‘‘Pure O” OCD signs and symptoms
by : Katherine Pica LCSW
Are you constantly worrying about something bad happening? Do you often feel really anxious and review past situations? You may feel like your mind is on a constant hamster wheel. This could be signs that you are experiencing OCD in a form called Pure O. Let me explain further and break it down!
What is Pure OCD?
Pure OCD is a form of OCD where there are intrusive thoughts, images and there are no visible physical compulsions or rituals performed. Pure OCD is a type of OCD that has obsessions “Pure Obsessions” and no visible compulsions. We used to call this Pure OCD because we thought there were no rituals attached to it. However now we realize that there actually are rituals they are just hidden. The rituals though lie in the mind and overthinking.
What is OCD?
First of What is OCD? OCD is a mental health disorder that affects about 2% of people in the US. It affects people of all different ages. When struggling with OCD there are most obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that cause distress. Compulsions are behaviors or mental acts that an OCD sufferer will do in order to get rid of the obsessions or distress.
What are obsessions in OCD?
Obsessions are thoughts, images, urges or impulses. These usually last less than a second. For example, what if I go crazy and hurt someone? What if there are germs on this counter? Obsessions can lead to anxiety, feeling overwhelmed, frustration, disgust or a sense of dread. Obsessions are unwanted, upsetting and intrusive. They come unbidden and are uninvited. Obsessions may go against one's wants, desires, moral codes, self image or character. They often can go against your values. Obsessions are the initial thought or image that pops into your head. OCD will latch onto the obsessions and then will want to do compulsions in response to make the obsession feel better in some way.
What are compulsions in OCD?
A Compulsion is any behavior or mental act done to try to neutralize the uncomfortable feeling or distress from the obsession. They seem urgent. “I must wash my hands, I must retrace my steps.” Compulsions often can be very time consuming and take over your life. Compulsions are trying to remove any doubt or uncertainty. “ If I just wash my hands I will be ok.” Most people with OCD suspect that the compulsions are not really realistic however they still feel compelled to do the behaviors or mental acts.
Many with OCD feel like compulsions are out of their control. “I must wash my hands, I must retrace my step, I need to tap this until it feels right.” There are 2 types of compulsions Physical compulsions and Mental Compulsions.
What are physical compulsions in OCD?
Physical compulsions are behaviors that are performed to try to make anxiety go away. FOr example: Hand washing, cleaning, checking, counting, repeating, retracing steps, ordering and arranging. ect
What are mental compulsions in OCD?
There are also mental compulsions. Compulsions are anything a person does mentally in an attempt to get rid of anxiety in response to the obsessions. Mental compulsions are mental acts or mental rituals are done to try to neutralize anxiety or to solve the problem, plan out for what if or trying to fix the situation. Mental compulsions are things done in your head in response to the obsession. An example could be analyzing the what if statements, analyzing past social situations.
What is the difference between an obsession and compulsion in OCD?
The obsession is the feared consequence. If this then that.. What if _____ happens. The obsession just pops into your head. The obsession is very quick, often described as less than a second. But the obsession introduces a sense of uncertainty, anxiety or dread. The mental compulsion is what is done to respond to the obsession, Maybe to answer the what if question. Compulsions in a nutshell are the response to the obsession. Here is the trick: we can't stop the obsessions but we can work on disengaging from the compulsions.
Pure O - OCD symptoms
Mental avoidance or thought suppression- Mental avoidance is trying very hard to not think about something. When you try to push something out of your head all you can do is think about it. (Unfortunately with this there is a rebound effect and it can make it come on even stronger.)
Thought neutralizing- replacing a bad thought with a good thought. Exp: I just thought of the devil now I am going to think of an angel. Or I thought of a cuss word now I will think of a good word.
Counting - Individuals with OCD might count how many times they brush their teeth and how many steps they have taken or how many times they turn the doorknob ect.
Tracing and tracking- This often comes up in contamination OCD where the person follows the contaminated item and follows it everywhere it has touched. Noticing all the items that it now has contaminated. I have heard it described as if they dropped an item in a bucket of white paint and now there is this trail of this item all over the home.
Mental Review- Reviewing things in the past. Exp: Did say something inappropriate , was I mean to that kid in middle school. This is a mental act of going back and try to remember the things. Sometimes this brings shame and guilt or embarrassment.
Future Review- Often people will compulsively play out scenarios in their head. This can look like imagining a future conversation or imagining a scenario in your head Mental images can come along with this one as well.
Mental Replay-Replaying the image of a past situation in your head.
Mental Image Checking - Sometimes this can come up in harm OCD where people will think of images to check their reaction to it. For example: Do I think of this image and see it as a bad thing and therefore it means I am really a good person. Or I am thinking of an image of driving off a cliff , well because I am feeling anxious then that means I really don't want to do it.
Emotional Checking- We like to call it checking the weather inside, or taking an emotional temperature. How do I feel today? How is my anxiety today? Is my OCD getting better , do I feel anxious? Is today going to be a good day?
