Pure O

What Is Pure O—and Why It Matters

Most people have heard of anxiety or OCD, but there's one type that often gets overlooked: Pure O, short for Pure Obsessional OCD. It’s a form of OCD where the obsessive thoughts are front and center, but the compulsions aren't as visible—because they mostly happen in the mind.

People with Pure O deal with upsetting, unwanted thoughts that can feel scary or intrusive. Unlike more commonly known OCD symptoms (like hand-washing or checking things repeatedly), the compulsions here are more mental—like replaying thoughts, trying to “prove” something to yourself, or constantly asking for reassurance.

Because these symptoms aren’t easy to see from the outside, Pure O is often misunderstood. Some people even question if it’s “real” OCD—but it absolutely is. The distress it causes can be just as intense and disruptive as more visible forms of OCD. That’s why understanding it—and getting the right kind of support—really matters.

What Does Pure O Look Like?

Pure O isn’t a separate diagnosis from OCD. It’s just a way to describe when someone’s OCD shows up mostly as mental obsessions and compulsions. These thoughts can involve:

• Fear of hurting someone (even if you never would)

• Doubts about your sexual orientation or identity

• Worries about being immoral or "bad"

• Constant fear of doing something wrong or against your values

These thoughts often repeat over and over and can be really hard to shake. And even though there may be no outward behavior, there’s usually a lot going on behind the scenes—like mentally checking, overthinking, or silently reassuring yourself that everything is okay.

For example, someone might get a scary thought about harming a loved one and then spend hours trying to figure out what it means—asking themselves, “What kind of person thinks that?” They may mentally review every action or memory to try and convince themselves they’re not dangerous. That cycle can be exhausting.

But… Is Pure O Actually Real?

Some mental health professionals have debated the term “Pure O” because mental compulsions are still compulsions. But many people find the term helpful—it puts words to what they’re going through and helps explain why they feel stuck, even without visible behaviors.

At the end of the day, whether you call it Pure O or something else, the experience is very real. And it deserves attention, understanding, and support—just like any other type of OCD.

Everyday Examples of Pure O

Pure O can be hard to spot, even for the person experiencing it. Here are a few common ways it might show up:

• Contamination fears—without handwashing. Instead of scrubbing hands constantly, someone may mentally replay every object they touched that day, trying to track any risk.

• Relationship OCD. This might look like constantly wondering, “Do I really love my partner?” or analyzing every moment of doubt or boredom as a sign something’s wrong.

• Taboo or unwanted thoughts. Some people get stuck on scary, strange, or disturbing thoughts that go against who they are. Even though they don’t act on them, they feel ashamed and stressed, trying to “undo” the thought mentally.

These aren’t just passing worries—they stick, loop, and interfere with daily life. That’s what makes it OCD.

Why Therapy Helps

Pure O can be incredibly isolating. Because the symptoms are invisible, people often feel like no one else would understand. They might also be scared to talk about the thoughts they’re having, worried they’ll be judged or misunderstood.

The good news? Help is available—and it works.

Two highly effective treatments for OCD are:

• Cognitive Behavioral Therapy (CBT)

• Exposure and Response Prevention (ERP)

With Pure O, ERP involves gently facing the scary thoughts without doing the mental habits that usually follow. Over time, this helps reduce the fear and gives the brain a chance to learn that the thought doesn’t need a reaction. It takes practice, but many people find real relief through this process.

Plus, with telehealth options, getting support is easier and more flexible than ever.

You’re Not Alone

Living with Pure O can feel incredibly isolating—especially when so much of the struggle happens in your head. You might worry that no one would understand your thoughts, or feel ashamed to talk about them at all. But you’re not the only one going through this, and there is help.

The truth is, intrusive thoughts are more common than most people realize, and having them doesn’t make you a bad person. What matters is how much distress they’re causing—and that’s where therapy can make a real difference.

Working with a therapist who understands Pure O can help you feel seen, supported, and empowered to break out of the cycle. You don’t have to keep managing this on your own. Whether you’ve been struggling for years or just recently started noticing the patterns, it’s never too late to get support and feel more in control of your mind again.

At Azra A. Kim, LCSW, LMSW, we’re here to help you take that first step. Let’s work together to make things feel a little lighter. For those looking into exposure and response prevention therapy for OCD to help ease the weight of intrusive thoughts, please get in touch with us.