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Pure OCD or purely obsessional OCD is a subtype of obsessive-compulsive disorder. Like all OCD types it has components of obsessing — thinking about things beyond what is reasonable — and compulsion. The compulsion aspect of purely obsessional OCD is frequently missed because people with this condition are compelled to think, research, or imagine in a compulsive way in addition to dealing with repeated and disturbing thoughts. In other words, compulsion is often cognitive instead of a series of observable and unusual behaviors like obsessive handwashing. Sometimes this type of OCD looks like extreme worry or generalized anxiety disorder, and even seasoned clinicians have missed appropriately diagnosing it at first.
There are many obsessional themes that might be the focus of someone with pure OCD. An affected person might constantly verify the state of a relationship. He could spend hours worrying if he’s in love, and if he’s loved, and repeatedly question whether the relationship is appropriate or worthwhile. Other times people become concerned with their sexual orientation, and will constantly wonder if they are heterosexual or homosexual. Some obsessive thoughts can occur along religious lines, where despite strong religious feelings, sacrilegious ideas might constantly intrude.
Additional sources of obsession might occur in a person with pure OCD. Some sufferers of this condition worry endlessly that they might hurt themselves or hurt others. Another common theme is a strong sense of guilt over what the sufferer thinks are failures. In other instances, a person could be most concerned that she’ll develop ill health or specific medical conditions.
When obsessional thoughts occur, the person with pure OCD may spend hours to days tortured by the thoughts, going to significant effort to try to understand and get rid of them. Ridding the self of these thoughts could take a variety of forms. People may endlessly question themselves about the truth of what they think, they might question others or repeatedly ask for forgiveness, they could ask for tests that prove or disprove thoughts (most common with medical pure OCD), or they might read and research to determine if what they think is plausible. Someone with pure OCD who is obsessed with avoiding pregnancy might over and again take pregnancy tests after sexual encounters, even if they have the evidence of several negative tests and practice safe sex.
It is easy to see from these descriptions why pure OCD doesn’t always get diagnosed immediately. People may just seem overly anxious and worried, but continued therapy would hopefully demonstrate that compulsive behaviors are a feature of the illness. Given the right diagnosis, there are a variety of ways to treat this condition.
Pure OCD often responds well to behavioral therapies, and some people benefit from medication, too. Behavioral therapy is almost always the first requirement of treatment because through it, people can learn ways to minimize negative thinking patterns and compulsive response. This may ultimately bring freedom from the condition or pronounced symptom reduction.