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What is Pure O OCD ?


Purely obsessional thinking, or “Pure O” is when repetitive, ritualistic, or obsessional thinking is present without the behavioral rituals. In Stop Obsessing, Drs. Edna Foa, PhD and Reid Wilson, PhD describe the symptoms in more detail.

Key Features of Pure O OCD

  • Reduce distress by using internal arguments

  • Perform specific and exact mental routines to get relief from obsessional thoughts

What are Pure O OCD Symptoms?

  • When triggered by a distressing thought, Pure O’s will create a reassuring thought to help reduce their distress.

  • The reassuring thought typically lasts for a brief period of time before the distressing thought reappears.

  • The pattern is then repeated.

  • This pattern is typical for most people when they feel distressed. Pure O individuals are different because they experience an internal dialog that is extreme and the lack of relief from the reassuring thought makes them feel out of control.

For example:

Pure O Thought: I am going to be fired

Reassuring Thought: You were promoted during the most recent cycle. They wouldn’t promote you and then fire you.

Pure O Thought: There’s always a first time

Reassuring Thought: You just received a positive call out at an all hands meeting last month

Pure O Thought: But I needed to ask for more time last week to complete the presentation for my team. There’s no way they don’t fire me.

Reassuring Thought: Other people have asked for more time for their projects, and they weren’t fired

Pure O Thought: Yes, but they are more talented than you. You know you don’t really belong on this team.


Common Features of Pure O OCD

Situations that can be a trigger

  • Any situation where someone could be harmed

  • Any place that provokes anxiety thoughts

  • Any situation where the Pure O could make a mistake

Clients at Good Therapy SF tend to be most triggered by these types of situations. For example, clients that are first time managers often feel they make many mistakes a day, because they are learning a new skill.


  • Harsh criticism of self or others

  • The thought of having made a mistake or doing something wrong

  • Guilt about the past

  • Thoughts of some unpleasant future experience

For example, clients that focus on setting new boundaries with others are fearful people will no longer like them or want to be associated with them.

Feared consequences of not obsessing (“What is going to happen if you stop worrying”)

  • I will fail

  • Something bad will happen to me / others

  • I will accidentally hurt someone

  • I will lose control and go crazy

  • I will be embarrassed

  • I will be punished

For example, someone could irrationally believe that if they stop telling themselves they are going to fail a test, then they will no longer be motivated to study, and they will be “punished” by failing.

Common Pure O OCD Compulsions (Reassuring thoughts)

  • Praying

  • Counting

  • Making mental lists

  • Retracing activities in memory

  • Mentally repeating phrases

It’s not uncommon for a Pure O to have a “go to phrase” or series of phrases that provide some relief as they are being spoken or thought out, but fail to provide relief after the fact. This short term relief is what reinforces the ritualistic nature of the compulsions.

A Final Word

Pure O is a unique sub-type of OCD. While there is a lack of compulsive behaviors, the ritualistic thoughts are no less triggering for Pure O sufferers. For help with Pure O and other anxiety disorders, feel free to reach out to Good Therapy SF.