What is Pure Obsessional OCD?
Pure Obsessional OCD, or Pure-O, is a form of OCD in which individuals report that they experience obsessions associated with OCD without any observable compulsions. Rather, the individual experiences obsessive and intrusive thoughts or mental images in which the individual commits immoral acts against others seemingly without any compulsive reaction to these obsessive thoughts. Sufferers of Pure-O find their intrusive thoughts to be abhorrent and experience extreme difficulty talking about their experience as it involves confronting their worst fears and intense feelings of guilt and responsibility.
What are the symptoms of Pure-O?
The symptoms of Pure-O vary greatly across individuals, however, some of the common symptoms include:
- Recurrent, intrusive thoughts of physically assaulting or killing one’s family members, friends or others or acting sinfully.
- Repeated worry about hitting another with a vehicle.
- Fear of accidentally causing harm to someone.
- Excessive worry about one’s sexuality or molesting a child.
- Worrying excessively about one’s romantic relationship.
- Worry about having said or written something inappropriate.
- Repeated worry about somatic sensations that are not indicative of a problem.
- Persistent thoughts questioning the nature of self or reality.
What treatments are available?
Exposure and Response Prevention
In recent years a type of Cognitive-Behaviour Therapy (CBT), known as Exposure and Response Prevention (ERP), has proven successful in the treatment of Pure-O. This therapy teaches clients how to face their fearful obsessions and identify the presence of compulsive and avoidant behaviours maintaining the obsessions and to challenge this behaviour. Often Pure-O sufferers have difficulty identifying associated compulsive actions due to the absence of any outward sign of a compulsion. These difficult to identify compulsions are covert in nature and may include a compulsive need for reassurance that the individual is in control or an avoidance of anything that may threaten this control (such as the person the thoughts are about or sharp tools). Once a Pure-O sufferer has identified that they do, in fact, experience compulsions, they can work towards replacing unhelpful compulsions with functional, long-term coping mechanisms.
A further variant of CBT, Mindfulness-Based CBT, has also now been found to be one of the most effective developments in CBT treatment of Pure-O as it teaches an individual to accept their uncomfortable thoughts in a non-judgmental manner. This, in turn, reduces the need for compulsive responses to cope with the uncomfortable feeling experienced as an individual more willingly accepts uncomfortable experiences.
Cognitive Restructuring and Imaginal Exposure
Other treatments found to be affective include Cognitive Restructuring, requiring a client to question the validity of their intrusive thoughts and Imaginal Exposure, exposing individuals to their own obsessive and distressing thoughts with the aim of decreasing an individual’s sensitivity to the thoughts.
Ultimately, the treatment of Pure-O involves breaking the cycle of obsessive thoughts and compulsive actions. This requires the identification of the separation between obsessions and compulsions, and accepting that the obsessions are there but are simply thoughts with no basis that do not require a compulsive reaction to dispel them.