Primarily Obsessional OCD (Pure O): Information, Symptoms, Treatment and More

Primarily Obsessional Obsessive-Compulsive Disorder, also known as and referred to henceforth as Pure O, is a mental health condition characterised by an individual predominantly having obsessive thoughts, along with mental rituals and few, if any, compulsive behaviours.

Pure O is very similar to Obsessive-Compulsive Disorder (OCD), although it isn’t as common. Pure O typically involves excessive rumination, intrusive thoughts, and feelings of anxiety.

Treatment for Pure O is available, with full remission from symptoms being a realistic objective. But this is a difficult condition to overcome.

What are the symptoms of Primarily Obsessional OCD (Pure O)?

An individual with Pure O will normally experience obsessive thoughts that repeatedly appear, just like regular OCD:

Obsessions: An obsession is an unwanted and unpleasant thought, doubt, image or urge that repeatedly enters a person’s mind. As a result, the person experiences anxiety or general unease. Examples include fear of contamination, and a need to organise items symmetrically.

Unlike OCD, the individual will not usually carry out a compulsive behaviour as a follow-up to their obsession.

Instead, the intrusive thoughts are typically linked to a certain fear that an individual has, normally based around their own behaviour.

Signs and symptoms

• The individual normally has distressing or unwanted thoughts entering their mind
• These thoughts are normally focused on an intense fear someone has
• Fears are normally based on how an individual may act in an embarrassing or uncharacteristic way that will either cause them or others harm
• Thoughts are often of a violent or sexual nature.
• Self-doubt is common, as an individual questions whether or not they are capable of acting in a way their thoughts are suggesting
• These intrusive thoughts cause an individual extreme distress and anxiety
• The individual will try and ignore these thoughts
• Excessive rumination

There is often a range of themes to obsessions. Sexual orientation, violence, health, an existential crisis, and other philosophical questions are common themes. Religion and relationships are other possible themes.

An example would be that an individual in a romantic relationship develops several obsessions. They may endlessly obsess over whether or not their partner is ‘the one’. They may analyse various elements of their relationship in great detail, often to the relationship’s detriment.

Understandably, these symptoms will often cause an individual’s behaviour to change. They may stop socialising out of fear of doing something embarrassing, or develop a severe phobia of people. They may blame themselves for their thoughts, which will commonly result in self-esteem issues. This typically causes impairment in multiple areas of life.

Pure O can be experienced in a multitude of ways. The symptoms listed here aren’t exhaustive, with obsessions manifesting in many different ways.

What are the causes of Primarily Obsessional OCD (Pure O)?

It isn’t entirely known that causes Pure O. Additionally, it also isn’t known why some people develop OCD rather than Pure O. It seems that there is significant crossover between the two conditions in terms of cause.

Pure O and OCD is known to run in families, suggesting a genetic component [1]. Similarly, a familial history of mental health problems is a risk factor.

Furthermore, there have also been suggestions that those with OCD (including Pure O) may have slight differences in brain activity, with some chemicals in the brain seemingly having increased activity and others having decreased activity [2].

Moreover, being a nervous person, having a lack of self-esteem, suffering from Anxiety, or experiencing trauma can all be additional risk factors.

Overall, further research is required to find out more about what causes Pure O and why some people do not have the compulsions seen in regular OCD.

Diagnosis of Primarily Obsessional OCD (Pure O)

Anyone with symptoms resembling Pure O should seek help from a doctor or mental health professional. This is a debilitating condition which can have a severe impact on a person if left untreated.

At an appointment, the patient will be asked several questions. These questions will be focused on the obsessions a person has, potential causes, and the impact they have on their day-to-day life.

There is no distinct set of criteria for Pure O. But someone will generally be considered to have the condition if they satisfy the following criteria:

• The individual has repetitive obsessions, characterised by intrusive thoughts
• These thoughts cause substantial distress
• The individual tries to ignore their intrusive thoughts
• The symptoms impact the life of the individual
• The symptoms cannot be attributed to substance abuse
• The symptoms aren’t better explained by an alternate mental health condition.

If a doctor suspects that Pure O is present, they will be offered treatment for the condition.

How is Primarily Obsessional OCD (Pure O) treated?

Treatment is available for Pure O, with the intention of a full recovery being made. This is a strong possibility, and the majority should see a reduction in the severity of symptoms.

The overall aim of treatment is for the individual to stop being affected by their thoughts, and feeling the need to answer the questions they pose themselves.

The main part of treatment is talking therapy, though self-help measures can be helpful too. Medication can be used if needed.

Self help

As with all mental health conditions, regular exercise, a healthy diet and a consistent sleeping pattern can all help.

Many self-help materials are available on the internet, while discussion and support groups are also available.

Talking Therapy

Talking therapy plays a crucial role in the treatment of Pure O. Cognitive-Behavioural Therapy is normally the therapy of choice – due to its focus on the thoughts and actions of an individual, which is a key area in Pure O.

In the event of a poor reaction to Cognitive-Behavioural Therapy, other talking therapies are available.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Cognitive Analytical Therapy (CAT): Cognitive Analytical Therapy provides a form of therapy that combines cognitive and psychoanalytic approaches to mental health. The aim is to instil techniques into an individual that should help improve the symptoms of their condition. There is a very strong focus on the relationship between therapist and client in this type of therapy.

As discussed, alternatives are available if needed. We have an article that lists the different types of talking therapies that are available. For more information, see our dedicated Therapy section.

Medication

In cases where necessary, medication can be prescribed. An antidepressant can help to make the intrusive thoughts seen in Pure O less prominent.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Pure O is a very difficult condition to live with and can have a debilitating effect on the life of those who suffer from the condition.

Treatment can certainly help however, and will often lead an individual to enjoying a far-healthier life, hopefully symptom-free. Our website has plenty of information to assist you in finding out more.

See Also

• Obsessive-Compulsive Spectrum Section
• What is the Prognosis for Obsessive-Compulsive Spectrum Disorders?
• Therapy Homepage
• Medicine Homepage