Pure Obsessional OCD

Defined

The chronic anxiety disorder pure obsessional OCD, commonly called Pure O, is a form of obsessive-compulsive disorder. It is distinct from traditional OCD in that it features no outward manifestations; instead, both the anxiety-inducing obsessions and relief-seeking compulsions of OCD take place in the mind.

With standard OCD, the compulsions manifest as physical rituals: excessive hand-washing, checking, cleaning. With Pure O, the compulsions manifest as unseen mental rituals, but they are compulsions nonetheless, which is why the term "pure obsessional" is somewhat imprecise.

With ongoing progress in mental health research, including fine-tuning in the field of anxiety, diagnoses of pure obsessional OCD have increased in recent years. Sufferers in the past were likely assigned broader diagnoses such as generalized anxiety disorder, panic disorder or standard OCD, possibly resulting in misdirected care.

Left untreated, Pure O can be debilitating to the sufferer, who often finds work and social time consumed by the condition. While OCD is an anxiety disorder, the longterm effects of its stress can include exhaustion and depression.

Symptoms and nature of the condition

A person with Pure O experiences periods of intense rumination that are triggered by intrusive or unwanted thoughts, sometimes called "spikes." Spike traits vary widely by individual, dictated by personal makeup and circumstance. Some frequently cited illustrations include:

• A heterosexual man is making love with his wife when the name of his male best friend happens to flash through his mind.
• A loving mother spots a pillow and has a momentary apprehension of infanticide.
• A young bachelor checks a mirror prior to a date and feels a surge of confidence, but shortly afterward cannot recall what exactly led to that feeling of pride.
• An aspiring painter glances at one of her works and experiences a sense of insecurity about her abilities.

Of course, these instances are not unique to those with Pure O; they are the sorts of day-to-day emotions and quirks experienced by human beings across the board. And for most people, such thoughts are passing and benign; at worst, they are momentarily jarring. For the Pure-O sufferer, however, such thoughts can be the spikes that induce panicky obsession, leading to an amplified sense of fear or self-doubt.

To neutralize the perceived danger presented by the spike, the Pure O is compelled into rumination, an often intricate mental routine driven by a pressing need to "solve" the fear or uncertainty. Ruminations vary from person to person. One type of rumination may involve continually reconjuring an unpleasant scenario. Another example might be an effort to precisely recall the sequence and order of thoughts that led to the spike.

These ruminations are accompanied by anxiety ranging from mild to severe, and can endure for extensive stretches, often hours at a time. Sufferers have described episodes that persist over a series of days. In most every instance, the rumination is all-consuming, essentially taking full occupation of the mind. During rumination, sufferers often find themselves unable to turn their focus to anything else, including "legitimate" sources of stress or danger. For instance: Genuinely bad news -- say, word of a friend's hospitalization -- may not trump or even penetrate the anxiety felt by an OCD sufferer who is ruminating on even a seemingly innocuous matter.

Like most OCD sufferers, those with Pure O wrestle with their disorder on a daily basis. They also largely recognize that their obsessions and compulsions are irrational. But without OCD treatment, such cognitive awareness may be of little benefit while under the deeper grip of the disorder.

Distinguishing Pure O and stress

It is important to distinguish between the clinical condition of Pure O specifically, or OCD generally, and what is casually called "obsessiveness" by the wider population in relation to stressful events.

For instance, a typical man who discovers he is losing hair may endure a genuine gnawing tension over the prospect of baldness. For a Pure O sufferer, however, the same discovery could spawn an entire new and daunting OCD template: new spikes to dread, new ruminations to endure. Glimpsing a shampoo commercial, spying a stray hair, catching a window reflection -- any number of everyday moments threatens to trigger a lengthy, agonizing rumination.

Treatment

Medications in the SSRI class of antidepressants have been used with some success in mitigating obsessive-compulsive symptoms (see "Treatment" section at "OCD"). But the emerging professional consensus is that pure obsessional OCD is best tackled with cognitive behavioral therapy. American specialists such as Edna B. Foa and Steven Phillipson claim increasing success with developments in intense exposure therapy.

External Links

• Stuck in a Doorway - online OCD support community with Pure O emphasis
• OCD Online - home page of Pure O specialist Dr. Steven Phillipson
• Center for the Treatment and Study of Anxiety - directed by Dr. Edna B. Foa