This is the first in a series of blogs addressing the Pure O branch of OCD as well as the unique challenges faced with Pure O.
In order to fully grasp the branch of Obsessive-Compulsive Disorder (OCD) ‘Pure O’, it is important to understand how OCD works.
What is Obsessive-Compulsive Disorder?
OCD is comprised of 3 important components:
They work together to complete the full circle of hell for suffering individuals. An individual will develop an irrational ‘obsession’, meaning a thought/fear/image disturbing and intrusive in nature. OCD is ego-dystonic meaning the origins of the intrusive thoughts or obsessions have nothing to do with the individuals’ character, morals, ethics, or personality. However, it is almost impossible for the sufferer understand this, so the obsession causes ‘anxiety’. The mind as well as the physical body reacts when anxiety is present exacerbating the irrational obsession. It is in this phase when the individual may question the obsession being OCD or not because ‘why and how would their physical body react if it really wasn’t something real and true?’
The simple but convoluted answer is: Because it is OCD
In response to anxiety, an individual will develop compulsions as a means to alleviate the anxiety associated with the obsession. For example: Hand-washing, organizing, ruminating, checking and rechecking, counting, or avoidance. While the compulsions will work short-term to relieve anxiety, they actually do more damage in the long run. A compulsion performed even once perpetuates the cycle and belief that ‘if I just do the compulsion ONE MORE TIME, it will prove or disprove something’.
Compulsions can last for hours at a time, rendering the sufferer unable to engage in normal activities. Days can turn into weeks, into months, and even into years. If left untreated, OCD can result in complete isolation or possible death by suicide.
Never mistake OCD for being a quirky or sought-after diagnosis. There is no such thing as ‘having a little bit’ of OCD. It is not ‘cool’ to refer to yourself or someone’s behavior as ‘so OCD’. This trivializes the extreme torment individuals suffer day-in and day-out and may cause them to stay silent out of shame and embarrassment.
What does ‘Pure O’ Mean?
‘Pure O’ was the term originally coined when patients were seen for intrusive obsessions/thoughts but no outward rituals were present. It was first believed people merely had obsessions vastly similar to the obsessions in other forms of OCD with physical compulsions. So, the condition was deemed ‘Pure O’ for ‘purely obsessional’.
Eventually, it became evident compulsions were present, however they were performed mentally.
A community of sufferers had formed by the time the name was called on to be changed due to its misleading description. This explains why some clinicians will actually say ‘Pure O does not exist’. While I understand the semantics argument, many of us adopted a title of belonging after suffering in silence for so many years that we don’t want to give that up. The feeling of relief and belonging was so poignant when I found out I was not alone with my obsessions, I could have cared less what people called it. I only called it the beginning of feeling okay about myself.
What are Pure O Obsessions?
Like any other type of OCD, the list of obsessions is not defined or limited by the norm. Never underestimate the imagination of OCD.
Pure O obsessions tend to involve sexual, violent, or blasphemous in nature intrusive thoughts. Their appearance is usually shocking to the individual when they occur. They are typically unwanted, undesirable, and the exact opposite in character and/or morality of the sufferer. While the average human being experiences intrusive and unwanted thoughts regularly, they are easily dismissed as odd, gross, or weird and one can go about their day. The Pure O sufferer will take the thought, dissect it, try to rationalize it, try to understand why it happened, doubt whether or not it really happened, fret over the idea that it did, and then worry because they are now worrying about it after it happened so that must mean there is truth behind it.
It is not uncommon for an individual to worry about one or several intrusive thoughts for years at a time, all the while keeping it secret from their family and friends. The secrecy comes from the shame, guilt, and embarrassment about the nature of the thoughts. While the thoughts are not true, real, or a reflection of the individuals morals or character, they will assume responsibility for the thought because OCD will not allow one to ‘prove’ or ‘disprove’ the validity.
I work as a coach and peer support for Effective OCD Treatment in Denver, CO with OCD Specialist Matthew Myles. Matthew treats the Pure O branch of OCD often and some of the most common intrusive thoughts include but are not limited to:
- Fear of becoming a violent murderer
- Fear of turning gay
- If gay, fear of turning straight
- Fear of committing or wanting to commit incest
- Fear of bodily fluids including but not limited to vomit, blood, semen
- Fear of becoming a pedophile
- Fear of having an attraction to a religious figure
- Fear of becoming possessed by Satan or selling soul to Satan
I believe there is no need to explain why one would experience shame, guilt, and embarrassment when dealing with these types of obsessions.
