“pure o” OCD: what it actually means (and why the name is a little misleading)
“Pure O” OCD: What It Actually Means (& Why the Name is a Little Misleading)
If you've spent any time in OCD communities online, you've probably come across the term "Pure O." Maybe you've even identified with it. “Pure O” is the idea of having OCD that lives entirely in your head, with no visible compulsions. Just relentless, terrifying thoughts on a loop.
That experience is real. But here's the thing: "Pure O" isn't actually an official diagnosis, and the name itself can be confusing and get in the way of people getting the right kind of help.
So Where Did "Pure O" Come From?
"Pure O" is shorthand for "purely obsessional" OCD. It refers to the idea that some people experience obsessions without any compulsions. It became a widely used term in online spaces and self-help communities, and it resonated with a lot of people who didn't see themselves in the stereotypical OCD image of someone washing their hands or checking locks. And that makes sense. If your OCD looks like hours of mental torture with no obvious outward behavior, it can feel like something entirely different from "regular" OCD. But here's what the research and clinical experience show: Pure O is not a distinct subtype of OCD. Almost everyone (dare I say everyone) who identifies with Pure O does have compulsions, they're just happening mentally.
What Are Mental Compulsions
This is the part that most people don’t understand about OCD… Compulsions don't have to be physical. They don't have to be visible. A compulsion is any behavior, physical or mental, that someone engages in in response to an obsession in an attempt to reduce uncertainty, discomfort, or doubt. And the mind is very, very good at generating them quickly and quietly (often without people even realizing they are engaging in them).
Mental compulsions can look like:
Mentally replaying a situation over and over to make sure nothing bad happened
Reviewing your own thoughts to check if you "really" meant something
Seeking reassurance (from others, from Google, from ChatGPT ) about whether your fears are real
Praying or repeating phrases internally to neutralize a thought
Analyzing the thought itself: Why did I think that? Does this mean something about me?
Trying to logic your way out of the fear ("I'm a good person, I would never do that")
Mentally confessing thoughts to yourself or others
These feel different from physical compulsions because they're invisible. Many people don't recognize them as compulsions at all. They just feel like thinking. Like trying to figure something out. Like being responsible. But they function exactly the same way: temporary relief, followed by the obsession returning stronger.
Why the "Pure O" Label Can Be Harmful
When someone believes they have "purely obsessional" OCD with no compulsions, a few things can go wrong. First, it can lead to the wrong treatment. ERP (Exposure and Response Prevention), the gold-standard therapy for OCD, works by targeting the compulsion. If someone doesn't believe they have compulsions, it's easy to skip that part, or to focus only on tolerating the obsessions without addressing what's actually keeping the cycle alive.
Second, it can keep people stuck longer. Mental compulsions are often invisible because they feel productive, like you're just "thinking things through." Recognizing them for what they are is often the turning point in treatment.
Third, the name can accidentally reinforce the idea that the thoughts themselves are the problem. They're not. It's the relationship to the thoughts and the compulsive effort (even mentally) to resolve, neutralize, or escape them that keeps OCD going.
What This Means for Treatment
If you identify with Pure O, the good news is that OCD is OCD and it responds to the same evidence-based treatment regardless of what the obsessions are about or whether the compulsions are visible. ERP for mental compulsions involves learning to notice the urge to mentally review, reassure, or neutralize and choosing not to. It means sitting with the uncertainty and discomfort without trying to think your way out of it. That's hard. It goes against every instinct. But over time, it teaches the brain that it's capable of tolerating doubt without resolving it and that the thought itself doesn't require a response.
You Don't Have to Keep Living Inside Your Head
At The Human Collective, we specialize in OCD and anxiety therapy using evidence-based approaches like ERP, CBT, and ACT. We work with clients online across California, Michigan, and Louisiana — including many people who spent years thinking their OCD "didn't count" because they couldn't see their compulsions.
Book a free 15-minute consultation with us to see if we'd be a good fit for your needs.
By Kaylee Bullen | The Human Collective | OCD & Anxiety Therapy in California, Michigan & Louisiana