Figuring it out- Often there are problems in our lives that are not solvable. This can involve thinking of a problem over and over trying to think about it in different ways to solve or figure this problem out. Here is the thing I tell people: If they can figure it out in less than 5 minutes then great , let's solve it and figure it out, and move on. However if this is a problem that if it can't be solved then this may be where OCD is coming into play. Also If you could have solved it by now you would have !
Mental Catastrophization - Thinking about the worst case scenario. Imagining the worst possible outcome. The difficulty about this is that when you start to imagine the worst outcome it starts to feel as if that bad thing is actually happening.
Mental Comparison - Comparing yourself or your relationship to others, or comparing you social interactions ect
Mental Rehearsal- projecting into the future about getting certainty about what will happen. If someone has moral scrupulosity and is afraid of offending someone, they may try to figure out what to say so they do not offend someone . Another example is going through a conversation in your head and thinking of different ways the conversation will go and how you will respond to it.
Mental Checking - going back in the past and mentally checking to see if you did something. Exp: For someone who has checking OCD , may be in bed and have the thought what if I did not lock my door. Instead of getting out of bed they may go over their checking routines their head. Reviewing the items someone has checked in their head.
Memory Hoarding - Focusing on a physical compulsion they are doing and keeping and storing that memory. Let's use the same example of someone with Checking OCD and and compulsively checks their locks at home , they might really focus on hearing the sound of the door clicking.
Compulsive prayer- praying to make sure something bad does not happening or that God will love you or you will be an authentic Christian.
Analysis - Trying to analyalize or figure something out . Here is the thing, maybe this problem does actually need to be solved but you are just thinking about it constantly! YOu have spent hours thinking it over and have not found a solution. (In OCD therapy there are special techniques we work on for issues like these. Just because you have OCD does not mean you can't solve it but we try to work at reducing the amount of time you spend on it.)
Scenario twisting- going back replaying a situation and replaying ways that it could have gone in a number of different situations.
Self Reassurance- I am going to be ok because this door knob is not that dirty. Or if you had harm OCD, i would never kill someone. Reassuring yourself that you are a good person.
Body scanning- Scanning through the body and checking to see if there is something wrong or a physical symptom and then hyperfocusing on that.
Mental repeating - repeating certain words or phrases to yourself
Self criticism - constantly repeating criticisms ( this can also be present in depressive disorders as well )
Mathematics - Repeatedly trying to figure out mathematics in your head. For example how much time you have to get something done or excessively figuring out how much money you have in your bank account. Reviewing the time and dates in your head.
Trying to solve or figure it out - If you have a problem that is not solvable in a few minutes and you keep going over and over it in your head.
This information was adapted from Hershfield, Spitalnick, & McGrath, GLOSSARY OF MENTAL RITUALS, nd.
What makes Pure O different from OCD?
With Pure O we see individuals mostly stick to mental compulsions and live their lives over thinking. As OCD therapists, after a thorough assessment sometime we may also find some physical compulsions hiding out as well. However the majority of compulsions are in the mental compulsion category.
OCD Therapy for Pure O
OCD therapy - Exposure and response prevention is very effective for all types of OCD even when we can not see physical compulsions. As an OCD therapist the first thing I teach my clients is to start to recognize the times you are doing a mental compulsion. Then you would shift your attention gently to something else. The OCD thought may still be there but we are not giving full attention to it. Over time you can get better and better at this. Over time you may even learn to resist scratching that itch and not even go towards a mental compulsion at all. This takes a lot of practice and in therapy there are certain exercises and tools that we go over that can help you learn and build on this skill.
How to find an OCD therapist for Pure O
When working with an OCD therapist it’s important to ask them how they deal with mental compulsions. We have worked with and have specialized training for OCD and more specifically how to deal with mental compulsions. In ou experience if we don't address mental compulsions then OCD has an opportunity to return.
San Diego OCD therapists trained in treating Pure O
As OCD therapists we teach people how to work with pure O and mental compulsions. There is so much freedom in this! If you are looking for help for your Pure O we are here to help. We have helped many overcome the grip that OCD has on their lives and can help you learns skills and tools too. Contact us today!
About the Author: Katherine OCD and Anxiety Therapist located in San Diego, CA
Katherine Pica is the owner and founder of Resilience Counseling. She supervises all the therapists at Resilience Counseling. She has been practicing since 2007 for over 17 years! Trained in ERP for OCD and EMDR for Trauma. Katherine brings years of experience working with OCD to you. Available in San Diego, CA for in person and all over California for virtual sessions
OCD therapy and other areas of treatment in the
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Disclaimer : The Content is not intended to be a substitute for professional and or medical advice, diagnosis, and or treatment. It is important to always seek the advice of your physician or other qualified health provider with any questions you may have regarding a mental health and/or medical condition. Never disregard any professional medical advice or delay in seeking it because of something you have read on the Resilience Counseling website. If you think you may have a medical emergency, call your doctor or 911 or local emergency number immediately.
