What Is Pure O? Understanding Purely Obsessional OCD
Explore our Therapists & Healers Directory | find specialists in OCD and anxiety who understand mental compulsions.
Intrusive thoughts and mental loops can feel isolating, especially when there’s no visible compulsion to show for it. Many people describe this experience as “Pure O” or pure obsessional OCD. In this post, we’ll unpack what Pure O means, common features, treatment strategies, and how you can find support (like through our directory).
What Does “Pure O” Mean?
Pure O is shorthand for purely obsessional OCD. It refers to a form of OCD in which a person’s compulsions are mostly internal (i.e. mental), rather than overt behaviors like checking, washing, or counting. Healthline
Importantly, Pure O is not a separate diagnosis in the DSM-5. It’s simply a way for people to describe their pattern of obsessions + hidden rituals. Verywell Mind
The term can be misleading because many people with “Pure O” do perform compulsions, they’re just often times mental (rumination, reassurance, mental reviewing) rather than physical. The Gateway Institute
Because these compulsions are hidden, Pure O often goes undetected or is mistaken for overthinking, anxiety, or rumination. LynLake Centers for WellBeing
Key Characteristics of Pure O
Here are some of the common signs and features:
Intrusive Thoughts / Obsessions
Distressing, unwanted, and repetitive thoughts, images, or urges.
Themes often include harming someone, blasphemy, sexual content, unwanted impulses, existential questions, or moral/ethical fears. Verywell Mind
Even though many people have intrusive thoughts occasionally, in Pure O they become persistent, distressing, and hard to dismiss. The Gateway Institute
Mental Compulsions / Hidden Rituals
Because the compulsions are internal, they may be harder to recognize:
Mentally reviewing or replaying past events to “check” that nothing bad happened
Reassurance-seeking (inner dialogue: “Is this safe? Did I mean it?”)
Repeating phrases, prayers, or mantras silently
Counteracting the intrusive thought with a “safe thought”
Mental avoidance or suppression efforts
These mental compulsions aim to reduce anxiety, but often only give temporary relief. TreatmyOCD
Shame, Isolation, and Misunderstanding
Because there are no visible rituals, many people with Pure O feel unseen or invalidated. They may hesitate to talk about their thoughts, fearing judgment. Child Mind Institute
How Pure O Fits into the OCD Framework
Although Pure O feels distinct, it follows the same obsession-compulsion cycle as other OCD forms:
Obsession → intrusive thought triggers anxiety
Compulsion → mental ritual or covert response
Relief (temporary) → the ritual eases distress for a moment
Cycle repeats → the anxiety returns, sometimes stronger
Because the compulsive response is mental, the cycle may be even more insidious and harder to interrupt. Healthline
Also, effective treatments for OCD (especially ERP, see next section) work similarly for Pure O. Stacysmithcounseling
Treatment & Strategies for Pure O
Exposure & Response Prevention (ERP)
ERP is considered the gold standard for OCD treatment and it can be effective for Pure O too. Verywell Mind
In ERP, you expose yourself to the thoughts, images, or situations that provoke intrusive thoughts (under guidance).
Then you resist the urge to perform your usual mental compulsion or neutralizing ritual. International OCD Foundation
Over time, tolerance builds, anxiety decreases, and the compulsion urges fade. International OCD Foundation
For Pure O, the exposures may not involve physical stimuli, often the exposure is thinking the intrusive content, or imagining it, without mental neutralization. stacysmithcounseling
Cognitive Techniques & Acceptance
Cognitive restructuring: challenging the meaning or threat value assigned to intrusive thoughts.
Acceptance & Commitment Therapy (ACT) principles: accepting that thoughts may arise, letting them pass without reacting.
Mindfulness practices help create distance from thoughts rather than buying into them.
Self-compassion: acknowledging the suffering without self-judgment.
These approaches often complement ERP, giving you tools when intrusive thoughts feel overwhelming.
When to Consider Medication / Other Supports
Many people with Pure O also benefit from medications (such as SSRIs) or augmentation strategies, especially when anxiety is very high. Treatment is often most effective when combining therapy + (if needed) medication. Healthline
Some individuals explore additional therapeutic modalities (e.g. transdiagnostic approaches, neurostimulation, etc.), but these are best considered under professional supervision.
Examples to Illustrate Pure O
You may think, “What if I accidentally harmed someone?” and spend hours mentally replaying events to “check” whether you did.
You might silently repeat phrases or prayers to “counteract” an intrusive thought.
You may avoid certain topics, images, or conversations that trigger disturbing ideas, even though avoidance becomes a compulsion in itself.
Even though others can’t see what’s happening, the inner pressure can be intense.
Challenges & Misconceptions
“There’s no compulsion” — This is a myth. The compulsion is just internal. The Child Mind Institute
“It’s just overthinking or anxiety” — The difference is the distress, persistence, and the pattern of trying to neutralize or control the thoughts.
Hidden nature delays help — Because you don’t show visible rituals, others may underestimate your suffering or dismiss it.
Risk of misdiagnosis — Some clinicians may misattribute symptoms to generalized anxiety or rumination unless they probe for mental rituals.
How to Find Support (You Don’t Have to Do This Alone)
If you suspect you have Pure O, or want a therapist who understands mental compulsions. Many mental health professionals specialize in OCD, ERP, and works with Pure O.
Visit our Therapists & Healers Directory to find qualified OCD / anxiety specialists, healers, and integrative practitioners.
When you reach out, you can mention that you’re seeking someone experienced with mental rituals / Pure O / ERP, this helps find the right match.
Final Thoughts
Pure O is real. Even though its compulsions may not be visible, it follows the same obsessive-compulsive cycle and is treatable. With ERP, cognitive strategies, acceptance skills, and professional support, people with Pure O can reduce distress, reclaim mental freedom, and reconnect with life.
