Obsessive Compulsive Disorder's Hidden Cycles
Written by Gold Tree Therapy's Registered Psychologist, Goldie Hamilton, in October 2025
This article introduces a lesser-known form of Obsessive Compulsive Disorder (OCD) that often goes unnoticed and can cause considerable distress and shame.
What is “Pure O”?
Pure Obsessional OCD, often referred to as Pure O, is not an official subtype of OCD. Rather, it's a term adopted by people who experience primarily internal (mental) compulsions and want to describe how their experience differs from more visible forms of OCD.
In more widely recognised forms of OCD, people experience intrusive worries (obsessions) that they respond to with outward, observable actions (compulsions). For example, in Contamination OCD, intrusive fears about germs may lead to repetitive cleaning or handwashing.
In contrast, both the obsessions and compulsions of those living with Pure O tend to remain hidden.
Invisible Obsessions and Compulsions
One reason Pure O can remain hidden is that the intrusive worries can feel deeply shameful. The obsessions are egodystonic - meaning they conflict with the person's values and sense of self.
Because these thoughts often feel unacceptable, people can hold back from seeking help. Imagine how hard it might be to share that you're experiencing distressing and unwanted thoughts about committing a terrible act - thoughts that feel completely repugnant and opposed to your core values. For example:
- Harm OCD: Intrusive fears of being violent towards others that are completely at odds with their compassionate nature, or of harming themselves despite a genuine wish to stay safe.
- Relationship OCD: Persistent doubts about their partner, and their commitment to their partner, despite their loyalty and truely valuing the connection.
When clinicians recognise this presentation and respond with non-judgemental understanding, it becomes easier for clients to open up and work towards healing.
Another reason Pure O is often missed or misdiagnosed is that its compulsions are less visible. They may be internal thought processes or behaviours that are not widely associated with OCD. For example:
- Postpartum OCD: Repeatedly checking or seeking reassurance that their baby is safe from themselves and others, even when no danger exists.
- Sexual Orientation OCD: Regularly searching online or mentally reviewing their experiences for reassurance about their sexuality.
- Scrupulosity OCD: Mentally reviewing whether they've done something wrong, or repeating prayers or atoning thoughts to relieve guilt about perceived moral failings.
While these rituals can temporarily reduce anxiety, they also reinforce the obsessive cycle.
Therapy for OCD
I've worked with clients experiencing all of these, and other, forms of OCD and it's incredibly rewarding to see them get their life back as they progress through therapy.
I take an integrative approach, often blending evidence-based modalities:
- Exposure and Response Prevention (ERP) – the gold-standard treatment for OCD
- Acceptance and Commitment Therapy (ACT)
- Psychodynamic Therapy
My approach is collaborative and tailored to each person's needs and preferences, including any co-occurring challenges or neurodivergence. Through therapy, clients learn to step back from distressing and time-consuming OCD cycles and reconnect with who they are and what truly matters to them.
Does This Resonate?
If you, or someone you know, is living with OCD in any form, please remember:
- Our minds produce all sorts of surprising thoughts - many do not reflect who we are.
- Shame-inducing obsessions and compulsions are more common than you might realise.
- Help is available, and positive change is absolutely possible.
I invite you to reach out to me, or another clinician with experience in OCD treatment, for help to free yourself from obsessive-compulsive cycles and find greater calm and happiness.
