dogs. Of course this thought is disturbing but the person may not actually feel like doing it. However, after having these thoughts repeatedly, the person may start feeling to kill a dog if he is standing next to it.

    Does this happen to OCD sufferers? Thank you.

    • Yes, this can happen. The first time an obsession occurs, the person may or may not attribute much significance to it. If it occurs again and again, the person might begin engaging in mental rituals to figure out why the thought keeps occurring.

      The mental ritual might play out like this, “Why am I having this thought? There must be a reason. I probably wouldn’t be having this thought if there wasn’t some element of truth to it.” This can result in a pattern of rituals that includes self-reassurance (“I would never do that. I’m a good person.”) or seeking reassurance from others (“Do you think I’m a good person?”).

      New obsessions often occur spontaneously, but they’re more likely to “stick” if people engage in rituals or avoidant behaviors to protect themselves from their feared outcomes. In your example, avoidant behaviors might include avoiding dogs, not being alone with dogs, not touching dogs on the neck, holding one’s body very stiffly when around dogs, keeping one’s hands in one’s pocket, etc.

  5. Hey Doc – I posted something else under another comment (blog) area – but I almost am wondering if I have some of this so-called Pure-OCD along with my breathing obsession that I face. For years I have had “what-if” thoughts about breathing. What if I think about this? What if these thoughts don’t go away? What if I think about it while I am working, etc. What if my weekend is spoiled due to the fact that I may fixate on my breathing or anticipate that I may fixate on my breathing? Currently, I don’t find so much anxiety with my breathing – I have learned to just let it be their and usually continue doing what ever I was doing. (I learned some of this exposure stuff by reading Jon Grayson’s Learning to Live With Uncertanity. Sure, I may experience some anxiety, but it usually subsides overtime. I have had very few problems with OCD for the past couple of years regarding my breathing obsession. However, in the past month, I have had some flare-up’s regarding my breathing. I started doing some exposure but also reminded myself to just let thoughts of breathing be in the background and eventually they would subside. However, I have also noticed myself re-reading books, researching the Internet, and trying to find a lot of answers about how I can make any thoughts about breathing leave me alone completely. Flare ups (reoccurences seem harder to deal with) – and I continually tell think in my mind of better ways to deal with obsessions only to become more anxious, upset, etc. It seems like this month I have driven myself into a round about circle of trying to analyze and figure out why I am having some OCD flare ups again and what I should be doing so that I can rid myself of this situation so that I can feel like I was feeling (prior to this flare-up). For one, I am seeking a lot of reassurance (even by writing to you) to seek a better plan to deal with what I face – hence, I came across the condition PUREO. In your opinion, do you think I am committing some PURE O rituals – if so, is it best not to address them? Not addressing some of these thoughts seems to cause anxiety and makes me commit a lot of what if thinking. By leaving them in the background are we (in a sense) doing an exposure in the hopes that anxiety will eventually subside by not consciously dealing with them? Is their a better way to deal with PURE O types of mental rituals. When you state “Say No to Pure OCD Rituals” what should I be doing. Your ideas?

    • Hi Mike,

      There’s not always a “why.” Sometimes the “why” is simply that you have OCD. Spending excessive time trying to “figure out” the reason for symptoms or the optimum solution for symptoms is a very common mental ritual. In order for you to habituate to your symptoms, you have to resist all efforts at internal or external reassurance. Although reassurance decreases anxiety in the short-term, it never lasts. Moreover, most reassurance seekers find that they have to seek more and more reassurance over time in order to get the same amount of relief. The truth is that reassurance seeking prevents you from learning to live the uncertainty. Because it temporarily neutralizes the uncertainty, you never have a good opportunity to learn to live with it.

      For example, when I work with people who seek external reassurance online, I’ll have them practice saying something like, “It’s possible the answer is out there, but I’m going to resist looking because I know that my information seeking strengthens my OCD. Even when I find information that I think will ‘fix’ the problem, it always wears off and I’m left still experiencing my symptoms and feeling distressed. The only way I can really get over this is to learn to live with not knowing. Living with uncertainty may be painful, but this pain probably pales in comparison to all the pain my OCD has caused me over the years. That’s why I’m going to take this risk.”

