Why ‘Pure O’ is Pure BS
If you’ve ever heard someone say they have “Pure O,” short for “purely obsessive” OCD, you might have wondered what that means. The term suggests that a person experiences only obsessions including distressing, intrusive thoughts or mental images, but no compulsions.
And while that phrase has gained traction online and in pop culture, here’s the truth from a clinical perspective: there’s no such thing as pure obsessional OCD.
That’s right: “Pure O” is pure BS.
It’s not that people using the term are lying or exaggerating their symptoms. It’s that what’s really happening underneath the surface isn’t being called by its true name: mental compulsions. And recognizing that difference can change everything about treatment and recovery.
The Myth of “Pure O”
When people say “Pure O,” what they usually mean is that they experience distressing, unwanted thoughts but don’t see themselves doing the outward rituals typically associated with OCD (like handwashing, checking, or counting).
For example:
Someone might have intrusive thoughts about harming someone they love.
Another might obsess about whether they’re truly attracted to their partner.
Or they might question their faith, their sexuality, or their morality.
Because these obsessions aren’t accompanied by visible rituals, people often assume there are no compulsions. But in almost every case, there are, they’re just happening inside the mind.
Mental Compulsions: The Hidden Rituals
Mental compulsions are the quiet, internal rituals people perform to try to neutralize distress or find certainty. These can include:
Reviewing: Mentally replaying past conversations or events for reassurance (“Did I really mean that?”)
Reassurance seeking: Asking others repeatedly for confirmation (“You don’t think I’m a bad person, right?”)
Rumination: Going over and over a thought or fear in an attempt to “figure it out”
Praying or repeating phrases: Trying to counteract a “bad” thought with a “good” one
Mental checking: Scanning your feelings to see if you feel anxious, guilty, or aroused
These behaviors serve the same purpose as washing hands or checking locks because they reduce anxiety temporarily. But just like physical compulsions, they reinforce the OCD cycle in the long run. To learn more about hidden compulsions, download our free eBook here!
So while “Pure O” might look invisible, the compulsion is still there, it’s just harder to see.
Why It Matters
Here’s why this distinction matters so much:
If we call it “Pure O,” we risk treating it like it’s just about intrusive thoughts. But that can lead to two big problems:
Misdiagnosis or delayed treatment — People (and sometimes even therapists) may think “I just need to talk about these thoughts,” and they get stuck in talk therapy that unintentionally reinforces the cycle.
Missed opportunity for ERP — The gold-standard treatment for OCD—Exposure and Response Prevention—targets compulsions. If you don’t identify them, you can’t treat them effectively.
ERP helps clients face their intrusive thoughts without engaging in compulsions, including mental ones. The exposure is the same, the response prevention just looks different.
Instead of resisting a physical ritual, you resist the mental urge to review, reassure, or analyze. It’s powerful, uncomfortable—and life-changing.
What ERP Looks Like for “Pure O” (a.k.a. Mental Compulsions)
ERP with mental compulsions focuses on awareness, exposure, and acceptance.
Here’s how that might look in practice:
Step 1: Identify your mental rituals. Notice how you respond to intrusive thoughts—what you do in your mind to make the anxiety go away.
Step 2: Create exposure exercises. These might include writing or reading your feared thoughts aloud, or sitting with uncertainty without analyzing it.
Step 3: Practice response prevention. When the urge to ruminate or reassure yourself hits, you name it, breathe, and do nothing. The anxiety will rise… and then fall, naturally.
Step 4: Focus on values, not fear. The more you engage with life—relationships, work, joy—the smaller OCD’s voice becomes.
ERP teaches the brain that thoughts are just thoughts—not emergencies.
Common Traps in “Pure O” Treatment
Even among therapists, “Pure O” can cause confusion. Here are a few red flags that therapy might be missing the mark:
You spend most sessions analyzing your intrusive thoughts.
Your therapist frequently reassures you (“That doesn’t mean you’re a bad person”).
You feel calmer temporarily after sessions, but the anxiety always comes back.
That’s not recovery, that’s OCD getting creative.
The goal of good OCD treatment isn’t to convince you your fears are false—it’s to help you tolerate uncertainty and live meaningfully, no matter what thoughts show up.
It’s Time to Retire the Term “Pure O”
The phrase “Pure O” might feel validating—it helps people put a name to their experience—but it’s misleading. There’s nothing “pure” about it.
OCD is a cycle of obsession and compulsion, whether the compulsion is visible or not.
By calling it what it is, we open the door to the right kind of help: structured, evidence-based therapy that breaks the loop instead of feeding it.
Final Thoughts
If you’ve ever thought, “But I don’t have compulsions,” I get it. I’ve sat with countless clients who said the same thing—until we unpacked the quiet mental rituals keeping them trapped.
You’re not broken or hopeless. You’re just human, trying to make sense of anxiety with the tools your brain has right now.
But there’s a better way.
ERP and approaches like Unified Protocol teach your brain to stop chasing certainty and start tolerating discomfort. That’s where the real freedom begins.
So the next time you hear “Pure O”?
Just remember: it’s not pure—it’s OCD doing what it does best.
At The OCD Relief Clinic, we specialize in treating all forms of OCD, including those that feel “purely mental.” Our team of OCD specialists understands the nuances of intrusive thoughts and mental compulsions—and we know how to help you break free from their grip.
You don’t have to keep managing this on your own or wondering whether what you’re doing counts as OCD.
Let’s get you the right kind of help—the kind that actually works.
Reach out today to schedule your intake appointment and start learning how to live freely again, with confidence and compassion.