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A Comprehensive Guide on Pure-O OCD: Overcoming Intrusive Thoughts and Developing Coping Strategies

Updated: Dec 3, 2023


man with anxiety
Intrusive thought disorder, also known as "Pure-O", is a subtype of OCD characterized by intrusive and distressing thoughts, vivid images, or urges with no accompanying compulsions.

The Dark Abyss of Intrusive Thoughts: Battling Shame, Guilt, and Self-Doubt

From nowhere, a sudden and horrifying thought entered my mind—dark and disturbingly vivid. I couldn’t believe my mind would conjure up the thought of something so terrible—something strongly against my values, morals, and everything I know myself to be. I was overcome with shame and guilt, and I began to doubt my own character. I was haunted by these images for days. I couldn't shake off the feeling of disgust toward myself. Am I that bad of a person? What's wrong with me? Am I delusional—a sociopath?


They persisted and knew no bounds. They came in a flood of disturbing images and scenarios. My thoughts consumed me without mercy. No matter how hard I pleaded with them, they persisted and grew stronger with each passing day. It was as if they had taken control of my entire being, leaving me helpless and vulnerable.


Thoughts of sexual deviancy, violence, and blasphemy shaped these intrusions. My mind was constantly racing with "what if" scenarios. What if I hit somebody with my car? What if I can't control my behavior? The ideas flooded in like waves, and I found myself frequently examining and reevaluating my own beliefs and actions.


Demystifying Pure-O Subtypes: The Landscape of Intrusive Thoughts in OCD

Many people have fleeting intrusive thoughts from time to time; while frightening, they are not always harmful or indicative of a mental health problem. They can, however, be especially distressing and impairing for people who suffer from obsessive-compulsive disorder (OCD). Intrusive thought disorder, also known as "Pure-O", is a subtype of OCD characterized by intrusive and distressing thoughts, vivid images, or urges with no accompanying compulsions. For example, someone suffering from intrusive thought OCD may have recurring thoughts of hurting their loved ones despite having no desire or intention to do so.


These thoughts can be extremely distressing and can lead to compulsive behaviors such as excessive checking or seeking reassurance in order to alleviate the intense anxiety they cause. This constant battle between intrusive thoughts and attempts to resist them can have a significant impact on a person's daily life and mental well-being. While there are no officially recognized subtypes of Pure-O (purely obsessional) OCD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), certain themes or categories of intrusive thoughts are commonly recognized in clinical literature and discussions about OCD.


The following are some of the most well-known Pure-O subtypes:

  • Harm OCD: Harm OCD is a condition characterized by intrusive thoughts or fears of causing harm to oneself or others, which frequently leads to excessive checking, avoidance behaviors, or seeking reassurance. Despite the fact that you have no intention of acting on these thoughts, the fear and anxiety can be overwhelming. Individuals suffering from Harm OCD generally lack the desire to act on these thoughts, causing them to avoid certain situations.

  • Sexual Orientation OCD (HOCD or SO-OCD): People with Sexual Orientation OCD have intrusive thoughts or fears about their sexual orientation. They may constantly question their own sexual identity and experience distressing thoughts about being attracted to the same sex, even if they are not. This subtype can lead to significant anxiety and compulsive behaviors such as seeking reassurance or avoiding situations that may trigger these thoughts.

  • Pedophilic OCD (POCD): People with Pedophilic OCD have intrusive thoughts or fears about being attracted to children, even if they have no desire or intention to act on these thoughts. This subtype can cause extreme distress and lead to compulsive behaviors such as avoiding children or constantly seeking reassurance about their true intentions. It is important to note that having these intrusive thoughts does not mean the person actually poses a risk to children.

  • Relationship OCD (ROCD): People with Relationship OCD have intrusive thoughts or fears about their romantic relationships, often questioning their feelings or constantly seeking reassurance about the strength of their love. This subtype can cause significant distress and lead to compulsive behaviors such as constantly analyzing and overthinking the relationship, seeking constant validation from their partner, or even avoiding relationships altogether. It is important to note that having these intrusive thoughts does not necessarily reflect the true nature of the relationship or indicate any actual problems within it.

  • Religious or Scrupulosity OCD: Religious or Scrupulosity OCD is another subtype where individuals experience intrusive thoughts related to their religious beliefs or moral values. They may constantly worry about committing a sin or violating religious rules, leading to excessive guilt and anxiety. This can result in compulsive behaviors such as excessive praying, seeking reassurance from religious figures, or engaging in rituals to alleviate their fears. It is crucial to understand that having these intrusive thoughts does not mean the person lacks faith or is morally corrupt; it is a manifestation of their OCD.

  • Existential OCD: Another subtype in which people have intrusive thoughts about the meaning and purpose of life, their own existence, or the nature of reality. They may have constant doubts about their beliefs, identity, or the significance of their actions, resulting in existential anxiety and distress. This can lead to compulsive behaviors such as obsessively researching philosophical concepts, seeking reassurance about the meaning of life from others, or engaging in rituals to try to find answers.

  • Somatic OCD: Another subtype of OCD is somatic OCD, which involves intrusive thoughts and obsessions related to one's physical health and bodily sensations. Individuals with this subtype may constantly worry about having a serious illness or disease, even in the absence of any evidence or symptoms. They may engage in excessive checking behaviors, such as constantly monitoring their body for signs of illness or seeking multiple medical opinions. This can significantly impact their daily life and cause immense distress.

While these themes are more common, it's important to note that people with Pure-O may experience a combination of these subtypes, and their symptoms may evolve or shift over time. Additionally, there may be other, less common themes that are equally distressing for people with Pure-O OCD.