      I responded to your other comment as well (re: the what-ifs). These must be addressed through imaginal exposure.

  6. What is the treatment for this type of OCD? I am a newly “self diagnosed” purely obsessional thinker. 28/Female. This all came on suddenly after a period of illness and stress. How do I relieve these symptoms?

    • The most effective treatment for all forms of OCD is exposure and response prevention (ERP). You can read more about it on this website. This page has an index of all articles published on this site:

      http://www.steveseay.com/psychoeducation/

      There are also articles that have been written about specific Pure-O symptom domains.

  7. Pure O is very time consuming, energy draining, confusing and painful; before I recognised it as a condition in itself I thought I was losing my mind. Another great article, you explain so well a condition that is sometimes hard to explain with words. Keep up the good work!

  8. I have Pure O OCD along with panic disorder and depression. I just started medication treatment and do a self help program, but am going to start to seeing a therapist for it all. I have sexual, hypochondria, and agressive obsessions/intrusive thoughts. Mental health issues are tough, but definitely manageable. Medication has done wonders in helping me live less in fear. So whoever is out there and afraid of medication, while it is scary, it can really help someone who is struggling from this.

    • Thank you for sharing, Joe. It sounds like you’ve been very proactive in your recovery. Great work!

    • ,,,,,

      • steven i m very much anxious and panicky from d obsessions i am having.i have obsessions that i m bound on this planet earth the gravity will not let me escape.my mind says “Escape” n surely when i cant, the pnic starts,this thought is making me insane from the last 15 years.what can be the E&R prevention for it?

  9. During a short-term consultation with a psychiatrist/MD, I was told that I am “in the realm” of OCD (she phrased it as, “mental compulsions are compulsions, too,” but did not specifically mention Pure-O). I identify strongly with most of the Pure-O Mental Compulsions listed above. It is a bit of a relief just to see them written in black and white.

    My OCD does sometimes revolve around common themes (i.e. Do I really love my partner? Thinking unwanted sexual/violent thoughts, etc.), but most of the time I am obsessed with thinking about whether I have done something “bad” or that things I have done can be put into a “bad category.” I have a really difficult time distinguishing between normal or ok actions/thoughts and those that are not ok- I know right from wrong, but I always question my actions and wonder if other people would label me as something bad. For instance, I took an online sexual assault prevention course for my college, and have now become obsessed with whether or not my actions within my relationship can be considered “sexually abusive.” Is what I have done ok or normal or does it cross the line and now I am an abuser? Another example: If my boyfriend smoked pot in high school, does that mean that he is a “drug user,” and is like a “drug dealer” you see arrested on the news, or maybe even in the same realm as the cartels in Mexico? Etc.

    I wonder if anyone else has these types of obsessions.

    • Google for the website “The Other OCD”. I found it really helpful.

  10. steven i m very much anxious and panicky from d obsessions i am having.i have obsessions that i m bound on this planet earth the gravity will not let me escape.my mind says “Escape” n surely when i cant, the panic starts,this thought is making me insane from the last 15 years.what can be the E&R prevention for it?

  11. does any1 has obsession like this one?

  12. hi , thanks for your helpful paper . we need more knowledge about the pure o . because it is a rare kind of ocd . i am in iran , and here there is few doctor that knows about pure o . they only do medication . i use medication know , and feel better , but when i get stuck in my compulsive thoughts , i do not know how to save my self , and i go with these thought . plz help ! i do not know what should i do .i have obssesion about doing sex with my family member . i want to reassure myself that these though is not true , and i have no interest to do it . but after a while i can not ressist and i ask my self , “what if i realy have interest to do it ” and i answer “no, i have no intrest , having sex with my family is wrong , and i will never do it” and he ask one question that i can not answer , and here my anxiety began , my ocd says” why it is wrong ? ” and what ever i answer , he does have an answer too , and at the end he beat me , and i ask myself ” he is right , why having sex with family member like sister and mother is wrong ?” and i have mo reasonable answer that satisfy my obssesion though , and after these conversation my anxiety going to kill me ! what should i do ? how should i treat with my thought ? plz answer , thanks .

