I don’t exactly remember when I first heard the term “Pure O” as applied to any type of OCD. I do remember wondering exactly what it meant. As someone who has specialized in OCD treatment since the early 80’s the term was puzzling to me. Did it mean an OCD sufferer was only experiencing obsessions and had no compulsions? This is what the term appeared to suggest. This struck me as odd as out of the hundreds of patients I had treated, I never met anyone who had obsessions but who totally lacked compulsions. I had met people who in the past had done compulsions, but which had faded over many years to the point where they couldn’t remember why they had done them in the first place, but this could not be called being purely obsessional. It was had to imagine that someone could have severe, doubtful, and negative thoughts and simply not do anything about them. It just didn’t square with the OCD I had become very familiar with.
After some investigation, I soon came to understand that what the term actually referred to was someone with OCD who in addition to having obsessions responded only with mental compulsions, done in their minds and unobservable to others. I had always thought of compulsions as falling into two large subgroups – physical (observable) compulsions, and mental (unobservable to others) compulsions. It occurred to me that creating this new and unnecessary category was bound to cause confusion among sufferers and professionals alike. To begin with, many people, including sufferers, did not seem to understand the difference between obsessions and compulsions. For those who aren’t clear about this, an obsession is an intrusive, repetitive, doubtful, and usually negative thought that results in anxiety. A compulsion is anything, mental or physical, that someone does to escape or avoid the anxiety caused by the obsessions. As mentioned earlier, it goes against human nature for someone to have thoughts of these types and to simply do nothing about them. Compulsions are essentially bad solutions to the problem of having obsessions. They may only work for a short time, but eventually become habits the sufferer gets locked into. Doing compulsions only leads to doing more compulsions.
Over time, some people coming for treatment would begin by saying that they had ‘Pure O’ OCD. Since I always screen for both types of compulsions, they would agree that they did compulsions in their heads. I would tell them that in that case the term “Pure O’ didn’t apply to them as it clearly implied that they only experienced obsessions but did not do compulsions. I would explain that this was a misnomer and that they should refrain from using it to describe their OCD as it could only cause confusion on the part of other laypeople and professionals who were not well acquainted with OCD. This could then potentially lead to misguided treatment. It seemed to me to be more descriptive to simply say that they used mental compulsions to deal with their obsessions. The term ‘Pure O’ was therefore unnecessary and simply incorrect.
I believe that if we are to have proper treatment for OCD, we also need accurate descriptive terminology. You need to know exactly what you are treating in order to know how to approach it. For those not acquainted with how OCD is treated, obsessions and compulsions are approached differently. We work in therapy to build people’s tolerance to obsessive thoughts so that they can experience them without having to do compulsions, and at the same time, resist doing compulsions to gradually weaken them as habits and eventually eliminate them. Compulsions are the real problem to be solved, as they are what can virtually paralyze an individual and prevent them from functioning in life. Because compulsions can be so paralyzing and debilitating, if someone is believed to not have them, there is a risk that these will not be treated. It is clear where this can lead to.
The term ‘Pure O’ has been around far too long. My colleagues in the field who I know personally, and there are many of them, all refrain from using it and also discourage others. I can only urge everyone to stop applying it to the disorder. OCD has been plagued with enough misunderstandings and misinformation over the years and it is about time that we retired this so-called category.