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4 Unique Challenges When Your Compulsions Are All in Your Mind

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Obsessive-compulsive disorder (OCD) is commonly known as the “hand washing” or “organizing” disorder. But there are many forms of OCD, including a lesser-known type called pure obsessional OCD, or Pure O. Pure O follows standard OCD patterns with one exception — the compulsions take place mentally. Examples of my mental rituals include avoidance, reassurance-seeking, ruminating and many more. But inward compulsions may make it difficult to recognize symptoms and identify an individual who may be suffering with Pure O.

While Pure O is as tormenting as other types of OCD, unique challenges often make the journey toward recovery more difficult to navigate.

1. People think Pure O doesn’t exist.

It’s not uncommon to hear “Pure O doesn’t exist” from clinicians. For me, this statement can be devastatingly triggering. When people hear “Pure O” they sometimes think it means obsessions but no compulsions. But we actually have non-detectable mental compulsions.

I was overjoyed to discover I was not alone in my obsessions. In my mind, the relief of a community overrides the need to be accurate with the terminology. The commonality of themes among our obsessions creates a community relieved to discover their disturbing fears are not uncommon.

2. Pure O obsessions are disturbing in nature.

All obsessions associated with OCD are frightening and unwanted. However, the intrusive thoughts of Pure O can be downright disturbing and tortuous for me. My Pure O fears may involve sexual, violent and/or blasphemous thoughts. While many people have fleeting, unwanted thoughts of this nature, I can latch onto the fear and possibly struggle for years with uncertainty.

Some common obsessions include: Fear of becoming violent or a murderer, fear of physically hurting another person or animal or fear of “turning” gay or straight.

I neither want to nor will commit these acts, but my inability to stop thinking about the fear leads me to doubt myself. With Pure O, we question our ethics and morality. It isn’t uncommon for me to think, “What kind of monster am I to have these thoughts? I must be evil inside to have these thoughts?”

There’s no reason why I may develop a particular obsession. Factually, my obsessions bear no reflection on my character, morality or ethics. While this explanation seems simple, people with Pure O often struggle with why and how could they could be capable of these thoughts, on top of managing the illness. This added stress can hinder the treatment process and the internal stigma surrounding the obsession.

3. We’re sometimes too afraid to say our fears out loud.

Many factors contribute to the silence about my Pure O fears. Despite knowing the fears are not real or a reflection of ourselves, we can still feel shame and guilt. It isn’t uncommon for me to wish I could have any other obsessions but my own.

Reasons we may be afraid to say our fears out loud include: Fearing others will believe the obsessions are true, fearing saying it out loud will make it a reality and fearing saying it out loud will “prove” it’s true. We also fear others will judge us.

The Pure O cycle is perpetuated by our inability to validate or invalidate the obsession. If saying the obsession out loud creates doubt in ourselves or others, I would go to great lengths to keep it hidden. This fear adds another difficult layer in navigating symptoms and oftentimes causes us to suffer alone.

4. Pure O creates a secondary fear that our thoughts are real.

Outward compulsions indicate to the outside world that help is needed. But my mental compulsions can overwhelm me and no one would know. This presents a unique fear. Because our compulsions are mental, we often cannot recognize their presence. We see them as part of our reality and perception, in turn making us doubt we have OCD at all.

I also used to agonize over whether my mental actions are truly compulsions because they feel so real. It isn’t uncommon for me to believe, “If these fears aren’t real, I wouldn’t still be thinking about them after all this time.” This secondary fear not only makes Pure O cycles hard to recognize, but they add to our shame and guilt and may prevent us from seeking help.

Every type of OCD is difficult to live with and manage; however, Pure O presents unique stress by way of shame, embarrassment and guilt. Pure O’s unique ability to call my moral code, ethics and character into question due to my disturbing obsessions can create a vicious cycle. The good news is I am not alone in this struggle and treatment has been found to be effective.

If you are experiencing any symptoms from OCD, you can visit the International OCD Foundation to find a specialist near you.

The Mighty is asking the following: For someone who doesn’t understand what it’s like to have your mental illness, describe what it’s like to be in your head for a day. If you’d like to participate, please send a blog post to Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

Originally published: January 29, 2016
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