“Pure O” OCD, or Purely Obsessional OCD, is a form of obsessive-compulsive disorder characterized by intrusive thoughts that cause significant anxiety, without the visible compulsions typically associated with OCD. Instead, a teen or young adult with Pure O may engage in mental rituals, such as rumination or seeking reassurance, to cope with distressing thoughts.
It may be scary as a parent to watch your loved one endure these feelings. It can make you feel helpless. However, it’s important to know that Pure O OCD is treatable. With the right support and therapeutic interventions, people with pure O OCD can learn to manage their symptoms and regain a sense of normalcy.
In this article, we will explore what Pure O looks like, how to recognize its symptoms, the potential causes, and effective treatment options available.
Quick Read
“Pure O” OCD, or Purely Obsessional OCD, is a subtype of obsessive-compulsive disorder characterized by intrusive thoughts that lead to significant anxiety. Unlike typical OCD, which often involves visible compulsions, Pure O primarily manifests through mental rituals. Teens and young adults with this condition may experience distressing thoughts related to aggression, sexuality, or religious issues and often engage in behaviors such as repeating prayers in their mind, seeking reassurance, or reviewing past actions or experiences.
Recognizing the symptoms of Pure O OCD is essential for effective treatment. Common signs include excessive worry, catastrophic thinking, and avoidance of triggers. Although the exact causes of OCD are not fully understood, factors such as genetics, environment, and social influences play a role.
With proper support and therapeutic interventions, people can manage their symptoms and improve their quality of life. Early intervention is crucial. Treatment options for Pure O OCD include Exposure and Response Prevention (ERP), Cognitive Behavioral Therapy (CBT), and medications like Selective Serotonin Reuptake Inhibitors (SSRIs). These approaches help teens and young adults manage their symptoms and regain a sense of normalcy.
What Does “Pure O” (Purely Obsessional) OCD Mean?
Primary Obsessional or Purely Obsessional OCD, also known as “Pure O,” is a form of obsessive compulsive disorder (OCD) characterized by frequent intrusive thoughts that are life-disrupting and create serious anxiety.
Pure O is not a diagnosis in the DSM-5. According to Expert Review of Neurotherapeutics, it’s a subtype of OCD. The distinction is that Pure O involves primarily mental rituals as opposed to observable physical ones. Upon experiencing intrusive thoughts, a person with Pure O will engage in rumination, the repetition of reassuring thoughts, and overanalyzing past thoughts and memories.
Intrusive Thoughts
The intrusive thoughts that come from Pure O are often related to the following:
- Aggression or physical harm
- Religion or religious symbols
- Sexuality or taboo subject matter
Mental Rituals
Individuals with Pure O will engage in mental rituals (that are actually compulsions) in order to resolve these thoughts. Examples may include:
- Repeating a prayer in one’s mind
- Reviewing past thoughts, actions, or experiences
- Seeking reassurance from others or the Internet through asking, telling, or confessing
- Frequent self-assurance
According to Depression and Anxiety, a person engaging in these activities, especially the ones that are primarily mental, may not even see them as compulsions. For this reason, Pure O can be hard to recognize and treat, especially in teens.
Recognizing OCD Symptoms
OCD can be a strong cause of anxiety and create problems that disrupt a teenager or young adult’s daily life and development. Recognizing OCD symptoms can pave a path for treatment that can alleviate symptoms and help you or your loved one thrive again.
Here are some symptoms of OCD in teens and young adults:
- Excessive and/or unrealistic worries
- Catastrophic thinking
- Highly superstitious thinking or behavior
- Constantly questioning their sexuality or gender identity
- Constantly checking and re-checking locks or switches, either for safety or a certain number of times (as a superstition)
- Frequent handwashing
- Excessive fears of germs, disease, or contamination
- Excessive desire for reassurance, and a strong emotional response when reassurance is not provided to their satisfaction
- Frequent cleaning or constant organizing
- Body dysmorphia (fixation on a certain body part related to self-image)
- Avoidance of people, places, or things that may trigger intrusive thoughts
OCD can often be misconstrued as just being about perfectionism or germophobia. But OCD symptoms can be debilitating for your child. If you find that your teen or young adult is suffering from intense anxiety and ritualistic behaviors, regularly seeking reassurance and practicing avoidance (even to the point of isolation), it’s time to get treatment professionals involved.
Take our OCD quiz, designed for young adults or for parents of teens) to help determine whether OCD is the root cause of the symptoms you’re seeing. Start now.
What Causes OCD in Teens?
According to the International OCD Foundation, the cause of OCD is unknown; but research has shown that, like many disorders, it is influenced by a combination of genetic, environmental, social, and personal factors.
Neurotransmitters like serotonin, dopamine, glutamate, and GABA have been shown to play a role in the presentation of OCD, but a chemical imbalance alone does not determine whether the condition will develop. About 10 to 20 percent of children who have a parent with OCD may develop it themselves, but environmental factors are also at play—such as background, culture, learned behaviors, and social influence. Obsessions and compulsions may differ depending on what families, cultures, religious groups, and ethnic societies consider to be threats or taboo.
