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Obsessional OCD

Obsessional OCD (Pure O) is a form of Obsessive Compulsive Disorder (OCD) in which individuals experience intense obsessions minus the obvious compulsions. These individuals will often experience intense ruminations that are often brought on by unwanted thoughts.

The obsessions come in the form of various intrusive thoughts, mental pictures, and impulses that individuals may feel are harmful or inappropriate. Some examples may include:

  • A person may have intrusive thoughts about having hit someone with their car even thought he/she hasn’t

  • A person may have a repeated worry that they have said or written something inappropriate, such as swearing in conversation or in a letter

  • A new mother may have unwanted images of hurting her child

  • An individual may have reoccurring fears that he/she might be homosexual, even though he/she is not

  • An individual may have constant thoughts and/or fears of molesting a child

  • An individual may have unwanted mental images or thoughts that feel sacrilegious

Many individuals may experience these thoughts day-to-day and though jarring in nature, we are able to recognize them as irrational and dismiss them. For individuals with Pure O, these thoughts may create so much fear that they begin to doubt themselves and become panicky. Thus, to neutralize these intrusive thoughts and extreme anxiety, they may continually ruminate on the obsession, repeat certain prayers, avoid various situations, confess their “bad” thoughts, and/or repeatedly ask for reassurance that they have not done or will do something “wrong.” 

The preferred Treatment for Obsessional OCD (Pure O) is Cognitive Behavioral Therapy (CBT). This therapy uses an approach called Exposure and Response Prevention (ERP). ERP allows individuals with OCD to experience the various events that cause them anxiety, while learning to tolerate the anxiety rather than performing a compulsive or ritualized behavior to quickly experience some relief. ERP assists individuals with OCD to become desensitized and/or tolerate the obsession without the marked anxiety. For those situations in which creating an exposure is not possible or appropriate, a form of ERP called “Imaginal Exposure” is used. This method involves writing a story of the individuals’ fears. These stories can be read or listened to while repeatedly exposing the individuals to their obsession. The use of “Imaginal Exposure” can assist individuals by decreasing the frequency and sensitivity to their unwanted thoughts and images.

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