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Characterizing Pure O

The differences between OCD and Pure O, and why OCD doesn't always mean compulsive rituals.

Written by Jana K. Hoffman

OCD3, Ep3: Characterizing Pure O and OCD

Contrary to popular belief, Obsessive Compulsive Disorder (OCD) is not always characterized by visual rituals like washing hands over and over again or checking the stove 10 times before leaving the house. We have the media to thank for this serious misperception. Instead, OCD is a mental disorder that oftentimes doesn’t conclude with an action.

We sat down with expert clinical psychologist Dr. Steven Phillipson to understand OCD without the “C.” Dr. Phillipson explains that Obsessive Compulsive Disorder without the resulting compulsions can be called Pure O. He was the first clinical psychologist in NYC to host support groups for OCD sufferers and coined the term after listening to a number of his patients who had OCD but didn’t have observable rituals. They experienced “non-observable” rituals.

So what’s a non-observable ritual? A good example might be that you experience an intrusive thought where you’re harming someone you love. The non-observable ritual is mentally, repeatedly thinking that you love this person and would never ever inflict harm upon him/her.

That’s Pure O, a subset of OCD. And the phrase Pure O became an incredibly valuable distinction to a community of people that were stigmatized by mainstream media and the public’s understanding of OCD. It gave people a voice and a way to explain what they were experiencing to someone else. Pure O also allows practitioners to think differently about treatment approaches.

Throughout his studies, Dr. Phillipson put people and their experiences above a textbook definition. We’d like to point out that Pure O isn’t a scientifically derived name. It’s a nickname that, although his colleagues don’t necessarily agree with, has distinguished people from those who have observable rituals.

If you believe intrusive thoughts could be affecting your ability to lead a normal life, contact a local psychologist to start on your personal path toward healing.

Read full video transcript below:

Aaron Harvey (AH): So you coined the phrase "Pure O." What is the difference between Pure O and our traditional understanding of OCD?

Dr. Steven Phillipson (SP): Patients came in believing that they had OCD, but they didn’t engage in any observable rituals like hand washing or checking the stove or light switches. And they had these intrusive thoughts that created the same amount of terror as someone with an observable ritual but their rituals just involved mental escapes. Their undoing response was just in their own mind to use logic and reason to try to extricate themselves from their brain's sort of presented possible emergency.

AH: And so, is Pure O a real diagnosis? Or is it a nickname?

SP: The technical term is actually called non-observable ritualizers, but for my patients' sake, they really liked the idea of having this term that distinguished them from observable rituals. It made for great television to show someone washing their hands like a surgeon for just having touched a doorknob. You really can’t really see, you know, a person ritualizing in an entertaining way so the subset of Pure O was really ignored. So it's just a term that I developed because I believed that my patients would want to have a term that distinguished them from this other type of OCD that had gotten a lot of publicity.

AH: In my own experience, I think the phrase Pure O was extremely important on getting on the right path to treatment. Because of what is understood about OCD in mainstream media, there seems to be, generically speaking, a cause and effect. So, you know, if I'm afraid of germs I wash my hands or don't shake your hand. If it's an intrusive thought, like I'm afraid of murdering my wife, I don't go and murder my wife. I do everything that I can not to do that. So, for a sufferer, it's a very important association.

SP: All OCD has the intrusive thought and then the escape, which is the ritual portion of it. Pure O would imply that a person is just having an intrusive thought without engaging in an escape response. I’ve known since I’ve started, that the term wasn't actually a scientifically derived one, but it was more of defining a subset for people whose rituals were just in their own mind.

AH: I mean, I think I could confidently say on behalf of the OCD community that that was a very important and valuable contribution to create that nickname because that provided an avenue for understanding, especially when you’re up against a mainstream media that is telling you something very different.

SP: Yeah.

About the author

Jana Hoffman is a writer, editor and storyteller based in San Francisco. She is currently working as a copywriter at the Chan Zuckerberg Initiative. Outside of work, she is a trained volunteer for Crisis Text Line and has been open about her experiences with mental health.

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