OCD/BFRB Discussion Post: Obsessions vs Compulsions (Pure OCD)

In our last session we talked about Obsession vs Compulsions and we touched on the topic of "Pure OCD". Some people expressed that they were interested more in the topic and wanted a longer discussion. So, I wanted to share some resources and an exercise as follow up to the discussion. Perhaps we can review these in future sessions as well!

Firstly, let's review some background.

1. What are Obsession and what are Compulsions?

While obsessions are recurring thoughts, compulsions are recurrent actions. Mostly these will be quite mild but in more extreme cases they may develop as a means for people to try to relieve themselves from their obsessive thoughts. For example, when there is an obsession with germs, a person may continually wash their hands, even to the point their hands become raw from so much washing. When a person continues to repeat an action, obsessions may go away for a short period of time, however, they will normally return. Once they return, the compulsion will begin again, starting a cycle of obsession-compulsion.

2. What is "Pure OCD?"

Pure OCD or "O-PCD" is a type of obsessive compulsive disorder where the compulsions are completed mentally. The name Pure Obsessional (Pure O) is a bit of a misnomer because it is, in fact, OCD. There are both obsessions and compulsions present. With that in mind, it is a name that has helped many people seek out treatment who otherwise would not have. Some may feel that they only experience obsessions, and not compulsions. That is typically not the case, and instead, mental rituals are occurring under the surface in a covert manner. People with pure OCD engage in mental compulsions (rather than physical ones) in an attempt to alleviate their anxiety.

3. What are some common themes in Obsessions?

Unwanted Harm thoughts, like:

• “Why if I lose control and hurt someone I love?”
• “What if I hurt my pet accidentally?”
• “What if I ran somebody over while driving?”

Religious or Moral Scrupulosity thoughts, like:

• “Did I offend god?”
• “What if I’m not living a life according to my religious or moral values?”
• “What if I wasn’t 100% honest?”
• “What if I accidentally cheated on a past exam?”

This can also include Relationships, Explicit thoughts, etc.

4. What are some forms of invisible "mental compulsions?"

Mental Reviews or Mental Checking

• Mentally reviewing past events to see if you missed any important details

• Mentally reviewing a drive to see if you accidentally hit someone
• Mentally checking to see if you’re still “appropriately” horrified by the thoughts
• Mentally checking to see if you’re still attracted to your partner

Self-Reassurance

• Repeating self-reassuring statements such as “I’ll be okay,” “don’t worry about this,” or “don’t be silly, that’s irrational”
• Repeating positive self-affirmations

Praying

• Silently repeating a prayer
• Praying for forgiveness due to unwanted thoughts

Counting

• Silently counting (family members, numbers, etc.)

Thought Neutralization

• Replacing “bad” words or thoughts with “good” ones through specific patterns

Note this is not an exhaustive list of Obsessions!

1. What are some forms of visible "mental compulsions?" Although Pure O is a nickname for OCD without observable compulsions, there are sometimes overt, or visible, compulsions that are present as well.

Reassurance seeking:

• Repeatedly asking someone if they think you did the right thing
• Repeatedly asking someone if they think you’d ever hurt anyone
• Repeatedly asking if something makes you a “bad person”
• Seeking reassurance from online forums or searches

Confessing:

• Sharing every detail of an interaction with a partner
• Overwhelming need to share a “bad” thing you might have done

Avoiding:

• Avoiding areas that could trigger obsessions (playgrounds, scary movies, songs, etc.)

Checking:

• Checking bodily sensations
• Checking that things are “safe” or how they “should” be

Great! Now that we have reviewed let's take a look at some examples of obsession and compulsions. Can you identify the following in each case?

1. What is the Obsessive thought? Was there are particular theme?
2. What part was the compulsion?
3. What the compulsion physical or mental?
4. If the compulsion was mental, was it visible?

Case 1: Taylor is watching a movie with his partner and thinks, “That’s weird. Why didn’t he laugh at that part? Does he not find it funny?” He might start thinking, “What if we’re not meant to be together? I’ve always found a shared sense of humor really important. Now that I think about it, we have nothing in common.”

Highlight the following for the answer: The obsession Taylor has is about Relationship OCD. He is engaging in a mental compulsion that is invisible as he "mentally reviewing or checking". He is not asking his partner for reassurance or confessing anything that would make it visible.

Case 2: Jim is sorting through his mail when he thinks to himself “what if I lose something important?” We begins to save every piece of mail that becomes huge piles on every surface of the house. Then he begins to save every notification and document, even when they’re out-of-date and no longer have a use.

Highlight the following for the answer: The obsession Jim has is about hoarding OCD. He is engaging in a physical compulsion by keeping every bit of documentation (physical or digital) "just in case" something bad might happen without it. There might be a "mental checking" portion of his compulsion that we are not fully aware of at this time.

Case 3: Marisol is getting ready in the morning and looks in the mirror thinking “what if I have a tumor?” She begins to visually and physically checking her entire body for lumps multiple times a day to make sure none have appeared.

Highlight the following for the answer: The obsession Marisol has is about health related OCD. She is engaging in a physical compulsion by checking herself over and over again by checking for lumps. There might be a "mental checking" portion of her compulsion that we are not fully aware of at this time.

Case 4: Connie is walking through the parking lot and has to counts the number of red cars before entering work. If she doesn't do the ritual, she is afraid she might get fired by her boss that day.

Highlight the following for the answer: The obsession Connie has is "magical thinking" or superstitious OCD. She is engaging in an invisible mental compulsion by counting to avoid a potential disastrous outcome.

Case 5: Sam is sitting in the car with his mother on the way to school. He has her if she loves him and she replies "Of course, sweetie!" A few minutes later Same asks his mother the same question. Slightly bewildered, Sam's mother repeats that she loves him with all her heart. Sam insists on knowing if she really loves him or she is just saying that because she is his mother?

Highlight the following for the answer:

The obsession Sam also has Relationship OCD. However, this is with his mother rather than a romantic partner. He is engaging in a visible mental compulsion by asking his mother if she truly loves him again and again. It is visible as he is engaging her in the compulsion and makes her part of the ritual.

Any questions? Ask below or join the next session at 8PM ET Wednesdays in the Support Session Room

Citations:

https://www.treatmyocd.com/blog/pure-obsessional-ocd

https://ocdla.com/obsessionalocd

https://www.choosingtherapy.com/pure-o/

https://www.goodrx.com/conditions/obsessive-compulsive-disorder/what-is-pure-o-ocd