Living with Pure OCD

Living with Pure OCD

What’s going on?

Purely Obsessional OCD, also known as Pure O, is a type of OCD in which a sufferer engages in hidden compulsions. Instead of combating their intrusive thoughts with visible rituals such as hand-washing or counting, they perform repetitive, mental rituals to minimize stress. Because of the hidden nature of the disorder, Pure OCD is extremely distressing and challenging to treat. Many sufferers go years without seeking help or opening up to loved ones.

Symptoms of Pure OCD vary greatly from person to person, however, the topics of people’s intrusive thoughts tend to fall within certain themes: sexuality, responsibility, violence, faith, health and romance.

Characterizing Pure OCD

Dr. Phillipson compares Pure O to the traditional understanding of OCD and explains how obsessions and compulsions differ between the two.

Common Pure OCD obsessions:

Common Pure OCD compulsions:

  • Guilt: Feeling deeply ashamed for having violent, blasphemous or sexual intrusive thoughts.
  • Thinking you’re a bad person: Your character is at risk if you do the wrong thing and you feel devastated if someone thinks you’re a bad person.   
  • Avoidance: Avoiding objects, places and people that are related to the nature of your intrusive thoughts.
  • Answer seeking: Establishing legitimacy and determining answers to your thoughts.
  • Reassurance: Going to church or temple and talking with clergy members or getting reassurance from family members that you’ve reached the right conclusion.
  • Research: Looking online to find answers to your questions.

Common misconceptions about Pure OCD:

  • That to have OCD, you have to engage in noticeable rituals like hand-washing or counting.
  • That people with Pure OCD are suffering from a disorder other than OCD, like schizophrenia or borderline personality disorder.
  • That a person’s intrusive thoughts are legitimate representations of their character.

How Do I Know it’s OCD?

Everyone gets intrusive thoughts, but having them doesn’t mean you have OCD. For people who do have OCD, these thoughts can be debilitating, causing extreme anxiety and discomfort. No matter how hard you try to get rid of them, they won’t go away.

Having intrusive thoughts does not make you a bad person. They are a misfiring in the brain, not a reflection of your character.

Everyday examples:

  • Your roommates are always touching everything: the refrigerator handle, the faucet, the bathroom light switch. You can’t touch any of those things without putting your sleeve over your hand. See Contamination OCD.
  • Pulling out a kitchen knife and immediately thinking about how it could be used to harm your partner. See Harm OCD.
  • You think your partner has bushy eyebrows. You pinpoint this “flaw” and think that you couldn’t possibly be with someone like this for the rest of your life. You start thinking that it’s time to find someone who has better-looking eyebrows. See Relationship OCD.

How can my family help my Pure OCD?

When it comes to family and friends, your thoughts can be confusing for them to understand. In their minds, the situations you’re obsessing over are clearly unrealistic. Often times, they’ll want to provide reassurance that you are not capable of the things going on in your mind. Unfortunately, enabling you in this way can actually make your OCD worse. It provides momentary relief, but over time, the thoughts strengthen. Involving your family in therapy can be a good way to help them understand the do’s and don’ts of the disorder, and create a game plan for helping you at home.

Is Recovery Possible for Me?

Yes! People with Pure OCD can get much better through Exposure Response Prevention Therapy (ERP). ERP is when you voluntarily expose yourself to the source of your fear over and over and over again, without acting out any compulsion to neutralize or stop the fear. By repeatedly facing something you’re afraid of, you force your brain to recognize how irrational it is. ERP Therapy varies greatly depending on the nature of a person’s Pure OCD. Someone with Harm OCD will need to tackle different fears than someone with Contamination OCD. It is crucial you work with a professional who is well versed in the disorder.

Examples of ERP treatment:

  • To start, a person with Harm OCD may be asked carry a plastic fork or plastic knife in their pocket and create an association with that item. As time goes on, they’ll build on these items until they’re carrying more threatening objects like sharp kitchen knives or scissors.
  • Or, a person with Contamination OCD may start by making a list of things they’re afraid of like touching door handles or not washing hands. Then, they’ll start the exposure exercises starting with the relatively low-level anxiety tasks. The tasks will become more challenging as they move down the list. Soon, they might be doing things like handing a homeless person a quarter or touching the faucet in a public bathroom.

There are other treatment options as well. Mindfulness-based Cognitive Behavioral Therapy, also known as CBT, teaches people to identify, understand and change negative thinking patterns and behaviors. Patients are taught problem-solving skills during therapy lessons and then instructed to practice them on their own time in order to build positive habits.

Can medication help?

Medication can help alongside ERP, but it shouldn’t replace it. Doctors should always be consulted before considering medicinal options.

The main family of medicines used to treat OCD are known as Selective Serotonin Reuptake Inhibitors, or SSRIs. SSRIs enhance your natural serotonin activity and are used to treat major depressive disorders and anxiety conditions. Examples include Lexapro, Prozac, Paxil and Zoloft.

What is the goal of therapy?

Some people with Pure OCD recover completely through ERP. But for many, their obsessions never fully go away. OCD recovery has more to do with managing the condition, than it does with eliminating it. However, that doesn’t mean you can’t lead a healthy, happy life. By prioritizing treatment and positive lifestyle habits, sufferers often gain confidence and freedom. Even if some anxiety is still present by the end of therapy, you’ll no longer feel debilitated by the condition.

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