What is 'Pure O'?

The term ‘Pure O’ has become very popular, especially since the start of the show Pure on Channel 4, which follows the journey of a woman who lives with this type of OCD. This term is generally used to describe a particular type of OCD in which compulsions are not visible or physical, but there are sometimes misunderstandings around this.

 

Why ‘Pure’?

‘Pure O’ is a term that is used to describe a certain manifestation of OCD. The term originally stood to mean ‘Purely Obsessional OCD’, because the people living with it struggled with intrusive thoughts and obsessions (the ‘O’ in OCD), but didn’t seem to take part in any compulsions (the ‘C’ in OCD) in response to them. Thanks to a better understanding of OCD in recent years, we now understand that compulsions are still present, just not always visible or obvious.

Compulsions that someone with ‘Pure O’ might take part in include:

  • Rumination, going over and over their thoughts, being unable to ‘let go’ of them, possibly to try to rationalise with themselves and use logic to show themselves that the obsessions aren’t true
  • Mental checking, checking their own thoughts or memories  to make sure that the obsessions aren’t true
  • Physical self-checks, checking for physical responses that deny or confirm the intrusive thoughts (such as groinal responses)
  • Reassurance seeking, repeatedly reminding or reassuring themselves that the obsessions aren’t true or real, or looking for this reassurance from others
  • Avoidance, avoiding situations or people that are the topic of the intrusive thoughts
  • Thought neutralising, thinking a good thought to cancel out the bad one
  • Giving in, trying to move on by viewing the intrusive thoughts as true, so as to not have to fight against them anymore – this is different from acceptance of uncertainty, which is a positive way of challenging OCD

These compulsions are a mix of physical and mental, but are sometimes difficult to identify by the person experiencing them or the practitioners they are speaking to because they are not conspicuous or don’t fit the idea some people have about what compulsive behaviours look like. It can also be difficult to realise just how much time and energy is being used on these, because things like mental checks or rumination can be going on in the background while going about everyday life.

Recent studies looking into the presence of compulsions in people being treated for OCD have found that, when including these as possible compulsions, 100% of participants experienced compulsions. Because of this, the meaning of ‘Pure O’ has now changed to mean OCD with covert, mental, or otherwise not noticeable compulsions, rather than with no compulsions.

 

Is ‘Pure O’ different from OCD?

OCD is defined by a cycle of obsession-anxiety-compulsion, in which the compulsions are acted on in order to temporarily reduce the anxiety brought on by an obsession or intrusive thought, but in the long run increase the strength and power of the obsessions. ‘Pure O’ follows this same cycle, with an intrusive thought bringing on an intense anxiety, which the person reacts to with one or more of the compulsions described above. Even though these compulsions are not visible to others, the person will usually be spending a significant amount of their time and energy repeatedly going through them.

The recommended treatments for OCD, which are medication and Cognitive Bevhavioural Therapy (CBT) with Exposure and Response Prevention (ERP), work to help the person with OCD to get out of this cycle. There is no research that shows these treatments are any less effective for different manifestations of OCD, including ‘Pure O’. Some people worry that they won’t be able to go through exposure tasks because their obsessions are too abstract or dangerous to be exposed to, or because they don’t have a physical compulsion to stop themselves from doing. While these things might make exposure more complex, they don’t make it impossible. Trained and experienced CBT therapists can be very creative in working out exposure programs and homework!

 

What about other types of OCD?

‘Pure O’ is only one of many terms used to label different types of OCD. Because these are not clinical or technical terms, we do not make use of them at OCD Action and they should not be used within diagnosis. However, individual people with OCD often choose to use these terms to label what they are experiencing, and can find comfort or a sense of community in knowing that there are so many others out there experiencing what they are that there is a term for it.

Where the ‘Pure O’ label describes the type of compulsions someone experiences, other labels for ‘types’ of OCD are descriptive of the topic of the obsessions. For example, ROCD (around relationships or responsibility), HOCD (around harm or homosexuality), and POCD (around paedophilia) are other popular labels used. It’s completely possible for more than one of these labels to be applicable to an individual’s experience, or for someone’s OCD to shift within their lifetime from one ‘type’ to another.

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