What It’s Like to Have "Pure O," a Type of OCD Characterized by Violent and Intrusive Thoughts

Trigger warning: This piece contains mentions of suicidal ideations and descriptions of the intrusive thoughts that can sometimes accompany obsessive-compulsive disorder.

I had my first experience with obsessive-compulsive disorder in the summer of 2017, though I didn’t receive a diagnosis for months. I was on vacation in North Carolina, away from all of my real-life anxieties, but suddenly, it didn’t feel that way. While taking a hot shower after a dip in the ocean, I felt my mind change radically in what seemed like a split second. I didn’t know what was happening or why, but I knew something was incredibly wrong.

Instead of being able to talk myself down from what I thought was a panic attack, my mind spiraled out of control: I’m going to hurt myself. I’m going to hurt somebody else. I’m a monster. I’m a monster. Oh my god.

When I stepped out of the shower, the world spun around me as I grabbed onto the bathroom counter and tried to regain my balance. These new intrusive thoughts were suddenly in the driver’s seat, and the rational Lauren that I had always known didn’t have a voice anymore.

Throughout the next few months, my mental health decreased rapidly. I couldn’t walk anywhere without these new thoughts nagging me to step in front of a car. It was startling. While I knew in my heart that I didn’t want to take my own life or hurt anyone else, my thoughts made me fear that I would someday. During the time before my diagnosis, I couldn’t even spend time with friends or family for fear of letting them in on this new secret I was trying to keep from everyone.

After months of depression due to these intense, harmful thoughts, I decided to give my psychiatrist a much-needed call and schedule a visit. During that appointment, I shook like a leaf as I told her about all the thoughts I had been feeling, completely petrified of what her response might be.

Instead, she nodded her head with understanding. Finally, someone understood what was going on with me. She gave me the answers I had been looking for — I had obsessive-compulsive disorder, and it was an actual mental disorder. Not only was I relieved, but I was also elated.

First of all, what is obsessive-compulsive disorder?

Obsessive-compulsive disorder (commonly known as OCD) affects people of all ages and different walks of life around the world. According to the International OCD Foundation, an estimated 2 to 3 million individuals struggle with OCD in the United States today.

The National Institute of Mental Health says, “Obsessive-compulsive disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.”

What many people don’t know about this mental disorder is that there are several different common "obsessions and compulsions" people with OCD tend to have. These can include washing and cleaning, checking, repeating, harm, and losing control.

Many people only think of OCD as the desperate need to clean everything and keep things organized. In the media especially, OCD is likely portrayed as this one variant, which causes confusion for individuals who haven’t yet been diagnosed. And as I have learned from my own experience, not everyone’s journey with OCD will be the same.

What is purely obsessive, or "Pure O," obsessive-compulsive disorder?

The OCD I personally struggle with is sometimes labeled by people as "Pure O." To be clear, Pure O is not a real medical diagnosis, but a term used by many people with OCD who experience intrusive, violent thoughts, but less of the physical compulsions most people associate with the disorder.

When talking to Tom Corboy, a licensed psychotherapist and the executive director of the OCD Center of Los Angeles, he clarifies, “People with Pure O are just like everybody else with OCD. They have unwanted obsessions, and they attempt to control the anxiety they experience related to these obsessions by doing compulsions.” He continues, saying, “In fact, the obsessions experienced by those with Pure O are often quite similar to the obsessions experienced by those with other variants of OCD. The real difference is in the types of compulsions they have.”

The compulsions I experience with OCD are mostly avoidance, along with incredible guilt for the types of thoughts I have running through my mind. In the beginning, I avoided my family and friends in fear that I would act on my violent thoughts. While I knew I wasn’t the monster my thoughts were making me out to be, intrusive thoughts are powerful and can truly change the way you view yourself.

How is obsessive-compulsive disorder treated?

Fred Penzel, a licensed psychologist with 36 years of experience in treating OCD, believes Exposure and Response Prevention (ERP) is the best kind of behavioral therapy for individuals who suffer from intrusive thoughts. ERP exposes your worst fears (or intrusive thoughts) and helps you face them head-on.

“Exposure and Response Prevention teaches people to face and stay with their thoughts and to even learn to agree with them," Penzel explains. "The goal is to build up their ability to tolerate the thoughts and to even become bored with them to the point where they can just let them be there without their causing any anxiety.”

If you and your doctor or therapist decide medication should be a part of your treatment plan, there are medications that can be used to treat OCD. Typically, the medication best fit to treat OCD is an SSRI (most often used as an antidepressant). Penzel says, “The purpose of the medication is to lower the level of obsessive thoughts, lower the anxiety, and improve a sufferer's mood.“

No matter which kinds of obsessions and compulsions your OCD manifests itself with, finding the right treatment for yourself is incredibly important, and after being diagnosed that summer, I knew I had to seek help. For me, Exposure and Response Therapy and the addition of an SSRI medication (that also works for depression and anxiety), helped me tremendously. This form of therapy helped me truly understand my own mind and made me realize that, indeed, my thoughts were just thoughts. I also upped my dosage on anti-anxiety medications, which made a huge difference in a matter of months.

A year after that terrible, gut-wrenching summer, I’m so far away from that scared and depressed girl I used to be. I’m stronger now. And that’s not because I overcame this disorder; I still struggle with it every day, but I keep going, even when the thoughts come back. And that's because I know that this mental illness does not — and never will — define me.

I ask Corboy for words of encouragement for sufferers today, and he tells me, “The most important thing to do is to accept the presence of your unwanted thoughts. That does not mean that you need to accept that the thoughts are accurate or meaningful because they aren't. It merely means accepting that the thoughts exist in your mind, without taking them so seriously, and without responding to them with compulsive attempts to eliminate or reduce them.”

If you are struggling with intrusive thoughts or any kind of OCD, please know you are never alone. You are not your OCD or any other mental illness you may have. You are so much more than that. And always remember, that at the end of the day, thoughts are just thoughts.

If you struggle with OCD, suicidal thoughts, or depression, help is available. In an emergency situation, call the National Suicide Prevention Hotline at 1-800-273-8255 or text “HOME” to the Crisis Text Line at 741741.

Read more about mental health:

• I Didn’t Believe Hypnosis Could Work — Until It Changed My Life

• 9 Things You Should Know About Borderline Personality Disorder, From Someone Who Has It

• This Is How it Feels to Have A High-Functioning Anxiety Disorder

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