Pure Obsessions or "Pure-O" Obsessive-Compulsive Disorder (OCD) is a lesser-known form of obsessive-compulsive disorder in which the patient is afraid of their own thoughts. Gruesome images, blasphemous statements and sporadic cursing may be going on in their head, leading one to think of themselves as grotesquely sinful, evil at heart, or plotting to do horrible things. Such fear leads to compulsory prayer, avoidance or mental habits designed to alleviate the anxiety.
Exposure-response prevention, in which exposure to the feared situation is followed by a restriction of compulsions, is a helpful technique in treating all forms of OCD. But how do pure obsessions patients employ ERP? This article offers a few suggestions.
Some Preliminary Steps for Pure-O Treatment
Perhaps the first step in treating pure obsessions OCD is to delay the compulsions the thoughts create. Before one can progress any further in treatment, they need to be able to avoid responding to the thoughts until a later time.
OCD is not treated in big leaps. The patient will likely start by delaying their compulsions, whatever their form, for ten, five or even one minute as the thoughts attack. After that, the time span can be lengthened to thirty minutes, an hour, three hours and so on until the person with Pure-O feels their anxiety decrease.
Learning to Not Respond to Obsessive Thoughts
Next, the goal is to not respond to the obsessions altogether. For this to occur, Pure obsessive patients may need to reconsider the significance and danger of the thoughts. If one suffers from a religious form of Pure-O, in which the thoughts and images are all directed against God, it helps to remember that involuntary things (like the obsessive thoughts) are not sinful, and that God would never do bad just because someone wanted Him to.
If the involuntary obsessions are of a violent nature, such as a strangling, a car crash or a murder, one should ask themselves: do the thoughts result in any harm? Does one’s spouse choke just because the husband imagines choking her?
Especially important is the knowledge that obsessive thoughts rarely, if ever lead to the acts they depict. Bruce Hyman and Cherry Pedrick state in their OCD Workbook that “People with the Pure-O form of OCD are extremely unlikely to every carry out the horrific acts and urges that pop into their heads.”
Putting Mental Exercises Into Practice
The goal in exposure-response prevention is to decrease the anxiety the thoughts cause. OCD patients are shocked and scared at first by some of the thoughts, images and even obsessive prayers that enter their heads. But with repeated exposure to the thoughts and absence of compulsions comes much less anxiety — to the point where the obsessions themselves begin to decrease.
Once Pure-O patients can avoid responding to their thoughts (meaning no compulsions), it is time for increased exposure to the thoughts. This can be done in a number of ways.
Suppose that one has obsessions about stabbing their wife. One of the first steps would be to delay their response to the obsession; the next would be to not respond at all. After that, one could sit down and “hold an uncomfortable thought in [their] mind without feeling undue discomfort,” as Hyman and Pedrick say. This would involve repeating the stabbing image until the Pure-O patient is almost bored by the thought—and, thus, free to love their spouse without anxiety over a possible murder.
Someone who imagines themselves shouting obscenities in public could amplify the visions. Instead of just shouting the "F word" in public, they could view themselves running down the street and yelling curses directly in people’s faces. When the anxiety over even these images drops, the patient would be cured of the anxiety caused by the “little” thoughts.
Important to remember is that these exercises do not mean consenting to, agreeing with or enjoying the thoughts. They exist purely to decrease the anxiety caused by one’s thoughts.
Again, according to Hyman and Pedrick, “the disturbing ideas depicted in the thoughts represent the exact opposite of the person’s true character, desires, and intentions.”
Going Beyond Mental Exercises
Repeating and amplifying OCD thoughts are important steps to decreasing the anxiety caused by involuntary obsessions, but there is more that OCD patients can do. In their OCD Workbook, Bruce Hyman and Cherry Pedrick suggest repeatedly writing down the anxiety-producing thoughts, recording them into a speaker or hearing them (with headphones) in the presence of the target of the obsessions. These steps may seem dangerous and unnerving at first, but for some, they could be part of the solution.
Related Articles on OCD
If the subject of obsessive-compulsive disorder interests you, or if you’d like more help in your fight against OCD, try reading some of these additional articles on obsessive-compulsive disorder.
Afraid of Your Own Thoughts? serves as a general resource for pure obsessions OCD sufferers.
Differentiating OCD Thoughts From Real Thoughts provides a helpful resource for identifying OCD thoughts, while How Does Exposure-Response Prevention Work? offers a guide to exposure-response prevention, geared towards a Christian audience.
