Purely Obsessional-Compulsive Disorder (Pure OCD)

"You can't help a thought that pops up, but you can help a thought you conjure up."
Photo by Micah Tindell / Unsplash

Purely Obsessional-Compulsive Disorder, also known as, "Pure OCD" or "pure O", is characterized by the presence of obsessive thoughts with repetitive mental compulsions. Pure OCD is considered a subtype of OCD. The difference with other types of OCD is that compulsions in pure OCD aren’t observable behaviors, like hand washing and pacing. Instead, pure OCD compulsions are thoughts and mental strategies used to relieve anxiety and distress.

Pure OCD occurs in both men and women, and typically develops in adolescence or early adulthood. Pure OCD causes intrusive, persistent unwanted thoughts, images, or urges related to germs, violence, security, harm, and sexuality, which leads to mental compulsions- more thoughts that attempt to reduce stress and obsessions.

Examples of mental rituals include counting, rumination, mental checking, reassurance seeking, mental reviewing past events, counting, avoidance and analyzing thoughts. Mental compulsions are invisible, time-consuming, and distressing just like observable compulsions, and can interfere with daily functioning.

Pure OCD is pretty much a person's repetitive and intrusive thoughts (obsessions) forming more thoughts (mental compulsions) against their own thoughts, which creates a constant storm in the mind. This leads to debilitating stress and anxiety that impacts everyday life; thankfully, there are effective treatments available.


The exact cause of OCD is unknown, but it is believed to be a combination of neurological, environmental, and genetic factors. Each person's experience with OCD is completely unique.

Research suggests that it may be related to an overactive imagination or an overactive threat detection system in the brain. This causes individuals to become hyper fixated on intrusive thoughts and engage in compulsive behaviors to alleviate the continuous anxiety caused by these thoughts.

Signs + Symptoms

The symptoms of Pure OCD are similar to those of other types of OCD, but they are often more focused on intrusive thoughts and mental compulsions rather than physical compulsions. Mental compulsions are repetitive, ritualistic thoughts or behaviors that an individual uses to try to reduce anxiety or prevent a feared outcome.

In severe cases OCD, individuals may become so consumed with the thoughts and the stories in their mind that they lose control. Storms of thoughts take over their minds all day, everyday. They are unable to sleep, function at work, do things they enjoy, have stable relationships with loved ones, and tolerate being alive.

Some common symptoms:

  • Intrusive, unwanted, secretive, and repetitive thoughts, urges, and images that are difficult to control.
  • Repeatedly analyzing these thoughts to try and find reassurance and certainty.
  • Engaging in mental rituals or compulsions to attempt to neutralize the thoughts, such as rumination, counting, self-monitoring, mental checking, thought suppression, mental reviewing, avoidance, repeating certain phrases, and analyzing.
  • Feeling intense anxiety, guilt, or distress as a result of the thoughts.
  • Avoiding situations or triggers that may cause the thoughts to occur.
  • Spending hours a day in a spiral of rumination and problem solving.

Some severe symptoms:

  • Aggressive, disturbing, horrific repetitive thoughts.
  • Dark thoughts about sex, self-harm, or violence.
  • Difficulty tolerating uncertainty.
  • Snapping or exploding from one second to the next.
  • Suicidal ideation and feelings of not being able to do it anymore.


A diagnosis of OCD can be made by seeing psychiatrist, psychiatric nurse practitioner, and licensed mental health counselor or therapist by performing a comprehensive patient history and diagnostic screening tools.

The diagnostic criteria for OCD includes the presence of obsessions, compulsions, or both, that are time-consuming, cause significant distress, and interfere with daily functioning.

A mental health professional can help determine whether an individual's symptoms meet the diagnostic criteria for OCD or another mental health condition, and develop a treatment plan that is personalized to their needs and goals.


There is no known cure for OCD, including Pure OCD; however, there are effective treatments available that can help manage symptoms and improve the ability to perform daily functions. Treatments include medications and therapy, such as talk therapy, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP).

CBT is a type of talk therapy that focuses on identifying and changing negative thought patterns and behaviors. ERP is a specific type of CBT that involves gradually exposing individuals to feared situations or objects while preventing them from engaging in compulsive behaviors or mental rituals. ERP has been shown to be particularly effective in treating OCD, including pure OCD. In addition, medications may be prescribed to help manage symptoms and provide relief.

The goal of treatment is to gain awareness of obsessions and compulsions, understand the function of each compulsion, realize that compulsions are habitual- not automatic, and learn how to let go of these mental compulsions.

The success of treatment depends on the individual's willingness to engage in therapy and their level of motivation to overcome their symptoms. True healing requires awareness, time, and consistent effort.

Stress Management Techniques

Some people find that practicing mindfulness meditation can help reduce anxiety and obsessive thoughts associated with mental compulsions, and create a sense of calm and peace. Exercise, journaling, getting enough sleep, and eating a whole foods, nutrient-dense diet also boost overall mental health.

Engaging in physical activity and exercise helps redirect attention away from obsessive thoughts and compulsions, release endorphins (natural mood boosters), and provide a sense of accomplishment and control.

Through mindfulness meditation, individuals can learn to become more aware of their thoughts and feelings, and how to view them from a distance in a nonjudgmental, objective manner. Meditation helps stop ruminating in thoughts, form new neural connections, and break negative habitual thought patterns.

It is of the upmost importance, if you are experiencing any of the symptoms above and are not working with a therapist, to seek a professional mental health clinician.

Final Thoughts

Pure OCD can be a very distressing and challenging condition to treat and live with it because causes an invisible thunderstorm in the mind. The intrusive, unwanted thoughts and images cause significant anxiety, stress, and frustration. Be aware that individuals with Pure OCD suffer in silence and can constantly feel like they are losing their mind.

If you or someone you know is struggling with pure OCD, or any other mental health condition, please seek professional help from a licensed mental health professional. Always remember, that you do not have to wait until symptoms are overwhelming or out of control to seek help. Do not suffer or just try to keep pushing through. Reach out to family and friends and talk about your concerns with your primary care provider, who can refer you to a mental health professional.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline.

Thank you for reading this article.


This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.