When the Compulsions are Invisible: Living with Pure “O” OCD
Do you ever struggle with replaying scenarios, wondering if you said something to offend the other person? Do you search for hours on Google or ask ChatGPT when you notice a small change within your body, questioning if it is something serious? Or maybe it shows up as that silent perfectionism of thinking something in just the “right” way?
This is just a glimpse of the ways that anxiety can become obsessive with doubts, leading to varying levels of rumination for folks. Typically, when people think about Obsessive Compulsive Disorder (OCD) it automatically goes to the stereotypical images of someone flipping the light switch repeatedly. But what gets overlooked often–and even misdiagnosed– is the mental compulsions that nobody else can see.
If you’re curious about the basics of OCD in general, I encourage you to also read through my previous blog that breaks down the essentials to know about the obsessive and compulsive nature of anxiety. However, in this blog I wanted to highlight more on the concept of Pure “O” OCD that people may struggle with internally and how it tends to get written off as “overthinking.”
What is Pure “O” OCD?
This form of OCD still shows up the same way characteristically as other types in the sense that there are the obsessions driving the compulsions, feeding into the never ending loop of “what ifs?” The main difference is the way someone tries to minimize the anxiety that builds isn’t through behaviors or physical rituals, it all happens mentally.
How this may show up for example is having a fear of being careless and internalizing the obsessive doubt as “What if it’s my fault something bad happens?” The anxiety or distress begins building because nobody wants to be labeled as careless, so the mental compulsions start by replaying scenarios when they did the right thing in the past. Or asking other people or Google for reassurance on ways to know they were being responsible in that situation. Or even a stream of negative self-talk that feels so convincing of them being at fault.
Anxiety at its core focuses on mentally convincing us of some threat, whether it is real or perceived. So for folks who have “loud” doubts about themselves, or the world around them, and also believe the obsessional stories created from those doubts. Then to go into a mental argument with the obsessions through engaging in mental compulsions can feel extremely draining at times.
Some Ways to Recognize Pure “O” OCD
This isn’t always easy to spot and oftentimes people can go years without the proper diagnosis for treating their OCD symptoms. A lot of the Pure “O” compulsions are dependent on the form of OCD a person has as well (i.e. Hit and Run, Pedophelia, Perfectionism, etc.).
Here is a general list of the ways OCD can show up as purely obsessional mental compulsions:
Excessively worrying that you don’t love your partner, or aren’t good enough for the relationship you are in. This can lead to replaying conversations or seeking reassurance often from your partner. (Relationship OCD)
Recurrent intrusive thoughts or images about something bad happening to you or your family. Which may result in avoidance of a lot of situations in life, or thinking good thoughts to override the bad thoughts. (Harm OCD)
Repeatedly worrying if you have hit or ran over someone with your car, leading to compulsively checking the car for blood or dents, or replaying the drive once you arrive at your destination. (Hit and Run OCD)
Persistent fears of harming or molesting a child, or that you are sexually attracted to children. This leads to intense feelings of panic the majority of the time, and can result in engaging in mental compulsions such as “checking” one’s body for signs of arousal when around children, replaying past scenarios that were harmless and worrying if you accidentally escalated it, or avoidance of being around children altogether. (Pedophilia OCD)
Recurrent fears that you are sinful or not living in a manner that is consistent with your religious, moral, or ethical values. The way this shows up for mental compulsions is by then silent praying or repeating certain phrases in an effort to counteract or minimize those “sinful” thoughts. (Scrupulosity/Blasphemous OCD)
There are so many subtypes with OCD, that this list could go on for pages to highlight all the ways Pure “O” can show up for someone. But the essence with each of these examples is that whatever your doubt is, there may be no physical ritual to neutralize it. The “solutions” are performed mentally and leave a person feeling even more stuck emotionally.
Options for Treatment for Pure “O” OCD
The gold standard for treating OCD for decades has been through Exposure and Response Prevention Therapy (ERP), which involves learning to tolerate levels of discomfort and working to change your response to the elevated distress. Through the techniques built in this modality, folks find ways to feel more in control of their compulsions which in turn helps minimize the obsessional doubts.
Another valuable option is called Inferential-Cognitive Behavioral Therapy (I-CBT) that addresses the obsessive doubts at the core which will progressively diminish engagement with compulsive behaviors. In other words, working through this approach folks learn to interrupt the obsessional narrative that keeps them stuck in the compulsive rituals. Both of these therapeutic approaches can work wonders for folks struggling with OCD, Panic Disorder, Social Anxiety, or other phobias.
Whichever route you take on your healing journey with anxiety, it’s important to prioritize the ways you can be kind to your mind. Living with anxiety can make you feel crazy because the two parts of your brain–emotional and rational–are fighting against each other. You are not alone.
Reach out today to schedule your consultation to join my 8 Week OCD Support and Skills Group, or begin individual therapy to address the ways OCD feels controlling in your life. You deserve to feel the mental freedom.
Resources:
OCD Center of Los Angeles. Pure Obsessional OCD (Pure O) - Symptoms and Treatment. https://ocdla.com/obsessionalocd
