What is Pure Obsessional OCD?

What is Pure Obsessional OCD?

A common experience for many individuals with obsessive compulsive disorder (OCD) is feeling imprisoned by their own thoughts. More importantly, the amount of usable space inside the gated area appears to be decreasing daily, and it can feel as though they are trapped behind an invisible electric fence that restricts their movements and means of transportation.

A subtype of Obsessive Compulsive Disorder known as Pure-O, or Pure Obsessional OCD, is characterized mostly, if not completely, by mental or hidden compulsive behavior. The Pure-O label is typically awarded to OCD manifestations that are more cerebral, abstract, and introspective. These include, but are not restricted to, obsessions with one’s personality, sexual orientation, morality, past, present, spirituality, behavior, or certainty, as well as existential and immaterial concerns.

The cluster of obsessions and themes is also referred to by other sub-type names, such as Scrupulosity, which deals with moral and spiritual issues, HOCD, which deals with thoughts about sexual orientation, Contamination, which deals with cleanliness, and Harm OCD, which is concerned with whether one will become a violent murderer or not. The OCD cycle’s experiences are explained by Pure-O.

To give an example, think of Pure-O as the distinction between spray paint and brushed paint rather than as a different hue in the spectrum of obsessions. It is crucial to keep in mind that although if their application techniques, procedures, and containers look to be very different from one another, they are both still paint that can be any hue.


What is OCD?

Like other anxiety spectrum illnesses, OCD is characterized by a reinforced cycle of preoccupation, trigger, and behavior. Anything that we encounter, perceive, feel, or think can set off an obsession. These can be internal or external triggers.

Triggers, for instance, can be things we see, people we engage with, thoughts in our minds, or internal bodily sensations. The brain notices all of these cues and attempts to foresee and forecast potential hazards, issues, and risks; yet, it typically overestimates the degree of risk or greatly exaggerates the probable outcomes of a particular situation. The brain is a fantastic guardian, but its prognosis is just “amateur” at best. Typically, this prediction appears in a “What if…” or “if ____, then ____” story framework. The Feared Story typically tells you what will happen to you or other people if you give in to your need to stop it.


What do OCD and Pure-O OCD compulsions entail?

Compulsions are any actions an OCD sufferer does in an attempt to reduce their worry or gain some degree of assurance that they are secure. These can be covert, that is, internal and concealed from others, or overt, that is, visible and external. Both overt and hidden compulsions are typically present in OCD sufferers. After carrying out these compulsions, the OCD patient feels relieved, at ease, and confident that everything will be alright. But this sensation is fleeting, and more obsessive behaviors will soon be needed to restore the same level of normalcy.

Common overt compulsions include:

  • Cleaning or hand washing

  • Setting things up and organizing them

  • Moving or concealing hazardous objects

  • Pressing to open or close doors

  • Reentering the rooms

  • Seeking confirmation from others

  • Admittance


Common covert compulsions include:

  • Mentally reliving a past exchange

  • Going over memories

  • Reciting a mantra or prayer aloud while monitoring one’s body for any physical symptoms

  • Assessing feelings (from the past, present, or future)

  • Modifying a memory’s component to observe how it would affect the person’s response or possibly the result

  • Trying to forecast how things will turn out

  • Mentally formulating sentences to guarantee a desired result or prevent a feared consequence


The Misconception of PURE-O

Many people misunderstand Pure-O since they do not think the sufferer has any compulsions. As the term implies, “purely” obsessional OCD is characterized entirely by obsessions or obsessional thinking; compulsive actions are not present. Some could counter that they just have obsessional ideas and do nothing about them. Some people think they just have “obsessions all day,” but they are unable to pinpoint any particular actions they do to counteract or negate the thinking.

Because it can lead to fears that Pure-O is a separate condition or less curable than standard subtypes, this knowledge of Pure-O is deceptive to both the ordinary therapist and OCD sufferer. This is untrue. The term “Purely Obsessional” or “Primarily Obsessional OCD” refers to an OCD that primarily manifests as more or exclusively covert compulsions.


A double-edged sword is Unique

In the OCD community, Pure-O is viewed differently due to its small variance in the compulsive manifestation. On the one hand, those with more obvious obsessive-compulsive symptoms have shown jealousy toward others who exhibit more subtle compulsions. Since overt obsessive habits are more difficult to conceal, it might be more challenging to “pass” as someone without OCD in social or professional settings. It can be tiring to constantly explain extremely noticeable compulsions to people who are not familiar with them, such as strolling in and out of doors or excessive hand washing. Thus, it must be a secret relief to be able to “get away with” one’s compulsions. On the other hand, people who have Pure-O will not agree.

Pure-O sufferers can experience pessimism due to their incapacity to turn off their brains and cognitive processes. One cannot avoid the mental onslaught of questions and images, even if they are able to physically resist the need to wash their hands or turn off their computer before accessing WebMD. If a person with Pure-O feels they do not have compulsions, then following therapists’ advice to “fight compulsions” does not seem to be beneficial. Recall that they are completely fixated! It simply takes knowledge that Pure-O does, in reality, have compulsions to partially allay a persistent anxiety of a “bad prognosis.” During treatment, challenging this negative perception of Pure-O is among the initial erroneous notions to address.


