Pure O

In classic OCD, the obsessions are persistent thoughts (e.g. obsession = "My daughter might die"), but the compulsions are rational or irrational physical actions to try to neutralize the obsessions (e.g. compulsion = "If I scrub the floors perhaps my daughter will not die"). Obsessions and compulsions are clearly separate and the compulsive act is observable by other people. In pure 'O' OCD, the obsessions and the compulsions are thoughts (e.g. obsession = "Did that thought of hitting that old lady mean I did hit her?" and compulsion = "I must try to re-live the past thought in my head to see if I can work out whether it was real or not").

Article link: The Guardian, 31st Aug 2013: Pure OCD: a rude awakening

Pure O establishes itself in the same way as classic OCD does - engaging in the compulsions (e.g. ruminating) keeps the problem going. Some people like the idea of the obsession as an imp that sits on the sufferer's shoulder, as in the following cartoon.

Pure O is arguably more difficult to treat than classic OCD (exposure and response prevention is more straightforward if the response to prevent is an action). Achieving step 4 in the above (the aim of therapy) is difficult as the imp's voice can be so loud and convincing. Pure O though is treatable. Some example treatment strategies that will help a sufferer get to step 4 are:

  • Writing down the obsession 'ad nauseam'.

  • Making a loop tape of the obsession, or an even worse one that you can think of, and listening to it 'ad nauseam'. The loop tape should be as explicit and anxiety provoking as possible. This maximises it's therapeutic value.

  • Exposing yourself to a huge number of situations that invoke the obsession so that your mind loses its ability to focus on any one of them.

  • Distraction - doing another activity.

  • Positive self talk.

In the example of a case where a sufferer has an obsession that he or she has done something terrible in the past, here is an example conversation that he or she might have with a therapist. If you want to use this to help with your own OCD, the exact wording will probably need to be adjusted for your own obsession. This example dialogue is not just useful to sufferers of pure O.

Sometimes doing an exposure can make a sufferer think that they have been reckless. E.g. because they made the conscious decision to do the exposure then that means that the harm that the sufferer thinks that they may have been responsible for is their own fault. Here is how the conversion might develop with the therapist in that case.

REMEMBER:

  • You have no choice about the intrusive thoughts that you have - don't punish yourself for having them, and, equally, don't punish yourself for doing exposures.

  • You have not got to be sure about anything! You can get better without knowing for sure. It's all about being comfortable with uncertainty.

  • You're unlikely to feel better immediately - getting better from OCD takes time for the benefits of rest and therapy to sink in to the subconscious parts of the brain that are alerting you to 'danger'.

  • Every time you try to 'resolve' an OCD thought with logic, your OCD affected brain will try to destroy the argument. Remember that your OCD has hijacked your brain and uses the resources it finds there to do its dirty work.

  • Act as if you don't have OCD - "fake it" until you "make it". It is hard, but it gets easier.

  • Take the risk.