Reviewed by Whitney White, MS CMHC, NCC., LPC
Nearly everyone has heard of OCD, and it seems nearly everyone believes they understand what it means. But is that really the case?
The average portrayal of OCD in pop culture and the media is often inaccurate, and it has the potential to misinform the general public. To a certain degree, it already has.
Much of the population is unaware of Primarily Obsessional OCD, unfortunately often including the fraction of the population actually afflicted by it. To effectively treat either of these disorders, we must develop a more solid and more accurate understanding of each.
With that said, understanding the difference between Primarily Obsessional OCD and OCD can be a bit of a challenge. Let's break down each one in more detail.
What Is OCD?
OCD, or obsessive-compulsive disorder, is a serious, chronic mental disorder characterized by obsessions and compulsions. These obsessions and compulsions are generally uncontrollable and cause a good deal of distress. They also significantly impact an individual's ability to function, and they interrupt parts of daily life, like work or school.
Both obsessions and compulsions are key parts of OCD. Obsessions are generally intrusive, often unwanted, and repetitive thoughts or imagery that cause stress, anxiety, or another discomfort. Compulsions are usually responses to these obsessions and are attempts to relieve the distress caused by them.
Many people with OCD feel as though they are trapped in a vicious cycle. This could be due in part to the cause-and-effect nature of their symptoms. For example, if an individual struggles with obsessions related to perfectionism, they may seek a way to eliminate the anxiety and stress they feel, like organizing a room relentlessly.
However, compulsions often don't fully alleviate the distress caused by obsessions, or it may feel like the only way to find peace is to carry out these types of elaborate rituals.
It can be hard to list general symptoms for OCD because the experiences and obsessions/compulsions an individual has may be quite unique to them. However, there are some common obsessions and compulsions to look out for:
- Contamination/cleanliness/anxiety surrounding germs
- Example: fear of being contaminated by others around you or objects that you've touched; there may be a lot of anxiety associated with the fear of being contaminated/made ill
- Having a hard time dealing with uncertainty
- Needing to keep things neat, organized, or symmetrical
- Fear of losing control of oneself
- Fear of harm
- Unwanted thoughts, like those related to aggression or sexual urges
- Washing hands, cleaning self or home
- A person may wash their hands until it causes them harm, or they might scrub a home for hours and hours every day, among other possible warning signs
- Repeatedly checking something
- Example: checking to see if the door is locked repeatedly, or that the stove is off, a window is closed, etc.
- Following a specific, strict ritual or routine
- Enforcing orderliness
Symptoms may be different and harder to identify in children who develop OCD when compared to adults. Most individuals who develop OCD will do so during their teenage years or early adulthood.
What Is Primarily Obsessional OCD (Pure OCD)?
Primarily Obsessional OCD, also known as Pure OCD (or Pure-O), is a less common, yet significant, obsessive-compulsive disorder. Individuals with Pure-O experience obsessions (which operate the same as those we've discussed above), but they do not experience observable compulsions.
Pure OCD: Intrusive Thoughts and Compulsions
As mentioned, obsessions for those with Pure-O generally function in the same manner as those with OCD. Pure-O obsessions tend to be more heavily based on intrusive thoughts (like unwanted sexual urges, existential fears, etc.). These thoughts are generally uncontrollable and cause a lot of emotional distress.
Though individuals with Pure-O may not experience the same outward compulsions that those with OCD do, their obsessions still create a great deal of affliction.
Some may think that Pure-O is an obsessive-only disorder, but that's not necessarily the case. Those with Pure-O may perform mental rituals or other inward compulsions to alleviate some of their anxiety (like guilt, constant answer or validation seeking, etc.).
Having some occasional intrusive thoughts (like being unable to stop thinking about a major upcoming event that you're stressed about) is to be expected. Those with Pure-O, however, experience their intrusive thoughts and obsessions constantly.
