Pure OCD, or pure “O” OCD, is a type of OCD where compulsions aren’t visible actions, but instead, they’re mostly thought-based.

“Pure OCD” is an unofficial obsessive-compulsive disorder (OCD) type. It’s also known as “pure obsessional OCD” or “pure O OCD.”

People with pure OCD still experience the main symptoms of the disorder: intrusive thoughts known as obsessions and repetitive rituals known as compulsions.

The difference with other types of OCD is that compulsions in pure OCD aren’t visible behaviors, like pacing around or wriggling your hands. Instead, pure OCD compulsions are mostly mental strategies used in an attempt to decrease your distress.

For example, praying a certain number of times, mentally repeating a mantra, or visualizing specific images.

No two people with OCD have the exact same experience, though. The intensity and frequency of the symptoms may vary from one person to the other, and even change over time.

Pure OCD is OCD characterized by obsessions and mental compulsions, as opposed to other types of OCD that involve obsessions and behavioral compulsions or rituals.

Obsessive-compulsive disorder involves two main formal symptoms:

  • obsessions: intrusive, upsetting, persistent thoughts
  • compulsions: measures you feel compelled to repeat in order to stop, soothe, or neutralize the obsessions

For example, someone might have distressing thoughts (obsessions) about burning their own house. To neutralize this upsetting obsession, they engage in actions (compulsions) like pacing up and down, getting rid of their matches and lighters, and constantly checking their gas is off. These are visible compulsions.

With pure OCD, the obsessions may be the same but the compulsions would be thoughts, not actions. So, instead of pacing up and down, you’d mentally sing a lullaby, for example.

“Pure O OCD in a way can be a misnomer, and a more accurate description is ‘primarily obsessional’,” says Sid Khurana, a psychiatrist based in Las Vegas. This is because you still have compulsions, Khurana says, but they aren’t visible to others — they all take place in your mind.

Most people have mental rituals that comfort them, even if they don’t live with OCD.

For example, you might repeat a confidence-boosting phrase to calm yourself during a job interview.

The difference when you have OCD is that compulsions are distressing, time-consuming, and often feel involuntary. They’re strategies you implement to try to decrease the distress obsessions cause.

Compulsions can impact your life in different aspects because you feel compelled to master them, which in turn leads you to repeat them until they “feel right.” This may take much of your time and cause you frustration and higher distress, which could impact your occupational and social life.

As per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the formal symptoms of OCD, including pure O OCD, are obsessions and compulsions.

A health professional will look for the following criteria to give an OCD diagnosis:

  • you experience obsessions, compulsions, or both
  • your obsessions and compulsions are disruptive and distressing
  • the obsessions and compulsions take up an hour or more of your day, every day

For pure OCD, a 2011 study and a 2015 study observed that symptoms involve mental compulsions like:

  • praying
  • mental counting
  • persistent and disruptive self-reassurance
  • mentally repeating phrases, affirmations, or mantras
  • mentally singing a specific song or reciting a poem
  • mentally reviewing your actions, thoughts, and memories
  • visualizing images that comfort you
  • attempting to “erase” memories or images

Compulsions are done in response to a specific thought or image that causes you distress, Khurana says.

“Often people with pure OCD have some level of insight and are able to tell the nature of the [distressing] intrusive thoughts, and the mental compulsions are their way to relieving the anxiety.”

Pure OCD feels different to different people. Even when you live with a mental health disorder, you’re unique and your experiences are related to your personality, experiences, and surroundings.

In general, OCD, including pure OCD, may involve different themes. For example, cleanliness, self-harm, relationships, or religion.

Here are some examples of pure OCD scenarios:

  1. Someone might experience intrusive thoughts that they believe are blasphemous. These thoughts are distressing and difficult to stop, and they’re worried about angering God. Their pure OCD compulsion might be to mentally pray for forgiveness 11 times every hour.
  2. A new father might experience intrusive thoughts and images that involve hurting his baby. Although he doesn’t want to hurt his baby, he worries that he might because of these persistent unwanted obsessions. His compulsion might be to mentally recall a specific song that (temporarily) soothes his anxiety and “turns off” the images.
  3. A person might have repetitive thoughts about cheating on their partner. Although they don’t want to be unfaithful, they worry that they’re mentally cheating because of these obsessive images. They might try to stop their thoughts by mentally reviewing their actions in the last 12 hours to reassure themselves that they’re not really cheating.

It isn’t always easy to tell whether you have pure OCD or not.

If you’re experiencing upsetting intrusive thoughts that won’t go away, it’s highly advisable to talk with a therapist. Therapy can benefit many people — even those who don’t fit the criteria for a mental health diagnosis.

Is pure OCD a formal diagnosis?

No. Pure OCD isn’t a formal mental health condition.

As per the DSM-5-TR, all OCD types and themes fall under the same diagnosis: obsessive-compulsive disorder (OCD).

The causes of pure OCD, much like the causes of OCD, aren’t yet established. Experts suspect many factors might be at play: your genetic make-up, your temperament, and your environment, for example.

Although the above-mentioned study from 2015 explored whether pure OCD could be hereditary, the authors could not reach a conclusion. More studies are needed.

Pure OCD, like all types of OCD, is treatable and symptoms can be managed.

OCD treatments include:

To supplement treatment, you may also consider:

“Pure O OCD is less well-studied so there is less data, but treatment remains the same,” Khurana says, pointing to ERP and medication as possible effective treatments.

“We do not know for sure whether the conventional treatments are less effective for this type, but we do know that [pure OCD] can go undetected and underdiagnosed,” he explains.

Pure OCD is an unofficial type of OCD where your compulsions might not be visible — but they’re still there. These compulsions are mainly mental methods instead of repetitive behaviors, like in other types of OCD.

Pure OCD may be difficult to live with. Symptoms can be managed, though, and treatment is available,

It’s possible to live a happy, healthy, fulfilling life despite experiencing pure OCD.