Pure-O OCD & Hidden Mental Compulsions

Pure-O OCD (Pure Obsessional OCD) is associated with hidden mental compulsions that interfere with treatment effectiveness.

“Pure-O” OCD, or Pure Obsessional OCD, is a relatively less common form of OCD that seemingly differs from classic presentations of the illness.  What distinguishes Pure Obsessional OCD from classic OCD is that in Pure-O OCD, symptoms are predominantly obsessive (rather than compulsive) in nature.  Although individuals with Pure-O OCD frequently experience intense and distressing obsessions, they typically report few (if any) overt compulsive behaviors.  However, in almost all cases, pure obsessionals do engage in a variety of rituals.  These rituals  just manifest as mental compulsions rather than behavioral compulsions.

Unfortunately, most psychologists haven’t been trained in how to ask the types of questions that are necessary to identify these “hidden rituals.”  As a consequence, these rituals often go undetected.  Because effective treatment requires consistent response prevention, a failure to recognize and resist mental compulsions makes true exposure and response prevention (ERP) impossible.  Treatment then proceeds in an ineffective and haphazard way, with neither the patient nor the therapist any the wiser.

Not surprisingly, treatment for Pure-O OCD often fails.  However, treatment failure occurs not because the patient is an ERP non-responder, but rather because the most important part of treatment (i.e., response prevention) was unknowingly omitted.  Sadly, many individuals with OCD wrongly get labeled as being treatment refractory (treatment resistant), even though they have never undergone a single course of response prevention that appropriately targets their very real mental compulsions.

Remember, not every ritual consists of an observable behavior.  Learn to more effectively fight your OCD and become a mental ritual detective by considering a few of the following “hidden” rituals that I assess when treating individuals in my South Florida (Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami) psychological practice:

Pure-O Mental Compulsions

  • Trying to “figure out” why you’re having a certain thought.
  • Trying to counteract, neutralize, or balance out negative thoughts with positive thoughts.
  • Trying to forcefully control an obsessive thought.
  • Trying to “figure out” what type of person you are (e.g., questioning your own morality).
  • Avoiding certain situations, people, or activities so that you don’t have an obsession.
  • Reassuring yourself (e.g., telling yourself, “I’d never do that.”).
  • Postponing certain behaviors or thoughts until “the right time” or until “they feel right.”
  • Repeating thoughts, phrases, or words in your head.
  • Repeatedly praying or asking for forgiveness (in a way that is not typical for others who share your faith).
  • Getting stuck in an OCD doubt/reassurance loop.
  • Asking questions and seeking reassurance from others.
  • Over-analyzing one’s own behavior or body and trying to do things “normally.”

Questions? Comments? Do you engage in mental compulsions? Sound off below.