Teens specifically deal with variations in hormone levels, changes in their physiology, and the exploration of their identity and self-image. Their fixations may be largely influenced by their environment, social groups, family life, and personal development. OCD may alter their thinking and behavior, but it can be treated effectively, and they can go on to live healthy, functional lives.
How Is Pure O OCD Treated?
There are a number of treatments for Pure O and general OCD that can help teens and young adults regain their mental health. Here are a few:
- Exposure and Response Prevention (ERP). ERP is a proven first-line treatment for OCD, including Pure O. It’s a form of Cognitive Behavioral Therapy (CBT) that involves doses of exposure to what the individual fears alongside planned responses to help prevent compulsive behaviors.
- Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are a class of medication designed to improve the balance of serotonin in a person’s system, providing more mental clarity and stability. It’s optimal when SSRIs are paired with therapies such as ERP to help individuals make measurable progress.
- Cognitive Behavioral Therapy (CBT). CBT is a research-backed treatment that has proven to be effective for a number of conditions, including OCD. CBT involves an analytical evaluation of fears, intrusive thoughts, and other stressors, emphasizing the ability to choose an appropriate response. It helps those with OCD rediscover their sense of agency through rational consideration.
- Acceptance and Commitment Therapy (ACT). ACT focuses on embracing the present moment and allowing intrusive thoughts or emotions to be fluid, not concrete. It takes the power away from unwanted experiences and offers individuals the chance to move through them with peace and purpose.
These treatments can be provided by a licensed therapist in either an inpatient or outpatient setting, though a psychiatrist or clinician must be involved to prescribe medication. With support and monitoring, young people with Pure O or general OCD can build resilience and navigate symptoms in healthy ways.
How to Help a Teen or Young Adult with Obsessive Tendencies
If you notice that your child is struggling with obsessive tendencies that may indicate Pure O or general OCD, offer to listen and have a conversation about what might be going on. They may be hesitant to disclose their intrusive thoughts or compulsive behaviors because of fear or shame. However, you can continue to provide support and stay engaged.
Getting a treatment professional involved is always a good idea, even if your teen or young adult child does not have a diagnosis. They may need another perspective and a sounding board when it comes to dealing with challenging thoughts and strong emotions. Waiting until a crisis will only create more problems.
Treatment for OCD in Teens and Young Adults
Newport Healthcare provides specialized OCD treatment for teens and young adults, using ERP therapy in combination with other modalities, including Dialectical Behavioral Therapy, Motivational Interviewing, and Attachment-Based Family Therapy.
Our family therapy component is core to our program and helps strengthen parent-child relationships. In addition, clients participate in experiential therapy, including art, music, yoga, and outdoor adventure therapy.
If you or your loved one is struggling with Pure O or general OCD, get in touch with us today to learn more about treatment options.
Frequently Asked Questions
Purely Obsessional OCD, also known as “Pure O,” is a form of Obsessive Compulsive Disorder (OCD) characterized by frequent intrusive thoughts that are life-disrupting and create serious anxiety. OCD is a condition known for obsessions and compulsions; with Pure O, it seems like the compulsions are not present, but the truth is that the compulsions are mental (and not typically observable).
Effective treatments for Pure O OCD include Exposure and Response Prevention (ERP), Selective Serotonin Reuptake Inhibitors (SSRIs), Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT).
Exposure and Response Prevention (ERP) is a proven first-line treatment for OCD, including Pure O. It’s a form of Cognitive Behavioral Therapy (CBT) that involves doses of exposure to what the individual fears alongside planned responses to help prevent compulsive behaviors.
The most common medications for Pure O OCD or general OCD are Selective Serotonin Reuptake Inhibitors (SSRIs), which are designed to improve the balance of serotonin in a person’s system, providing more mental clarity and stability. It’s optimal when SSRIs are paired with therapies such as ERP to help individuals make measurable progress.
Exposure and Response Prevention (ERP) is a proven first-line treatment for OCD, including Pure O. It’s a form of Cognitive Behavioral Therapy (CBT) that involves doses of exposure to what the individual fears alongside planned responses to help prevent compulsive behaviors.
Support them by encouraging professional therapy (like CBT), helping them understand their condition, practicing coping strategies, and being patient and non-judgmental.
Signs include intrusive, unwanted thoughts, excessive rumination, anxiety about these thoughts, avoidance behaviors, and distress over their inability to control these thoughts.
Yes, OCD can have a genetic component, as it often runs in families, but environmental factors also play a significant role.
Residential treatment can be beneficial for severe cases of OCD, providing intensive therapy and support, but it depends on the individual’s needs and circumstances. Newport staff can help you determine next best steps for your child.
Length of stay for residential treatment is determined by the care team and takes into consideration the unique needs of each client.
Sources
- Grassi, G. (2023). Expert Review of Neurotherapeutics, 23(12), 1051–1052.
- Depress Anxiety. 2011 Apr 20;28(6):495–500. doi: 10.1002/da.20820.
- International OCD Foundation
