“Pure O” OCD: How it Differs from Typical OCD

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Written by:Cynthia V. Catchings, LCSW-S

Published On: February 3, 2023

Medically reviewed by: Jill E. Daino, LCSW-R

Reviewed On: February 3, 2023

Updated On: July 17, 2023


Obsessive-compulsive disorder (OCD) is a kind of anxiety disorder that causes intrusive thoughts (known as obsessions) and an urge to engage in ritualistic behaviors (called compulsions). The condition affects an estimated 1% of the population, but not all types of OCD are the same. Some people experience a purely obsessional form.

Pure O OCD (also known as  pure-O or pure OCD) is an unofficial diagnosis that describes people who only experience mental compulsions.

Read on to learn more about this condition and the differences between it and typical OCD. We’re looking at how severe it tends to be and what can trigger an episode. Most importantly, we’ll share expert tips on stopping pure O thoughts because while there’s no cure for it, you don’t have to let pure O OCD control your life.

What Is “Pure O” OCD?

Also known as purely obsessional OCD, pure OCD is an unofficial subtype of obsessional-compulsive disorder. It’s a form of OCD in which a person experiences obsessions but doesn’t have external compulsive behaviors.

Note that, despite the condition’s name, people with pure O OCD can still have compulsions. It’s just that their compulsions are internal rather than external, making them difficult to observe. Common pure OCD symptoms might include things like:

    • Reassurance seeking
    • Mentally repeating words or numbers
    • Ruminating on past thoughts

“It’s important to remember that “pure O” OCD does not present itself in expected or typical ways. This type of OCD does not involve rituals or compulsions, and that confuses or invites people to think that it’s not a true form of OCD.”

Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR Cynthia Catchings

Differences Between “Pure O” OCD vs. Typical OCD

An intrusive thought every once in a while is normal, but people with OCD usually deal with intrusive thoughts more than most. People with typical OCD experience uncontrollable recurring intrusive thoughts. Those thoughts lead them to engage in repetitive, ritualistic — unhealthy, and unhelpful — behaviors.

Examples of compulsions in traditional OCD might include:

    • Constant cleaning
    • Counting objects
    • Engaging in repetitive actions or movements
    • Repeating tasks like knocking on a door a specific number of times or checking locks
    • Washing hands repeatedly


While these signs are easy to observe, people with pure O OCD have virtually invisible compulsions. Instead of outward compulsions, they engage in mental compulsions or avoidant behaviors. For example, someone with pure O OCD might avoid drinking water because they’re worried that it’s contaminated.

“While “pure O” OCD is an unofficial type of OCD and manifests mostly through intrusive obsessions, OCD shows as compulsions, rituals, and unwanted behaviors. So, the main difference is that one involves thoughts and the other one actions.”

Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR Cynthia Catchings

Since people with pure O don’t show outward compulsions, they may not view their behaviors as compulsions at all. Instead, they may see them as an extension of their obsessions. Because symptoms of pure OCD are less obvious, the condition is much more likely to go undiagnosed, which can be a barrier to treatment. The stereotypes of what OCD looks like means some people with pure O may not even realize they have OCD.

Is pure O less severe than OCD?

Studies show that people with purely obsessional OCD have fewer suicidal thoughts, and their symptoms may be less severe. However, the intrusive thoughts and internal compulsions they experience can still be deeply distressing.

What triggers pure OCD?

While obsessions and compulsions mark OCD, the actual OCD triggers can vary from person to person. Episodes may be triggered when someone’s exposed to something that reminds them of their thoughts and urges, but they can also occur when they feel stressed, anxious, or out of control.

Someone with purely obsessional OCD may be triggered by the following:

  • Violent imagery
  • Romantic relationships
  • Major life changes
  • Illness
  • Religious fears


Also, depending on the nature of their triggers and obsessions, they might also fall into one of these subtypes of OCD:

How Do You Stop Pure O Thoughts?

Intrusive thoughts can surface at any time. Once they appear, for people with any form of OCD, it can be challenging to think about anything else. OCD obsessions are often very upsetting. People with pure OCD might feel like they’re a hostage to their own brains.

