When my 17-year-old son Dan told me he had obsessive-compulsive disorder, my first comment was “But you never even wash your hands!” While that statement surely revealed my limited knowledge at the time regarding OCD, what I was really trying to say was that he had no outward signs of the disorder. There was no repeated checking to see if the front door was locked, no order that had to be maintained in his room (in fact it was a mess), and not even any requests for reassurance from me. But yet, he had OCD. Enter Pure-O, or Pure Obsessional OCD. The name is deceiving however, as it leads us to believe that those with Pure-O have obsessions, but not compulsions. The truth is that those with this type of OCD do in fact have compulsions; however they are either not easily observable, or not the “typical” compulsions most of us associate with OCD. Compulsions might appear in the form of avoidance behaviors (Dan avoided so many people, places, and things that his world became one safe chair he would sit in for hours at a time), reassurance-seeking behaviors (for Dan this manifested through excessive apologizing), and mental compulsions (this included counting, reviewing events and conversations in his head, and lots of other things I don’t know about because I couldn’t read his mind and he didn’t often share with us).
Hindsight is a wonderful thing, and now that I know so much more about OCD than when Dan was first diagnosed, there definitely were some visible signs of his obsessive-compulsive disorder early on. Dan had stopped eating ice cream (avoidance) and would no longer go into our backyard swimming pool (more avoidance). And he did a lot of touching and tapping (visible compulsions but not as well-known as hand-washing). While I did notice these behaviors, they certainly never stopped me in my tracks and made me wonder if my son had a brain disorder. At the time, all I knew about OCD was what I had learned from the media, which often misrepresents the disorder. So because Dan didn’t present with “classic OCD symptoms” my husband and I didn’t know he had the disorder until Dan diagnosed himself with the help of the Internet and then told us himself.
The truth is that those with Pure-O often have an easier time of hiding their OCD than others with the disorder because of their unobservable compulsions. This means those with this form of OCD might suffer in silence longer than others with more visible compulsions.
However, there is good news as well. No matter what type of OCD you or a loved one might be dealing with, there is good treatment available. Exposure and response prevention (ERP) therapy is the front line psychological treatment for all types of OCD, including Pure O. A competent therapist who specializes in treating OCD will be able to help you fight your OCD, and might incorporate other techniques such as imaginal exposures into your ERP treatment plan.
OCD, no matter what form it takes, can be an insidious disorder, but with commitment, hard work, and a good health-care provider, it can be beaten. While many with Pure-O believe that their OCD isn’t treatable, that is simply not the case. My son has gotten his life back — others with Pure-O can too.