    • If you haven’t seen my article on sexual obsessions, feel free to check it out. In general, back-and-forth dialogues with OCD are unhelpful. In most cases, these conversations represent figuring out rituals that strengthen OCD over the long term. Moreover, you can never really win these debates because they tend to focus on objectively unanswerable questions. One strategy is to sidestep the question entirely by not participating in the conversation. Another is to agree with the unwanted thought and let it pass through your mind without holding onto it and without letting it affect your actions. When you reach the point that the unwanted thoughts don’t evoke a strong emotional reaction, you’ll be much less bothered by your symptoms.

      • thank you doc for your time and for your attention .

      • I have a similiar problem. And had pure O problem in the past.
        Steven can you recommend the best self help book for “pure O” OCD?
        What is the best approach to treat pure O?

  13. I do every single one of those in one form or another…

    At least I know what I have, but I still don’t know how to fix it…

    • It is critical to practice response prevention, which is the most important skill in your arsenal. Other articles on this site talk more about ERP, which is the most evidence-based treatment for OCD. You should also read my reply to the comment above yours, which mentions two possible strategies.

  14. I have severe pure o ocd and I am treatment resistant. I wish there was a way to effectively treat my symptoms and a lot of them are like the ones listed above. I am still searching for a combination of medications that may work. these include medications for treatment resistant cases.

    • Many quality research studies have shown that behavioral therapy (consisting of ERP) is superior to medication for the treatment of OCD. A combination of medication and ERP may be especially helpful in your case. If your symptoms haven’t responded to traditional outpatient therapy, you also might want to consider an intensive outpatient program (IOP) for OCD.

  15. Hi Dr. Seay,

    I’m a 20-year-old female, and I believe that I might have Pure-O. However, I’m not sure my university’s counseling clinic will understand. Do you have any recommendations for OCD specialists in central Florida (namely the Orlando area)? I’m a bit scared to get an official diagnosis, but I know if I want to get better, I have to know the truth. Thanks so much for any information you can give.

    Lauren

    • Last time I checked, I wasn’t able to locate any OCD specialists in Orlando. Your best bet is probably to try the university clinic (in the absence of a suitable recommendation from ocfoundation.org). You could also consider remote therapy options like Skype- or telephone-based therapy… However, those options may not be ideal depending on the specific situation.

  16. Hello! Thank you so much for a great blog! I suffered from OCD as a child and in my teens (fear of AIDS and of harming others, scrupulosity, emotional contamination ++) and wonder if my present struggles might be related to OCD… I’m very afraid og being rejected by others/that they won’t like me, of being unworthy of love and of being a mean person. I can get panic attacks. I have the habit of seeking reassurance from my husband (I retell what happened in detail and need him to “release me” of my guilt and fear). This feels very much like a compulsion. My craving for love and affirmation and fear of rejection is making one of my relationships really hard. Could clinging to a person be a kind of a compulsion? Lately I’ve become confused about what are my true feelings and needs and what is OCD…Have you ever heard of anyone being obsessed about having their value as a person affirmed? I wonder how I should relate to what appears to me as real emotional needs but could be OCD in disguise. Thank you.

  17. I have a friend who suffers from ocd and depression. Recently her condition has taken a toll for the worse despite being on celexa 60mg and wellbutrin. She is seeking out therapy and I really hope this will help her. AFter reading all the mental compulsions, I see that she does almost every single one of them. She is constantly trying to talk to me and seeking reassurance. I tell her that I will not answer her questions, or that I have answered it once and will not do so again and it just leads her to get more anxious and frustrated and usually things end with her crying or having to take a sedative. She was diagnosed and hospitalized 3 years ago and had been doing really well until recently. What can I do to help her? She is a very intelligent high functioning individual but I am scared with the onset of her recent symptoms her condition will deteriorate. Moreover, she has moved to a new city and has not been able to find a good psychiatrist that she trusts. I would appreciate your help and suggestions.

    • She might benefit from reading some of the self-help books on OCD that discuss mental rituals and the role of reassurance in maintaining symptoms. If her OCD is significant, though, she really should work directly with an OCD specialist. Check out ocfoundation.org for providers in her area.