In Pure-O, thinking is still difficult to do

Since Pure-O can be found in many different OCD presentations, it is misleading to refer to it as a separate OCD subtype. A Pure-O subtype may coexist with overt compulsions associated with other categories. In addition to their overt compulsions, an individual with OCD may also exhibit Pure-O symptoms. This is the more overt kind of OCD.

In the end, it is all just a compulsion, even though Pure-O has several distinct thought-based compulsion kinds. Though they may be hidden, deliberate acts of studying, analyzing, preparing, or assessing are all regarded as compulsive behaviors and ought to be handled similarly to compulsions.


 A few illustrations of covert compulsions in PURE-O OCD for subtypes

HOCD – Involves going over all of your past relationship memories and rating your level of arousal or affection using a fictitious “over-under” scale.

Pedophile OCD – Examining one’s past interactions with and around children in an effort to find any possible signs of arousal or interest.

Contamination – Recalling instances in which one touched a doorknob and nothing occurred

Relationship OCD (ROCD) – Is the practice of seeing yourself in other people’s relationships and comparing your present one to one with friends or a former partner to see if you would be happier or more content.

Religious scrupulosity – Consistently praying in one’s head to keep one’s sense of divine connection or to push away “bad” thoughts.

Harm OCD – By mentally repeating, “I am safe and I am not a killer,” when brandishing a knife in front of other people.


Existential OCD – Precisely remembering the statement “nothing is real.”


PURE-O is just as treatable as traditional OCD subtypes

Cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and mindfulness-based techniques including acceptance and commitment therapy (ACT) are used in the treatment of Pure-O.

Cognitive behavioral therapy

The primary therapy paradigm for OCD and associated anxiety disorders is cognitive behavioral therapy (CBT). In general, the Cognitive Restructuring technique helps someone question the veracity of the fearful tale in order to establish a solid foundation from which they can proceed with alternative behaviors.

For a person with Pure-O, cognitive restructuring can be a significant obstacle. Since it reflects their obsessive pursuit of certainty, Pure-O sufferers frequently find this step difficult. In fact, it can be challenging for many OCD subtypes. Some people who have Pure-O are already going over old events in their memory, refuting the stories they are afraid to tell, and applying reason to their compulsive thinking.

Therefore, although cognitive restructuring can be a revolutionary strategy for some people to overcome their OCD, it can also have the opposite effect. It will take some conversation between the therapist and the client to choose which one it will be, and throughout the therapeutic process, there will need to be periodic reassessments. In the end, exposure and response prevention are important because they help the client become more willing to confront their anxieties, regardless of how much cognitive restructuring is done.


Exposure and response prevention

Writing down the tale you are afraid of might sometimes be the greatest approach to face your worries when they are solely mental.

ERP serves as a foundation for methodically tackling one’s concerns in traditional OCD treatment. The OCD sufferer will gradually feel less distress and discomfort when performing the exercise in relation to the idea, picture, object, or event that triggers the episode.

Response Prevention and Exposure are the two halves of ERP. For rehabilitation, both are essential. Exposure may occur accidentally or on purpose. The OCD patient will come into contact with those triggers just by going about their daily lives, but they can learn to live with and tolerate them. In the therapeutic setting, the client and the therapist would collaborate to create a list of triggers and then purposefully confront them. This methodical approach can begin modestly, such as by writing it down or examining an image of it, and then gradually advance toward the actual or in vivo trigger.

The harder part is response prevention. The compulsion is the OCD “reaction.” Thus, coercive prevention. This might take the form of refusing to wash your hands, staying on the highway, not changing the channel, maintaining eye contact, or finishing a botched prayer, to mention a few in the context of conventional OCD treatment. With time, the OCD sufferer will discover that they can face their fear and not let it destroy them, all the while surviving and not having to carry out their ritual or obsessive activity.

Within Pure-O, response prevention is avoiding secretive or mental compulsions. Treatment will teach the patient that although they cannot stop their thoughts from existing, they can choose which thoughts to actively interact with and support. Raising awareness of these internal compulsions and attempting to lessen one’s active involvement in them is the aim of ERP for Pure-O.


Acceptance and commitment therapy

Acceptance and Commitment Therapy (ACT), which is mindfulness-based, provides a plethora of techniques and viewpoints that assist the Pure-O sufferer in confronting their worries while taking a chance to lessen their dependency on internal compulsions.

ACT assists by assisting individuals in seeing that they are not their thoughts; rather, they are a person going through ideas, sensations, feelings, pictures, emotions, and desires. One can learn to let these experiences come and go from their lives by realizing that they are not a part of them and that they are not in control of them. A framework for facing and going through higher levels of discomfort and anxiety, whether they come from memories from the past, worries about the future, or thoughts, is another benefit of ACT.

Acknowledging the existence of thoughts is one thing, but what happens next? Utilizing ACT, the client and the therapist collaborate to identify the client’s top priorities before attempting to live a life that is more and more centered around value-driven action. Even if their compulsions reduce their anxiety, OCD sufferers never like them. Therefore, ACT assists the OCD sufferer in refocusing their attention from unwanted and needless behaviors toward those actions that truly give them a sense of meaning and purpose, as opposed to engaging in activities they do not care about (compulsions).

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