What is Pure OCD?


– Carolyn Moriarty, LCPC


Pure Obsessional OCD (often called “Pure OCD” or “Pure O”) is among the many subtypes of obsessive-compulsive disorder (OCD). Before looking more closely at this particular subtype, let’s do a quick review of OCD.

OCD is characterized by the presence of disturbing thoughts or images (obsessions) that are intrusive and unwanted. As a result, people with OCD feel driven to engage in repetitive mental or behavioral acts (compulsions) that help them to feel that they are preventing a feared outcome.

These compulsions are effective in the short-term because they can immediately extinguish intense guilt, shame and anxiety. However, the relationship between obsessions and compulsions is cyclical, with one only serving to reinforce and perpetuate the other.


What is Pure OCD?


Individuals who fall under the Pure OCD subtype experience the same type of intrusive and distressing thoughts seen in other forms of OCD.  These thoughts can be disturbing, irrational, or violent and are often accompanied by significant anxiety.

The key difference is that individuals with Pure O typically do not engage in outwardly visible compulsive behaviors (such as “checking”). Instead, they may engage almost exclusively in internal, mental compulsions and rituals that cannot be observed by others.

Examples of compulsions that are performed mentally include:

  • excessive rumination
  • mental review (excessively replaying a situation over and over, in hopes to find “new” information
  • mental neutralizing: engaging in mental rituals or behaviors to counteract a distressing thought. This might involve:
    • mentally repeating certain phrases
    • counting
    • thinking of a positive thought/image to neutralize a “negative” thought/image.
    • performing other mental rituals to reduce anxiety.

People with Pure OCD may also

  • avoid situations or triggers that provoke intrusive thoughts to prevent the discomfort they cause.
  • experience high levels of anxiety, distress, guilt, or shame, affecting daily functioning and quality of life.


Treatment for Pure OCD usually involves:


Exposure and Response Prevention (ERP)

  • ERP exposes a person to a stimulus (i.e. person, person, thought or memory) that produces anxiety or discomfort. Throughout the exposure process, the individual is encouraged to actively resist engaging in their typical response to that trigger. This allows people to learn that their feelings of discomfort and doubts naturally subside on their own without them doing anything about it.

Read more about ERP


Acceptance and Commitment Therapy (ACT)

  • ACT is an additional treatment modality that can be incorporated into OCD presentation. The intolerance of uncertainty is very common for people struggling with OCD, and acceptance can be an integral part of treatment by learning how to tolerate feelings and thoughts that may have once seemed unmanageable. Instead of trying to fight off compulsions with rituals, ACT helps guide the person towards acceptance of thoughts and feelings as part of the experience of life.ACT works to help teach the individual that these compulsions can come and go rather than getting stuck.

Read more about ACT


  • Medications like selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help manage anxiety and obsessive thoughts.

Read more about medication for OCD


Seeking Mental Health Support

Schedule an appointment with Chicago Counseling Center . Our therapists specialize in OCD and can develop an appropriate treatment plan tailored to your specific needs. — Meet our team to learn more!


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