  18. Hello Dr. Seay,
    I have a few doubts regarding pure-o. For about a month, I was extremely afraid whether I was a gay or no. Very similar to sexual obsessions. However I came to know that sexual orientation cannot be changed, and since then I am not afraid of the thought. Today, I won’t even mind if someone calls me a gay.The fear has totally disappeared. I also had a schizophrenic and cancer obsession, which didn’t last more than a day. Again, I am not afraid of that thought either anymore. Today , the only thought that concerns me is whether I have pure-o or no. Please help.

    • Hi Sam,

      It’s great that many of your worries have eventually faded. If you’re worried about Pure-O, I would suggest scheduling an evaluation with an OCD specialist who can help determine what’s going on and offer treatment recommendations (if necessary).

      All the Best…

  19. A poem I wrote about Pure O OCD before I realized I even had it. I thought I was on the verge of going insane. The poem metaphorically expresses the damaging cycles of rumination.

    The angel stepped forth from the light
    To simply explore, to navigate the night
    He raised his eyes, gazing the dark sky
    To take an ascent, and look on from high

    Dashing through dark, he flew far
    Inhaling the night, and tasting stars
    Swerving through skies and hazy clouds
    Riding the winds, flying proud

    His curiousty now fully in amends
    It was time his journey was at an end
    One last gaze into the dark
    He turned to regretfully depart

    What occured next, he never dreamed
    Never again, to see what he had seen
    Echoing through the skies, his own scream

    After a thousand cracks, the night shattered
    Shards falling, leaving wings battered
    His flight pierced, torn to bits of matter

    Fallen, he was broken and bent
    And while he tearingly began to repent
    A fiend stood over his finished limbs
    Glaring down hatefully, expression grim

    As the creature looked on,
    A realization slowly had dawned
    Realizing the familiar complexion,
    What he saw had been his own reflection

    He lay there in the black trench,
    Smelling death, a familiar stench
    So he died, once again
    Dead, all along he had been

    He found himself in the light
    Ignorantly curious, wanting flight
    Wondering, how would dark suit his sight?
    He then cackled away into the night

  20. Hi Steve, to be honest: your article made me a panic a little bit more about my POCD. Why? Because it sounds like there’s hardly good psychologists who can treat this, and treating it is very hard to nearly impossible… If i read correct, what works best is try to work on the response mechanism in your head that goes off? As in: let the bad thoughts in, give ‘em a cup of tea and show them the door in a gentle way, instead of obsessively trying to close the door or kick the thoughts out?

  21. Hi Steven,
    My wife has been diagnosed with OCD and have read the above I would say it is more likely to be Pure O as she does not have any behavioral issues it is all in her head which mean unless I ask her what she’s thinking she generally keeps it to herself and suffers in silence. She is currently on Zoloft (150mg @ 1.5 a day) which certainly helps with it but does not rid her of it all together. She is a well educated, intelligent woman who knows that her thoughts are irrational but cannot help but indulge in process such as counting or reciting countries in alphabetical order. Her main thought patterns revolve around harm or death becoming family and loved ones (particularly when it gets close to their birthday) but a recent miscarriage and the discovery (and safe removal) of a melinoma

  22. (sorry hit the wrong button)…have her obsessing about her own health. Sorry to ramble there, in short i just wanted to know what the best thing is that I can do to support her. at the moment I try to take her mind of things by changing the subject or distracting her mid conversation with some silly behavior. I don’t want her to think that I am ignoring her thoughts and concerns but at the same time I don’t want to feed the negative thoughts. I myself suffer from depression and when it’s bad I can have repetitive negative thoughts but I get past them so it hurts & and upsets me to know that due to the very nature of OCD she is not able to get past these thoughts and I just want to know the best possible thing I can do to help her best deal with it.

