Beyond the Symptoms: Understanding Pure O

When we think of OCD, we often picture visible compulsions - handwashing, checking, or ordering things in a particular way. But for many, OCD operates almost entirely in the mind. This is sometimes called “Pure O” (Purely Obsessional OCD), where the compulsions are internal - rumination, mental checking, reassurance-seeking, or avoidance.

Pure O can be exhausting. Intrusive thoughts feel relentless, distressing, and deeply personal. They latch onto what matters most - our values, identities, relationships - leading to intense doubt and uncertainty. It can feel like a never-ending battle to find certainty, reassurance, or the “right” feeling before moving forward.

OCD and the Role of Emotional Distress

It can be tempting to approach OCD as something to “get rid of” by managing symptoms alone. And while therapy can absolutely help reduce distress and loosen OCD’s grip, it can also offer something deeper: an opportunity to explore why this cycle began in the first place.

For some, OCD has roots in early experiences - times when uncertainty, fear, or emotional distress felt too overwhelming to hold. When emotions couldn’t be processed safely, the mind may have stepped in with rituals, avoidance, or hypervigilance as a way to cope. Over time, this can evolve into compulsions that offer a sense of control, even if only temporarily.

Attachment patterns can also play a role. If relationships felt unpredictable, critical, or emotionally distant, OCD may have developed as a way to create safety - by mentally scanning for danger, seeking certainty, or controlling thoughts in an attempt to prevent harm.

Healing Beyond the Symptoms

In therapy, we don’t just work on managing compulsions; we also explore the emotional landscape beneath them. Together, we might look at the function OCD has served, the fears and feelings it protects against, and how past experiences might shape present-day distress.

Rather than battling thoughts or pushing them away, therapy offers a different approach - learning to sit with uncertainty, soften self-judgment with compassion, and develop a relationship with your mind that is grounded in curiosity rather than fear.

If any of this resonates, I’d love to hear from you. Therapy is a space to explore - not to force change, but to understand, to untangle, and to move toward a life that feels more spacious and free.