Obsessions and compulsions may be painful, but there are ways to cope with obsessive thoughts. The following self-soothing strategies can help you distract yourself from your distressing thoughts.

Find ways to relax

Stress can make OCD symptoms more severe, so finding ways to unwind when you’re feeling overwhelmed can be crucial to managing your condition. While you can’t always control the amount of stress in your life, you can use relaxation techniques to make your stress more manageable. 

Use grounding techniques

Grounding techniques, such as deep breathing or progressive muscle relaxation, can also calm your body. Guided meditation can help you calm your mind and redirect your thoughts.

Get active

Everyone knows that physical activity is good for your health, but some studies suggest it can improve OCD symptoms. When you exercise, your body produces feel-good hormones called endorphins that elevate your mood and relieve stress. Relaxing, low-impact exercises, like yoga, can benefit people with OCD.

Focus on self-care

When intrusive thoughts creep up, it can be hard to think about anything else. Instead of fixating on these thoughts, try focusing on taking care of yourself.

A healthy diet, consistent sleep schedule, and self-compassion can all make OCD symptoms easier to manage. Make a point of engaging in activities you enjoy, whether that means watching a movie, spending time with friends, or reading a book.

Start therapy

If you keep your symptoms to yourself, you may feel as though you’re completely alone. Talking to a therapist can help you understand your condition. In addition, your therapist can work with you to manage your symptoms so you can learn to avoid internal compulsive behaviors. Certain types of therapy are known for their efficacy in managing OCD symptoms.

Common types of therapy for OCD include:

  • Cognitive behavioral therapy (CBT): A commonly used therapy in treating OCD, CBT helps identify and change problematic thought and behavior patterns and other mental conditions stemming from their OCD, including social anxiety.
  • Exposure and response prevention (ERP) therapy: Exposure to fears is the hallmark principle in exposure therapy for OCD. Facing and overcoming fears can be instrumental in learning to manage your condition.
  • Mindfulness-based CBT: A highly effective therapy for OCD, mindfulness-based techniques help you accept the thoughts and urges your OCD causes you to have. Then, you can respond appropriately and in the healthiest manner.
  • Psychodynamic therapy: This type of therapy looks at how your past and present are related. It can be beneficial in targeting how we see, anticipate, understand, and react to unhelpful OCD-related thoughts and urges.


Your therapist may also recommend one of the types of OCD medications. Medications that might be prescribed for pure OCD include selective serotonin reuptake inhibitors (SSRIs) or atypical antipsychotics. Clomipramine, a tricyclic antidepressant, can treat OCD symptoms when SSRIs haven’t been effective.

Does pure O OCD ever go away?

While pure OCD symptoms can be intense, and the condition isn’t curable, research shows that OCD is highly treatable. While OCD treatment won’t cure your symptoms, it can limit their impact on your day-to-day life.

OCD can be severe, even when you have purely obsessive symptoms, but most people see a significant improvement in your condition after you start treatment.

Get Professional Help for Pure OCD with Talkspace

Pure OCD presents itself differently from typical OCD. Because of this, it can go unnoticed. You should discuss your symptoms with a mental health professional if you’ve been struggling with unwanted thoughts or urges. Even if you don’t have any outward signs, you could be suffering from purely obsessional OCD.

However, we can help by matching you with a licensed mental health care professional. With Talkspace, you’ll receive a personalized treatment plan designed to help you cope with your symptoms. You don’t have to let your pure OCD symptoms take over your life.

Reach out to Talkspace today so you can get started with the professional help you need to take back control over your life.

See References

Cynthia V. Catchings, LCSW-S

Cynthia Catchings is a trilingual licensed clinical social worker-supervisor, mental health consultant, professor, and trainer for federal law enforcement agencies. Cynthia has over 15 years of experience in the mental health profession. She is passionate about women’s mental health, life transitions, and stress management. Her clinical work, advocacy, and volunteer service have focused on working with domestic violence survivors and conducting mental health research in over 30 countries.

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