  23. As the Mom of a daughter who struggles with OCD/Pure-O, I just want to let all of you know that my heart goes out to you. I walk this walk every day with our daughter and I know first hand the pain, the shame, the fear and the emotions that you and your families are going through. I commend you for seeking help and for just being able to talk about this with someone. It is the first step and it is extremely difficult to talk about things that seem so “out of the norm” for most of us. I was devastated to learn of our daughter’s struggles with Pure-O and frustrated to learn that there are few specialists experienced to help and that most do not accept insurance at all. Our daughter was born with medical problems and has had 12 operations to date. We struggled to make ends meet on one income and with medical bills piling up, we are so far in debt we will never recover financially. The only way I could help our daughter was to read, research and immerse myself into finding out everything I could about Pure-O. I couldn’t discuss this with anyone because I knew they would never understand. I did find a therapist that worked with my insurance and although Pure-O was not their specialty we worked together to help my daughter. I emailed specialists from all over the country for advice. I created my own therapy sessions at home. I encouraged our daughter to talk about her thoughts and kept the lines of communication open no matter how horrible those thoughts seemed to be. Our therapy involved knives and our daughter’s thoughts of stabbing me. I clearly remember the pictures she drew of me sitting right where I am now, the knife in her hand and the blood dripping. The sexual nature of her other thoughts were horrifying especially for such a young girl. So many thoughts, rituals and worries to deal with. I can only imagine how hard it was for her to tell me the things she was thinking(and still does) and I am so thankful that she trusted me. She was released from therapy but she still struggles every day and I am doing everything I can to help her. We live paycheck to paycheck and cannot afford to see a therapist. I have wondered many times how other patients and parents have dealt with this. I carried our daughter into the operating room many times but I can tell you that her operations were a piece of cake in comparison to OCD & Pure O. I need therapy from the therapy. It is no wonder people don’t reach out for help. Besides the nature of the thoughts, how is everyone affording this? I lay awake many nights and I have cried so many silent tears. I have no one to talk to about this. My husband is having difficult dealing with it. I worry about our daughter’s future. She has been through more than any child should have to deal with. It is interesting that the person that she relies upon the most(me), is the same person most of her thoughts are geared toward but I will never waver and she will always be able to count on her Mom. I just needed to vent and to tell you all that I relate and understand and I admire your strength and courage to seek help and discuss such difficult subject matter. You are stronger than you think.

    • I am so sorry to hear about your daughter. My heart goes out to her! I have battled OCD since early elementary years and now I am a mom of 2 and happily married! I also went through a major surgery at 13 and OCD is so much harder! Hang in there! There is hope and I pray your daughter learns how to manage it so she too can live a happy life. My mom was there for ,e every step of the way too. Without her and my relationship with Jesus and my mentor/coach, I know I wouldn’t be where I am at today. Just know that your daughter CAN learn to identify the symptoms and take control of her thinking. Best advice for her: no matter how real it feels, it’s OCD! Hope that helps.

  24. I do most of the things on that list. Do you have any advice?

  25. 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.

  26. Hi,

    I can’t know for sure that I have pure-O, but I’ll try to tolerate not being able to find that out. Nevertheless, I’ve found many OCD symptoms relatable, also do I find pure-O compulsions familiar, but then again, some type of rumination and never reaching the ‘right’ or satisfactory answer that would eliminate anxiety seems humane, not necessarily a symptom of a disorder. But, we can of course judge things in degrees and severity, which changes the big picture.

    I’ve had some observable OCD compulsions that I overcame and dealt with some of the obsessional fears. But then, focusing fully on OCD, I became afraid of this disorder itself, especially of pure-o. Pure-O themes (except for health-related fears) seemed pretty unimaginable for me to obsess about in the past…….so I once ‘checked’ myself on one of the theme such as incest on whether I was resistant to such an obsession. The thoughts and images just freaked me out. Since I then had fully believed to be prone to ANY obsession, the incest-obsession fear did become my obsession for a while. Same thing happened with HOCD, because of certain triggers, I got this doubt on my orientation and my belief in disorder kinda helped it flare up into HOCD. Now I fear developing other obsessions that I’ve read about. Do you think ‘checking’ the proneness to this or that obsession is a compulsion and if yes how do I resist it? Because, the ‘compulsion’ happens to turn into an obsession if not stopped at a right time. Hope I made sense.

