What Is Pure O OCD? A Columbus Ohio Therapist Explains the “Invisible” OCD Type That Women Often Miss
Have you ever had a terrifying thought pop into your head—one you didn’t want, didn’t ask for, and certainly didn’t agree with—and then spiraled into a cycle of "What does it mean about me?"
Maybe it was violent. Maybe it was sexual. Maybe it involved someone you love.
Maybe you thought:
“If I’m thinking this, does that mean I want it?”
“What kind of person has thoughts like these?”
“Am I going crazy?”
And because you didn’t check the locks 10 times or wash your hands until they bled, you might have thought:
This isn’t OCD. This must just be...me.
But here’s the thing: it is OCD. It’s called Pure O, or “Purely Obsessional” OCD. And it’s often misunderstood even by the people suffering from it.
So, what is Pure O OCD?
Pure O is a subtype of Obsessive-Compulsive Disorder where the compulsions are mostly internal mental rituals like reviewing, reassuring, ruminating, or avoiding.
There’s still a compulsion. It’s just less visible.
Let’s break it down:
Obsessions: Intrusive, unwanted, and distressing thoughts, images, or urges (often violent, sexual, blasphemous, or morally wrong).
Compulsions: Mental acts done to neutralize the anxiety. This might look like:
Mentally reviewing past actions
Repeating certain phrases in your head
Praying in a specific way
Seeking reassurance from Google or loved ones
Avoiding triggers altogether (e.g., avoiding knives, kids, places of worship)
The cycle is exhausting. You may look calm on the outside, but your mind is screaming on the inside.
Why women often miss it
Many women with Pure O are high-functioning perfectionists. They’re the “good girls.” The responsible ones. The anxious overthinkers who hide their distress behind a polished exterior.
And because Pure O doesn’t fit the stereotypical OCD mold with no hand-washing or light-switch flipping that means they often don’t get help. Or they get misdiagnosed.
Often for years.
The truth about intrusive thoughts
Here’s something your OCD doesn’t want you to know:
Everyone has weird, random intrusive thoughts. There was once a study that showed that one hundred percent of humans have inappropriate, violent or socially unacceptable thoughts each and every single day. It’s part of our normal brain.
What makes Pure O different is not having the thought, but how your brain responds to it. Those who have OCD tend to respond with fear, shame and a desperate attempt to “make sure” you’re not a terrible person.
Pure O convinces you that your thoughts = truth.
But thoughts are just thoughts.
Not intentions. Not identity. Not danger.
What therapy for Pure O looks like
As a therapist in Columbus, Ohio who works with anxious women (and a big fan of making OCD less terrifying), I use a combination of:
ERP (Exposure & Response Prevention) – the gold standard for OCD treatment
ACT (Acceptance & Commitment Therapy) – helps you notice, allow, and de-fuse from thoughts
Self-compassion practices – because shame doesn’t heal OCD, but curiosity might
We work together to help your brain stop reacting to thoughts like alarms and start letting them pass like clouds.
You’re not dangerous. You’re just anxious.
Pure O is brutal. But it’s also beatable.
With the right support, you can stop obsessing over your thoughts and start trusting yourself again.
If this sounds like your brain, you’re not broken. You’re just in a loop that can be interrupted.
Ready to feel like yourself again?
I offer in-person and online therapy for women in Columbus, Ohio struggling with OCD, anxiety, and racing thoughts. Let’s get you unstuck.
👉 Book a session or email me at bethany@emberoakcounseling.com