The degree to which these obsessions affect their lives is more than what is considered healthy. In fact, those who experience obsessive-compulsive disorders often recognize that their fears are irrational but are still unable to stop them.
Is Pure-O OCD curable?
Unfortunately, like OCD, there is no definitive cure for Pure-O OCD. The disorder usually requires long-term treatment, and an individual may experience some periods with minimal symptoms and some with many.
Pure-O is treatable even if it is not curable. Sadly, many individuals may be living with Pure-O without realizing it; because both the obsessions and compulsions associated with Pure-O can be harder to identify from the outside, it may be challenging to diagnose.
In addition to that, public awareness of the disorder is not nearly as high as other mental disorders. Luckily, we have the power to help change the latter.
Differentiating Between OCD and Pure OCD
Both Pure-O OCD and general OCD are misunderstood in their own ways, but the two are distinct, different disorders.
Both OCD and Pure-O can be considered obsessive-compulsive disorders. Both disorders can cause obsessions and compulsions, though Pure-O is generally associated with internal compulsions rather than external, physical compulsions.
Pure-O and OCD also cause different types of obsessions (in general). The obsessions experienced by individuals with Pure-O are usually more focused around intrusive thoughts and reflections on oneself rather than anxiety about external stimuli.
Remember, it's possible to have intrusive thoughts, anxiety, or perform some routines or rituals in your life. These phenomena aren't inherently harmful, but when they begin to take over someone's life, they cross the line between healthy and obsessive-compulsive.
How Is Pure-O OCD treated?
As with OCD, treatment for Pure-O generally involves some type of cognitive-behavioral therapy.
Therapy treatment is usually designed to help lessen the intensity of symptoms and help target the root of the issue.
A common practice is to expose a patient to something that triggers intrusive thoughts or obsessions while instructing them to resist the urge to perform rituals to avoid it. In this case, the goal is to teach the mind how to rationalize and process the source of the obsession without creating the same level of stress or anxiety.
It’s important to remember that your thoughts are not necessarily a reflection of who you are. If you are experiencing disturbing thoughts, remember that they are just that: thoughts. You are ultimately in control of your mind, and you can let the thoughts drift away without them ever influencing your actions. Many people have intrusive thoughts all the time, and there is no need to feel shame or guilt for thoughts that pop into your head without your control.
The only way to know what treatment might look like for you, though, is to see your doctor. You may be referred to other healthcare professionals as well as part of your treatment.
Another important part of treatment and recovery for many is the support of those around them. If you love someone with any form of an obsessive-compulsive disorder, do your best to extend your support and love to them. It may make a world of difference.
Purely Obsessional OCD Test/OCD Test
If the symptoms we’ve discussed sound familiar to you (either because they relate to you or to someone you know), you might benefit from taking our free OCD test.
Please note that this test is not meant to be a diagnostic tool for you or anyone else. Instead, you can think of it as a tool to help you analyze your symptoms and familiarize yourself with the disorder. Always consults a healthcare professional if you have concerns regarding OCD or another mental health issue.
Our test is not exhaustive, and it's certainly possible for you to experience symptoms indicative of an obsessive-compulsive disorder even if they aren't listed.
That's why it's always best to share your concerns with a professional who has the resources to provide adequate treatment. OCD symptoms and Pure-O symptoms overlap with various other mental health issues, so it's always best to avoid self-diagnosis.
Pure-O OCD and OCD may overlap somehow, but it's best to recognize them as individual and unique disorders. It's also not necessarily accurate to suggest that they are a more or less severe version of the same disorder.
An important part of helping more people who experience mental illnesses receive the diagnosis and care they deserve is spreading awareness.
This is especially true for lesser-known disorders (like Pure-O OCD) or those that begin later in life. Many adults may be afflicted by symptoms of either of these disorders (or something else entirely) without even realizing it.
If you're concerned about OCD-like symptoms, it's always best to speak with your doctor. It's the necessary first step to set you up on the road to recovery.