What are Pure O Compulsions?
While some individuals my have outward compulsions when dealing with Pure O obsessions, typically the definitive characteristic of Pure O is that the rituals are mental and often undetectable to outsiders.
In my experience, I made a conscious effort to hide my compulsions out of fear someone may see me as ‘odd’ or ‘different’ and then possibly pick up on my horrible obsessions. My life not only became wrapped up in ‘proving’ or ‘disproving’ my sexual intrusive thoughts and scrupulosity, but it also became a full time job to disguise my secret world from everyone around me.
It isn’t uncommon to spend time with an individual who is suffering with Pure O and never suspect they are avidly engaging in ritualistic behavior the entire time.
Pure O sufferers learn to become incredible real-life actors.
Oftentimes, individuals with Pure O do not even know their behaviors are compulsions. The rituals become part of everyday life with the intrusive thoughts. The compulsions are born out of a need to find out whether or not the unwanted thoughts are valid or if the person could possibly be capable of the obsession called into question. There is no definitive answer in either direction, leaving the sufferer completely exposed to a lifetime of compulsions with no permanent relief or satisfaction.
Mental rituals serve the exact same purpose the physical ritual does, however the only difference is it is in the mind and can be hidden from view almost at all times.
Common compulsions individuals with Pure O experience but are not limited to are:
- Avoidance; Avoiding people, places, objects, situations, events, etc
- Rumination; Attempting to solve an unsolvable question in one’s mind
- Prayer Rituals/Mantras
- Seeking Reassurance; From others or informational sources (Google, etc)
- Mental counting/checking
- Memory checks; Associating a memory with feelins
There is no limit to what one will do to eliminate the anxiety associated with Pure O obsessions.
I think I have Pure O, what do I do now??
While having Pure O is hardly good news, there is effective treatment options for Pure O as well as any type of OCD. While many tactics are used to ‘manage’ symptoms, Cognitive Behavioral Therapy/Exposure Response Prevention (ERP) with or without medication is the proven method of managing Pure O symptoms and living successfully with this illness.
Before you start jumping up and down and waving your hands in the air with excitement, let me preface with something. ERP is effective ONLY if you give 100% effort and commitment to the therapy. It is incredibly hard work. You are not only challenging your Pure O symptoms, you are also challenging your thoughts and behaviors you have lived with for a very long time. This can be daunting to find out when you meet with an OCD specialist for the first time. You may be thinking you will go into the office and he/she is going to just take it all away, but that is the opposite of how the therapy works.
ERP is designed to challenge the fear and anxiety by understanding how it acts and reacts with your mind and body. You will then learn to condition yourself to the feeling of anxiety and challenge it by desensitization. This requires much effort, trust, and faith in the process and the therapist.
Through the therapy you learn to recognize intrusive thoughts, triggers, and how your body reacts. It becomes a road map for your journey to recovery.
ERP was hellishly difficult for me, but I was willing to do anything and everything by the time I found out my real diagnosis of Pure O. I didn’t want to live under OCD’s rules anymore. I successfully eradicated my sexual obsessions in under 3 months of ERP. It was scary and challenging, but worth it.
If you are thinking ERP probably works for everyone else, but it won’t work for my Pure O…you are not alone. That is a common thought and fear when contemplating and entering therapy. I will address this fear and other unique challenges of Pure O in my next blog about ‘Understanding Pure O; The Peer Perspective’.
If you are looking for an OCD Specialist in your area, please contact www.iocdf.org for recommendations and therapists who practice effective treatment for OCD.
Mental Health Advocate/Public Speaker; Peer Support Specialist/Behavioral Healthcare Inc/Institute at Ft. Logan; CBT/ERP Coach and Peer Support/Effective OCD Treatment; Crisis Intervention Team Presenter/Denver Police & Sheriff Department; Blogger at ‘Mental Health at The Mighty’