What Is Pure-O? Understanding Purely Obsessional OCD

When people think of obsessive-compulsive disorder (OCD), they often picture visible rituals like handwashing, checking locks, or organizing items. But for some people, the compulsions happen entirely in the mind. This lesser-known form of OCD is often called Pure-O, short for “purely obsessional OCD.”

As a therapist in Dallas Texas specializing in OCD treatment for children, teens, and adults, I help clients with Pure-O reduce distress, challenge intrusive thoughts, and regain a sense of peace.

Pure-O: More Than Just Thoughts

Pure-O is often misunderstood as “OCD without compulsions,” but that’s not entirely accurate. People with Pure-O do have compulsions—they’re just mental rather than physical.

Common mental compulsions include:

Mentally reviewing past events for reassurance

Silently repeating phrases or prayers to neutralize a thought

Analyzing “what if” scenarios over and over

Seeking certainty about moral, religious, or personal questions

Common Themes in Pure-O

Pure-O can take many forms, including:

Harm OCD – Fear of harming yourself or others

Relationship OCD – Doubts about love or compatibility

Sexual Orientation or Identity OCD – Repeated questioning of identity

Religious/Moral OCD – Fear of sinning or moral failure

Existential OCD – Obsessions about reality, meaning, or death

How Pure-O Affects Daily Life

Intrusive thoughts can feel intensely real and emotionally draining. The mental rituals that follow often provide temporary relief but strengthen OCD’s hold over time, creating a frustrating cycle of doubt and reassurance-seeking.

Treatment for Pure-O

Two of the most effective, evidence-based approaches for Pure-O are:

Exposure and Response Prevention (ERP) – Learning to face intrusive thoughts without engaging in mental rituals.

Inference-Based CBT (I-CBT) – Identifying and stepping out of OCD’s false “what if” stories to reconnect with reality.

At Hope Springs Counseling and Consulting, PLLC, I specialize in ERP and I-CBT for clients ages 5 and up. Together, we’ll build tools to reduce anxiety, break the cycle of mental compulsions, and create lasting change.

Getting Help for Pure-O in Dallas Texas

If you or your child is experiencing intrusive thoughts and mental rituals, you’re not alone—and it’s not something you have to hide or fight alone. I offer in-person therapy in Dallas and online counseling across Texas. Contact me today to learn more about OCD treatment and schedule a consultation.