Pure OCD: Why You Shouldn't Trust Every Inner Voice
Pure OCD can feel like your inner voice is warning you about something important. It isn't. This page covers what Pure OCD is, the hidden compulsions that keep it going, and how it's treated.
By Nathan Peterson, LCSW, OCD therapistWhat is Pure OCD?
Pure OCD, sometimes called Pure O or "purely obsessional" OCD, is a nickname for OCD where you can't see the compulsions from the outside. There's no hand washing or door checking. The rituals happen in your head.
That's why the name is a little misleading. Pure OCD isn't only obsessions. The compulsions are there. They're mental, so nobody sees them, including you sometimes.
Different types of obsessions
Any OCD theme can show up as Pure OCD. Some of the most common:
- Harm: Fear of hurting yourself or someone else.
- Sexual: Unwanted sexual thoughts, including HOCD.
- Relationship: Doubts about your partner or your feelings.
- Religious and moral: Fear of sinning or being a bad person.
- Existential: Questions about reality, death, or meaning.
- False memory: Fear you did something bad in the past.
The hidden compulsions
- Reviewing. Replaying a moment to check what happened.
- Analyzing. Trying to figure out what the thought means.
- Checking feelings. Testing how you react to see if the fear is true.
- Neutralizing. Replacing a bad thought with a good one, or praying it away.
- Reassurance. Asking others or Googling for an answer.
Mental reviewing is the one that hides best. For more on it, see OCD rumination.
The causes of Pure OCD
Pure OCD has the same causes as any other OCD. The exact cause isn't known, but genetics and brain differences seem to play a part, and stress can make symptoms flare. Having a scary thought doesn't mean something is wrong with you. Everyone gets them. OCD makes them feel important.
Treatment options for Pure OCD
Exposure and response prevention (ERP) is the main treatment. With Pure OCD, the "response prevention" part means skipping the mental ritual. No reviewing, no analyzing, no arguing. You let the thought be a thought.
I know, not analyzing a thought this scary feels reckless. Like you're letting your guard down. The analyzing is what keeps the thought around.
Some people also take medication, which is a conversation for your doctor.
Next time you catch yourself analyzing a thought, say "There's OCD again," and go back to what you were doing. Let the thought come along. (Your brain will want to solve it first. Let it want to.)
If you want help building the whole plan, that's what Master Your OCD is for.
Common questions about Pure OCD
Is Pure OCD a real diagnosis?
Pure OCD isn't a separate diagnosis. It's a nickname for OCD where the compulsions happen mostly in your head, so they're harder to see.
Does Pure OCD have compulsions?
Yes. They're mostly mental, like reviewing, analyzing, checking your feelings, praying, or arguing with the thought. Reassurance-seeking is common too.
Can Pure OCD be treated?
Yes. Exposure and response prevention (ERP) works for Pure OCD. You practice letting the thought be there without doing the mental ritual.
How do I know if I have Pure OCD?
If you have unwanted thoughts that keep coming back and you spend a lot of time trying to figure them out or make them go away, it could possibly be OCD. Take the free OCD test to get a starting point.
