Pure O OCD, sometimes called Pure Obsessional OCD, can feel like you can’t get out of your head. Intrusive thoughts make you feel stuck in a negative thought loop.
When people refer to “Pure O,” they are describing an OCD presentation in which physical compulsions (e.g., excessive hand washing or repeated checking) are not present or are not the predominant compulsion.
Obsessions are involuntary and unwanted thoughts, images, and urges that are experienced as intrusive and disturbing.
Compulsions are behaviors we feel compelled to do even when we don’t really want to. With Obsessive-Compulsive Disorder (OCD), compulsions are used as attempts to neutralize distressing feelings like anxiety and to prevent a feared outcome. Compulsions can be mental or physical acts, including avoidance.
Does Pure O OCD Really Have Compulsions?
Despite the name, Pure O OCD does involve compulsions. Even though it may feel like only obsessions are at play, compulsions are happening in the form of invisible mental rumination.
To the person with Pure O, the experience often feels like being trapped in a mental loop of overanalyzing: trying to figure something out, reviewing past events, or churning worries around and around without resolution. This experience can easily be mistaken for a steady stream of involuntary obsessions when, in reality, the person is repeatedly engaging with the obsession through mental compulsions.
The distinction that compulsions are present in Pure O is important because we have the power to change compulsive behavior. Learning to stop mental compulsions is possible with the help of an OCD Specialist. With professional guidance, it is possible to unhook from the mental patterns that keep you stuck.
Rumination-Focused ERP for Pure O OCD
In Rumination-Focused ERP (RF-ERP), clients can experience an empowered position of being able to choose to stop engaging with obsessions.
Of course, it’s not easy to change longstanding patterns. The drive to perform compulsions often feels like you don’t have a choice, and there may be emotional or traumatic factors that make things more complicated. With the help of an OCD Specialist who is sensitive to your emotional experience and has the technical understanding of how rumination works in Pure O OCD, change is possible.
Exposure and Response Prevention for Rumination
With Rumination-Focused ERP, we recognize that mental engagement with obsessions is compulsive rumination. Exposure and Response Prevention (ERP) works by helping people with OCD stop compulsions.
This process is more straightforward when compulsions are physical—like handwashing or checking—but sometimes clients continue to engage in mental compulsions once they’ve stopped washing their hands. They may mentally review all the “what if” scenarios or mentally track what’s been touched by their contaminated hands.
Unless this mental process is directly targeted, the client hasn’t stopped compulsions and therefore will not experience recovery.
In RF-ERP treatment, clients learn to stop both physical and mental compulsions. Exposure exercises are practiced in the context of not ruminating. The “response prevention” (RP) part of ERP is preventing the response of rumination when faced with obsessive thoughts.
Triggers and areas of avoidance are approached in the context of not ruminating. Stopping the mental compulsion of rumination often significantly reduces anxiety, making this kind of exposure work more gentle.
Prior to the exposure stage of treatment, clients are taught how to stop ruminating through attentional training practice and motivating encouragement. Emotional and relational factors that may interfere with the ability to stop ruminating are sensitively explored and worked through in a trauma-informed manner.
Getting Help for Pure O OCD
If you’re struggling with Pure O OCD, compulsive rumination, or mental compulsions, specialized treatment can help. Through Rumination-Focused ERP and evidence-based Exposure and Response Prevention (ERP), it is possible to regain your freedom.
If you’re looking for individual therapy in California, schedule a consultation to learn whether RF-ERP is the right approach for you.