When most people think of obsessive-compulsive disorder, or OCD, they think about frequent hand washing, constant counting or preoccupations with symmetry. A less well-known form of OCD known as pure obsessional OCD, also known as “pure O,” is defined as experiencing obsessions without visible compulsions. Although it is less visible than other forms of the disorder, it can be just as dangerous or debilitating.
Most people have experienced an occasional, unpleasant, involuntary thought or mental image. For instance, a person might envision stepping off of a building or pushing a friend into traffic. For the average person, this thought is discounted and quickly vanishes. For people with pure obsessional OCD, however, their brain chemistry prevents them from letting go of the thought. Instead of pushing it aside, they obsess over it (hence obsessive-compulsive disorder) and let the thought define their identity. They wonder: If I’m the type of person to think about this horrible thing, am I also the kind of person who would do this horrible thing? These intrusive thoughts begin to overtake their daily life, leaving them guilt-ridden, anxious or even suicidal.
Common obsessions in people with pure obsessional OCD include:
Some people with pure obsessional OCD fear that they might be gay or become gay. Individuals with this particular obsession might compulsively check their body to find evidence that they are not sexually attracted to the same sex. They might completely avoid members of the same sex. This form of OCD is distinct from someone who is gay but does not want to admit it. People with sexuality obsessions are typically straight.
Individuals with violent obsessions might fear that they will hurt themselves or others. They experience intense thoughts about self-harm or suicide despite having no desire to hurt themselves. Others, meanwhile, are convinced that they will eventually snap and hurt someone close to them. Some people are afraid that they might be pedophiles. People who have these intrusive thoughts might be afraid of using sharp objects, such as cooking knives, or avoid spending time with loved ones. It should be stressed that people with these obsessions are not violent – in fact, they’re so afraid of hurting someone that their own life suffers.
People with religion-based obsessions are afraid that they will commit a sin or do something “impure.” They might constantly pray for forgiveness, attend church or perform religious rituals. People with this form of OCD are often convinced that they are destined for hell or damnation. This disorder is distinct from extreme religiousness because people experiencing these obsessions are fraught with anxiety about their beliefs.
People with relationship obsessions are afraid that they don’t actually love or care about their significant other. They might “test” themselves by flirting with other people or going to locations where other people will flirt with them. They might frequently break up (or think about breaking up) despite being happy in a relationship.
Some people might have none of these obsessions, whereas others might have symptoms that fit within all categories.
Pure obsessional OCD can be particularly dangerous because it doesn’t look like the OCD that is portrayed in the media. For this reason, people with pure obsessional OCD don’t always recognize that they have a disease and, therefore, do not seek treatment. People with this disease are also deeply ashamed of their thoughts – think they’re crazy, impure or a murderer waiting for an opportunity – and avoid telling other people. Pure obsessional OCD is a serious, potentially life-threatening condition that requires immediate treatment. Antidepressants and therapy can significantly reduce symptom severity and improve a patient’s quality of life.