    Hardly anyone knows about pure-O in my country, so self-diagnosis and the realization of needing help won’t change much. But I think the advice given to pure-O sufferers can be used even by people who don’t suffer from disorder but have some anxiety and problems with worries and managing their thoughts, so there will be no harm anyway in applying techniques. But I just fear that if I apply ERP to some of my compulsion-arisen obsessions, this will itself become a part of the compulsion.
    Like, if incest-obsession developed out of “having pure-O/developing pure-O obsessions fear”, would applying ERP to incest-obsession and checking if it works, be a compulsion to the primal obsession? :) Once again, I hope it makes sense :D

  27. Is compulsively talking to someone in your mind when you worry about something a form of pure o? Like imaginary conversations that are compulsive in nature.

  28. yes i got all this symptoms and i am taking floxtenine 20 mg daily dose and it control the things but when i try to lower dose the obsession increase , i have tried CBT many times and it help but i wanna cure it completly , shall i stuck on 20 mg for the rest of my life ?

  29. Hey I’m here because I think I have HOCD, I’ve never thought about being with a man in my life but recently something inside my head just keeps telling me I’m gay I’m gay over and over, I watched some some gay porn but I didn’t get hard I’m in a relationship which is even worse because every time I’m with my girlfriend the thoughts in my head tell me I’m faking this which causes my erections to fail, I guess being gay wouldn’t be bad but I just don’t feel gay I mean even though my mind tells me this over and over I still get aroused when with my gf and whenever I think of other guys I just can’t get erections any tips ?

    • Hey deshuin, have you taken an Antidepressant or any other meds the time the HOCD started?

  30. Mann OCD is one crazy illness. I think mine started when I was young because I can remember always obsessing about thinking my parents are going to die in a car accident and this gave me really bad anxiety as a 10 year old. Then in highschool I would obsess over my body and think that I have developed cancer and would go to the hospital. I would be constantly checking my heart beat all the time thinking that I was going to have a heart attack. Then at age of 18 I developed HOCD which I didn’t know about at the time and I thought I was in some gay denial when I know that I was attracted to girls and would hook up with girls and feel pleasure from it. I just couldn’t get the disturbing images out of my head and would do mental rituals which I was unaware of at the time. finally 3 years later at the age of 21 I finally got help from a psychiatrist because I started developing all kinds of sexual themes like incest, and pedophilia and still HOCD which was causing me significant anxiety that I couldn’t deal with anymore. I’ve been on a newer SSRI and its starting to help with the intrusive thoughts and images but I think i’ll still need cbt therapy. My words of wisdom is if you have any of these intrusive thoughts and images, especially about your own sexual orientation and its giving your severe anxiety, nightmares, self doubt and just plain being disturbed I would seak out help to a trained dr. who knows his stuff. Just remember your not really gay, a pedophile, or like incest. Its your mental disorder tricking you and making what you fear the most become and irrational reality.

  31. Thank you so much. This helped beyond description, the past several months have been kinda hellish OCD-wise. Many things going on I figured were rare OCDs, but wasn’t sure. This article pretty much confirmed they were, and I thank you from the bottom of my heart. Now the work begins!

  32. Thank you Dr. Steven for your articles, I have had ocd since I was 15 with the themes changing overtime and some coming back on the surface again. Now am suffering of pure ocd related to religion and sin as I am thinking so much about some issue related to money that should be halal.somtimes I say to my self this is just my ocd and not me, but I have even read in an article that one should not say it is just ocd, but rather accept the uncertainty.I am seeking your advice. Thank you :)

  33. Ocd is an evil, insistent, horrible thing. It keeps adapting to whatever I try to do. I can barely even write this without it interfering. Leave me alone!

  34. I thought my ocd was pretty much under control until It was time to get my period now I feel like it is full force. I was curious how to tell if the thought is a pure o one or if there is something seriously wrong with me. I had a what if thought that has truly been making me miserable and I can’t seem to kick this one . Can you please help :)

  35. Hi dr. I know this post is fairly old but I was hoping to still get a response because this article seems very informative. I am currently seeing a psychologist but she does not have much experience with OCD quite obviously. I currently suffer from many different themes of violence and the pedophelia. I constantly fear I will hurt people and or my loved ones. I will hear about a killer on the news and fear that I may be like them or become a killer. I am very afraid that I actually want to do these terrible things and that I will actually do them. For instance if I’m holding a knife I will get an “urge” and have to put it down and walk away instantly due to fear of losing control. I am in constant fear of losing control in different areas but this gives me the most anxiety. Does this still sound like OCD? Does ocd progress into other illnesses? Thank you.

