When OCD is Invisible: Understanding Pure O

When people think of Obsessive-Compulsive Disorder (OCD), they usually picture visible compulsions like handwashing, checking locks, or arranging items “just right.” But not all OCD looks this way. Some people live with Purely Obsessional OCD, often called “Pure O.”

If you’re wondering whether Pure O is really OCD, or if it can get better, you’re not alone — and yes, effective help is available.

What Is Pure O?

Pure O is a bit of a misnomer because there are compulsive actions - they are just in your mind. Instead of repeating physical rituals, people with Pure O get stuck in mental rituals like analyzing, mentally reviewing, or seeking reassurance.

At the root is the same problem: intrusive, unwanted thoughts that trigger intense doubt and anxiety and compulsive actions meant to neutralize that anxiety.

Common Pure O Themes

Pure O can focus on any intrusive thought that feels disturbing, taboo, or out of character. Common themes include:

• Harm OCD: Fear of harming someone you love, or yourself.

• Sexual Orientation OCD: Constant doubt about your sexual orientation, even when you’ve never questioned it before.

• Relationship OCD: Obsessing over whether you really love your partner, or whether they love you.

• Religious or Moral OCD (Scrupulosity): Obsessive worry about committing sins or being immoral.

Why Pure O Feels So Distressing

The thoughts in Pure O feel real and personal, like they say something terrible about you. But intrusive thoughts are normal; nearly everyone has them. In OCD, though, your brain gets stuck trying to make 100% sure they’re not true and that’s where the mental rituals start.

What Mental Rituals Look Like

People with Pure O often:

✅ Repeatedly analyze thoughts to “figure them out”

✅ Seek reassurance from loved ones or the internet

✅ Mentally review memories or check feelings

✅ Avoid situations that might “trigger” the thoughts

Unfortunately, these mental compulsions make the anxiety worse in the long run.

How Therapy Helps Pure O

Two evidence-based therapies work well for Pure O:

✔️ Exposure and Response Prevention (ERP): In ERP, you learn to face the intrusive thoughts without doing mental rituals or seeking reassurance. Over time, your brain learns that you can tolerate the uncertainty, and the anxiety fades.

✔️ Inference-Based CBT (I-CBT): I-CBT helps you spot the “reasoning error” that makes the thought feel true. You learn to see how OCD creates false doubts and how to trust your senses and logic again. I-CBT can feel less intimidating than ERP for people who struggle with mental rituals.

While ERP is the gold standard for OCD treatment I-CBT is a promising option for undoing the doubt and getting you out of the OCD cycle.

Finding the Right Support

Living with OCD can feel isolating but you don’t have to go through it alone. Whether you’re searching for an OCD therapist near me in Campbell, San Jose, or prefer an OCD therapist online anywhere in California, evidence-based help is available.

Start Finding Relief

If you think you may have Pure O and want to stop the cycle of intrusive thoughts and mental rituals, I’m here to help. Together, we can create a plan using ERP, I-CBT, or a blend of both to help you feel like yourself again.

✨ Reach out today to learn more about OCD therapy in Campbell, San Jose, or online throughout California.

Request a Consultation

Contact Me

Caitlyn Oscarson, LMFT

Helping adults, students, and new parents overcome OCD and anxiety with compassionate, evidence-based care.