PURE OBSESSIONAL OCD

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 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. Some examples of pure obsessional OCD include:

• intrusive thoughts or mental images of killing ones spouse, parent or child
• 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, and 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

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 known as "Exposure and Response Prevention" (ERP) has proven to be very successful in the treatment of pure obsessional OCD. To learn more about Cognitive-Behavioral Therapy for the treatment of pure obsessional OCD, click here.

Additionally, a variant of ERP has been developed that has also been found to be extremely effective with 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.

In addition to individual therapy for pure obsessional OCD, we also offer five weekly, low-fee, therapy/support groups for people with OCD and related conditions. These groups are lead by our staff therapists, and use the same treatment protocol as our individual Cognitive-Behavioral Therapy program. For more information on our weekly groups for 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.