  36. This is exactly what I have. Wow. I’ve been in therapy for 5 years and it hasn’t helped at all but we never made a distinction b/w ocd and pure-o so I’m going to print it out now. CBT hasn’t helped and I’m not sure what you suggest would help. I am severely chronically ill so all of my fears and obsessions surround my illness. For example they are all based on: not sleeping, not resting, and my bladder (very very severe IC). Every day something new makes a connection to my bladder, I hardly get any sleep. On top of this, I have a diagnosis of: Autoimmune encephalitis, Chronic fatigue syndrome, POTS (dysautonomia), complex regional pain syndrome, Interstitial cystitis, and more. What do you do if your fears and obsessions are quite valid? I’ve dealt with my bladder problems for 20+ years so it seems only natural the ocd latches onto it…….. Eliminating my bladder as a problem would relieve so much ocd. Medication doesn’t help. I’m receiving immunotherapy for AE but hardly can sleep or rest even though I have deathlike fatigue and am incapacitated. Resting is a nightmare, all I do is ruminate and “battle” the new obession of the day…….. constant, battling, battling, thoughts, thoughts. I ask my mom lots of questions to try and alleviate the obsessions.

    • Also want to mention that I’m too sick to go to any intensive ocd program, some days I literally cannot get out of bed. I am mostly bedbound, housebound, only leave for appt’s and I have severe post exertional malaise after doing ANYTHING EVEN a shower. So what am I supposed to do about treatment?? Also, I have excessive daytime sleepiness so in appt’s I have not been able to keep my eyes open or I was too fatigued to talk about what was going on.

  37. Pure O mom- I read your post and almost cried. If I hadn’t known better I would have sworn I had written it. I know exactly what you are feeling and how much your daughter and you suffer. I have a son who sounds exactly like your daughter. He has had medical problems since in birth and suffers from Pure O. His intrusive thoughts are all over the map, but most revolve around harming me or my husband. Some are quite simple like-I though a cuss word about you-or -I think i moved my foot to the left to trip you. But he also has intrusive thoughts involve stabbing, or pushing in front of a car etc. They are very distressing for him, and he constantly wants to confess them to us and get reassurance.
    It is an exhausting disease that few people can understand unless they live it. I know for me there have been days where I literally did not know if I can do this for the rest of my life. We are trying meds and looking for a therapist but are having trouble finding a good one. You are right, Pure O is not something you can discuss with most people. There are even family members who do not know because we know they will not be able to “handle it.” I feel so alone sometimes and at the end of my rope trying to help my son but also exhausted from helping my son. I have seen him go from a happy, silly, witty, fun loving kid to someone who spends most of the day battling his Pure O.
    If you ever want to talk or vent you can get in contact with me. I would love to know how you and your daughter are doing. I just wanted to let you know there is someone out there who knows the stress a parent of a child with Pure O have.
    Take care!

  38. I just returned home from vacation and received a notification that someone replied to my post. Her son is struggling with Pure-O and she totally related to my situation. When I clicked on the link her post is gone. I don’t know who she is or how to contact her but wanted her to know that I saw her reply. If you see this please post again. Thanks!

  39. I have tips to deal with HOCD for you. I’m dealing with HOCD and incest, pedophilia themes right now. I’ve been dealing with it for 3 years but finally got help for it at the age of 21 and I just got diagnosed recently. My suggestion would be to get on an SSRI and go to CBT therapy. I still need to go to therapy but i’m only on an SSRI right now and its starting to help. Just keep telling yourself that its just the illness and you no that you are really not gay. People become gay when there young so its impossible to just become gay out of know where. OCD likes to mess with your mind and I feel you on this one. Just remember that this is an illness and you should be fine. Mine all started when a friend said that he thought I used to think I was gay and that got stuck in my head and that’s when the obsessions started. Totally irrational.

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  1. Down the Rabbit Hole with Pure-O (Pure Obsessional OCD) | Cupcakes and Whimsy: The Journey to Mindfulness - [...] O is a lesser known manifestation of the disorder (explained here by Steven Seay, PhD and in this blogpost …

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