Some individuals may suffer from "Pure Obsessional OCD" (sometimes called "Pure O") in which they report experiencing obsessions without observable compulsions. These obsessions often manifest as intrusive, unwanted thoughts, impulses or "mental images" of committing an act they consider to be harmful, violent, immoral, sexually inappropriate, or sacrilegious. For individuals with Pure Obsessional OCD, these thoughts can be frightening and torturous precisely because they are so antithetical to their values and beliefs.
Symptoms of Pure Obsessional OCD ("Pure O")
Symptoms of Pure Obsessional OCD vary widely from person to person. Some examples of common obsessions seen in Pure Obsessional OCD are:
- intrusive thoughts or mental images of killing ones spouse, parent, child, or self
- recurrent fear of molesting a child
- repeatedly worrying that one has or will physically assault another person or run over a pedestrian while driving a car
- repetitive thoughts that one has said or written something inappropriate, such as swearing at ones employer or writing hate-filled letters to a friend
- recurrent fears that one might be a homosexual, when in fact he or she is not (sometimes called "gay ocd" or "HOCD")
- intrusive thoughts or mental images that one considers to be sacrilegious or blasphemous, such as wanting to worship Satan or have sex with Christ.
However, it should be noted that the term "Pure Obsessional OCD" is somewhat of a misnomer. While it may at first appear that these individuals experience obsessions without compulsions, a careful assessment almost always uncovers numerous compulsive behaviors, avoidant behaviors, reassurance-seeking behaviors, and "mental compulsions,". These behaviors are not as easily observed as other, more obvious OCD symptoms, such as hand-washing and lock-checking, but they are clearly compulsive responses to unwanted obsessions. Some common examples of compulsions seen in Pure Obsessional OCD include:
- avoiding numerous situations in which he or she fears the possible onset of their obsessions
- repeatedly asking for reassurance that one has not and/or will not commit an act that he or she perceives as being "wrong" or "bad"
- silently praying or repeating certain phrases in an effort to counteract or neutralize thoughts that one considers to be immoral or sacrilegious
- repeatedly confessing to people, even total strangers, that one has had thoughts which he or she considers to be unacceptable
- continually ruminating about obsessions in an attempt to prove to oneself that he or she has not done and/or will not do anything inappropriate
Treatment of Pure Obsessional OCD ("Pure O")
For many years it was thought that Pure Obsessional OCD was next to impossible to manage because there were no behaviors to treat, only thoughts. However, a specific type of Cognitive-Behavioral Therapy (CBT) Cognitive-Behavioral Therapy known as "Exposure and Response Prevention" (ERP) has proven to be very successful in the treatment of Pure Obsessional OCD. Using ERP, clients challenge their fears of specific obsessions, as well as the compulsive and avoidant behaviors they use in an effort to cope with the anxiety caused by these obsessions.
Additionally, a variant of ERP has been developed that has also been found to be extremely effective for the treatment of Pure Obsessional OCD. This method, sometimes called "imaginal exposure," involves using short stories based on the client's obsessions. These OCD stories are audiotaped and then used as ERP tools, allowing the client to experience exposure to situations that cannot be experienced through traditional ERP (e.g., killing one's spouse or molesting a child). When combined with standard ERP for the above-noted compulsions, and other cognitive-behavioral techniques, this type of imaginal exposure can greatly reduce the frequency and magnitude of these intrusive obsessions, as well as the individual's sensitivity to the thoughts and mental images experienced in Pure Obsessional OCD. To learn more about Cognitive-Behavioral Therapy, Exposure and Response Prevention, and Imaginal Exposure for the treatment of pure obsessional OCD, click here.
One of the most effective CBT developments for the treatment of Pure Obsessional OCD ("Pure O") is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with Pure Obsessional OCD ("Pure O"), the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with avoidance behaviors, reassurance seeking, and/or mental rituals.
Group Therapy For the Treatment of Pure Obsessional OCD ("Pure O")
In addition to individual therapy, the OCD Center of Los Angeles also offers six weekly, low-fee, therapy/support groups for adults with OCD, Pure Obsessional OCD, and related conditions. These groups are led by our staff therapists, and use the same treatment protocol as our individual Cognitive-Behavioral Therapy program. To learn more about our weekly groups for adults with OCD, Pure Obsessional OCD, and related conditions, click here.
We also offer four, age-specific, therapy/support groups for children and adolescents with OCD, Pure Obsessional OCD, and related anxiety conditions. These groups are held monthly, and are limited to six participants. To learn more about our therapy/support groups for children and adolescents with OCD, Pure Obsessional OCD, and related conditions, click here.
If you are experiencing any of the above Pure Obsessional OCD symptoms, and would like to discuss individual or group treatment at the OCD Center of Los Angeles, you can call us at (310) 335-5443, or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.
Please note that the above is not meant to replace a complete and thorough evaluation by a licensed cognitive-behavioral therapist or other qualified mental health professional. Some individuals with OCD may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between OCD and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in our area. Furthermore, it is imperative to make the distinction between OCD and other medical conditions. For this reason, a medical examination may be necessary.
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