Pure O OCD: Obsessions Without Visible Compulsions

Part of our OCD articles. For evaluation and medication management, see OCD care at Ridge Way.

Pure O OCD is an informal name for OCD in which compulsions are mostly mental or difficult for other people to notice. Someone may experience disturbing intrusive thoughts and respond with silent rituals, reassurance-seeking, checking or avoidance. Here is what Pure O means and how it is treated.

What Is Pure O OCD?

Pure O is short for purely obsessional. People use it to describe OCD that seems to be all thoughts and no rituals. OCD-UK, a patient charity, describes it as merely a phrase, and certainly not a medically listed term. In other words, Pure O is OCD, described by how it shows up for some people.

The National Institute of Mental Health (NIMH) defines obsessions as repeated thoughts, urges or images that are intrusive and unwanted and make most people anxious. Compulsions are repetitive behaviors a person feels the urge to do, often in response to an obsession.

The Compulsions You Cannot See

Pure O can look compulsion-free from the outside, but the compulsions are usually present, even when they are hard to see. NIMH lists praying or repeating words silently and compulsive counting among OCD compulsions, and both can happen entirely in the mind. OCD-UK adds that people described as Pure O almost always have other compulsions too, such as checking, seeking reassurance from loved ones, or avoiding places and people that trigger the thoughts.

Common Themes in Pure O

NIMH lists unwanted, forbidden or taboo thoughts involving sex, religion or harm, and aggressive thoughts toward others or oneself, among common OCD obsessions. These thoughts are often upsetting because they conflict with the person’s values, intentions or sense of who they are. Having an intrusive thought does not by itself mean someone wants to act on it.

Our article on intrusive thoughts explains why they happen, and types of OCD covers the other forms OCD takes.

How Is Pure O OCD Diagnosed and Treated?

Because Pure O is OCD, it is diagnosed the same way, by looking at the obsessions, the compulsions that answer them, and how much they take over daily life. Treatment follows the same principles used for OCD generally.

NIMH explains that the most common medications are antidepressants that act on serotonin, mainly SSRIs, and that it can take 8 to 12 weeks before symptoms start to improve. A form of therapy called exposure and response prevention (ERP) is also effective at reducing compulsions.

Ridge Way provides psychiatric evaluation and medication management. We do not provide therapy, and when ERP is part of the plan, we can refer you to an outside clinician trained in treating OCD and providing ERP. With your written permission, we can exchange relevant information with another clinician when coordination is part of your care. See how we treat OCD.

When to Get Help

Consider an evaluation if intrusive thoughts take up a lot of your day, cause real distress, or lead you to check, avoid or seek reassurance over and over. Intrusive harm thoughts can occur in OCD and do not automatically mean a person intends to act. If you are thinking about suicide, believe you may act on a thought or cannot stay safe, call or text 988 now, and call 911 if you are in immediate danger.

Ridge Way provides psychiatric care across Georgia, by telehealth and at our Sugar Hill office. Request an appointment and we will usually call you back within one business day.

For what treatment can involve, read how antidepressant medication is used.