The obsessions experienced by individuals with “Pure-O” OCD are commonly accompanied by mental compulsions.

As a follow-up to my previous post on Pure-O OCD, I thought it might be helpful to identify some obsessions that are commonly reported by individuals with Pure Obsessional OCD.  These same obsessions may also be experienced by individuals with non-Pure-O forms of the disorder.  Keep in mind that some of these symptoms are quite common (when experienced in a limited form) and may or may not represent an underlying psychological condition.  If you experience symptoms like these, consult with your doctor for clarification.  I am also available to conduct assessments and provide treatment if you’re located in South Florida (Palm Beach Gardens, Jupiter, West Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami).

Remember that most people who have Pure-O OCD actually perform compulsions.  These compulsions just tend to be mental rather than behavioral in nature.  Mental rituals are varied and include such activities as repeating certain words or phrases in one’s head, counting, intentionally thinking “positive thoughts” to counteract “negative thoughts”, pre-planning words before speaking, making mental lists of similarities between one’s own experience and others’ experiences, conducting online research to prove or disprove a fear, or repeating/restarting prayers due to distraction or worry that one’s prayers are not 100% genuine.

For some individuals, mental rituals also include complex cognitions.  Complex mental rituals often begin simply with one of the following statements or questions and then take on a life of their own:

OCD Mental Rituals

• “I would never do that…but what if I do?…I don’t want to…but what if I secretly do?”
• “Why is this happening?”
• “When will this stop?”
• “I can’t live this way…”
• “I need to know…”
• “I’ll never be strong enough to face this…”
• “I wouldn’t be having these thoughts if I didn’t secretly want this…”
• “Maybe I need to act on these thoughts to finally be rid of them and feel closure…”
• “It’s always going to be this way…”
• “I can’t take the chance, because if I did…”
• “If I could just figure this out, I would be able to move past it and it wouldn’t bother me anymore…”

Such thoughts usually begin innocently enough, but in the case of mental rituals, they become repetitive, desperate, and counterproductive. The reason these thoughts are so seductive is because they have the semblance of being helpful.  People often feel that by engaging with these thoughts, they are somehow making progress in solving their own mental puzzle.  In some ways, this parallels the way that chronic worriers ruminate and prepare for every possible contingency (even remote ones that other people would consider unreasonable).

With OCD, you cannot get better by “figuring it out” in your head. This won’t happen today, tomorrow, or even a year from now. OCD does not yield to insight.  Overcoming OCD requires active non-avoidance and actually confronting the very things you fear.

See if you can imagine how the following obsessions might give rise to complex mental compulsions/rituals.

Pure-O OCD Obsessions

Harm-related obsessions

• Fear of harming self or others (e.g., stabbing, hitting, shooting, suffocating, or poisoning)
• Fear of wanting to harm self or others
• Fear of hitting someone while driving (“Hit-and-run” OCD)
• Fear of leading to someone’s accidental injury or death
• Fear of assaulting or killing strangers

Religiously- or morally-themed obsessions (often referred to as religious scrupulosity)

• Fear/doubt about one’s faith, fear that one might not truly believe in God
• Fear of being damned or committing an “unpardonable sin”
• Repetitive sacrilegious thoughts (desecrating religious icons, imagining nude images of Jesus/Mary/Pope/priests/rabbis or other religious persons)
• Fear of being sexually attracted to religious figures
• Fear of secretly wanting to worship the devil or becoming a Satanist
• Excessive concern about past mistakes or previous decisions

Obsessions focusing on sexuality or romantic relationships

• Fear of being gay (also referred to as Homosexual OCD, or “HOCD”), when the person is actually straight
• Fear of being straight, when the person is actually gay or bisexual
• Fear of being attracted to children (i.e., pedophilia)
• Fear of being attracted to animals (i.e., bestiality)
• Fear of being attracted to dead things or dead people (i.e., necrophilia)
• Fear that one might cheat on his/her partner or spouse (infidelity-related)
• Fear that one might want to cheat on his/her partner or spouse

Obsessions about acting on an unwanted impulse (also see harm obsessions above)

• Fear of acting in a sexually inappropriate manner (e.g., exposing one’s genitals to others, flashing people)
• Fear of shouting or screaming obscenities
• Fear of committing arson
• Fear of attacking police, taking firearms/guns from police and using them on self or others
• Fear of accidentally talking about robbing a bank (while at a bank)
• Fear of accidentally talking about terrorism/hijacking (while at an airport)
• Fear of throwing important items (e.g., keys, wallets) in places where they cannot be retrieved (e.g., lakes, shredders, elevator shafts, public mail receptacles)
• Fear of confessing to crimes (that one did not commit)

Obsessions involving health or bodily sensations (somatic obsessions)

• Hypervigilance/hyper-awareness of bodily sensations/getting attention “stuck” on thinking/analyzing various autonomic processes (breathing, heart rate, swallowing, blinking, eye “floaters”, flickering of the visual field)
• Persistent feelings of unreality, depersonalization, or derealization
• Fear of having or developing a chronic, progressive illness (AIDS/HIV, ALS, Alzheimer’s Disease, cancer)

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