Stress and Intrusive Thoughts: Impact, Escalation, and Coping Strategies

Dog under a blanket
During stressful situations, individuals with intrusive thought disorder may experience an increase in the frequency and intensity of intrusive thoughts.

As with most disorders, stress can exacerbate intrusive thoughts. During stressful situations, individuals with intrusive thought disorder may experience an increase in the frequency and intensity of intrusive thoughts. First, stress can increase anxiety levels, diminish an individual's capacity to cope with or manage intrusive thoughts, disrupt sleep patterns and overall mental health, and cause or amplify other mental health conditions. Finally, stressful life events can provoke or exacerbate intrusive thoughts in those who have them.


An individual with Pure-O Obsessive-Compulsive Disorder (OCD) who is already vulnerable to intrusive thoughts may experience an exacerbation of these thoughts when under extreme stress, such as when studying for a major test or breaking up with a loved one. Because of the increased tension, their anxiety levels can rise even higher, and they may find it even more difficult to rein in or cope with their intrusive thoughts.

Moreover, the stress may trigger new intrusive thoughts or make existing ones more persistent and intrusive, leading to increased distress and impairment in their daily functioning.


Keep in mind that not everyone with intrusive thoughts will have the same level of stress-induced escalation of symptoms, and that the degree to which stress can affect intrusive thoughts can also vary from person to person. Nonetheless, the management of stress and the cultivation of effective coping strategies can greatly contribute to the overall well-being of individuals dealing with intrusive thoughts, thereby positively impacting their mental health.


Guilt, Values, and Intrusive Thoughts: Navigating the Moral Terrain of OCD


It's common for people with intrusive thoughts to feel guilty, ashamed, or afraid of their thoughts and to worry that the thoughts represent who they truly are. However, it's important to recognize that intrusive thoughts do not define a person's character or moral compass. In fact, a person's values and beliefs are frequently at odds with the content of their intrusive thoughts. In certain respects, intrusive thoughts can be seen as a hideous repercussion of one's moral stance against such thoughts.


As an illustration, an individual who holds deep religious reverence may experience intrusive thoughts pertaining to fears of committing blasphemy or transgressing moral and religious principles. Individuals suffering from this disorder may find the incongruity between thoughts and values particularly distressing because it contradicts their deeply held beliefs. It's critical to recognize that intrusive thoughts are a symptom of a mental health problem, not a reflection of a person's true desires or intentions.


The intuitive response to intrusive thoughts is to "push them away" or ignore them, but this can actually exacerbate the problem. Attempts to suppress intrusive thoughts are generally ineffective for various reasons.

  • Paradoxical Effects: When you try to suppress a thought, it can actually lead to a rebound effect, where the thought becomes even more persistent and stronger. This is known as the "white bear" or "don't think of a pink elephant" phenomenon, where the very act of trying to avoid or suppress a thought can make it more prominent in your mind. The thought will return stronger and more frequently, causing distress and anxiety. Furthermore, suppressing intrusive thoughts can lead to a rumination cycle in which the more you try to push them away, the more they return, leading to increased frustration and feelings of being out of control. It is critical to develop healthier coping mechanisms that enable the acceptance and acknowledgment of these thoughts without judgment.

  • Emotional Arousal: Trying to suppress an intrusive thought can trigger a stress response in your brain, leading to increased emotional arousal and anxiety. The effort and energy required to suppress the thought can actually heighten your emotional response to it, making it more difficult to let go of the thought or reduce its impact. This can manifest as increased heart rate, rapid breathing, and a general feeling of unease or restlessness. It is critical to recognize that attempting to suppress intrusive thoughts can be counterproductive and contribute to increased emotional distress. Instead, engaging in grounding exercises or practicing mindfulness techniques such as observing thoughts without judgment can help manage emotional arousal and promote a sense of calm and control.

  • Cognitive Load: The act of trying to suppress a thought can consume cognitive resources and mental energy, leading to increased rumination and preoccupation with the thought. This can further reinforce the thought and make it harder to let it go or move on. A person may experience this if they find themselves continually seeking validation or reassurance from others or if they find themselves mentally replaying the thought. It can also manifest as increased anxiety or a sense of being overwhelmed by the thought, making it difficult to focus on other tasks or responsibilities. Individuals can reduce the cognitive load associated with suppressing intrusive thoughts by practicing mindfulness and allowing thoughts to come and go without judgment.

  • Lack of Control: Intrusive thoughts are typically involuntary and automatic, and trying to suppress them can create a sense of lack of control, frustration, and distress. This can further exacerbate the thought and increase its impact on your mental well-being. As the intrusive thought continues to dominate your mind, you may feel overwhelmed and helpless. It may also manifest as an internal battle in which you desperately try to regain control of your thoughts but are unable to do so. These feelings of frustration and distress can have a significant impact on your overall mental health, making it even more difficult to find peace and calm in the midst of the intrusive thoughts.

  • Maintenance of the Thought-stress Cycle: Engaging in efforts to suppress or avoid intrusive thoughts can perpetuate a cycle of thought-stress-thought where the thought triggers stress, which in turn reinforces the thought. This cycle can sustain and even intensify the thought's intrusiveness and persistence. This can manifest as engaging in repetitive behaviors or rituals, such as excessive hand washing or checking, to try to alleviate the anxiety caused by the intrusive thoughts. These behaviors may provide temporary relief, but they ultimately contribute to the stress and intrusive thoughts cycle. To break free from this cycle and improve your mental health, seek professional help and learn healthy coping mechanisms.

Man looking stressed
Man looking stressed

The Pitfalls of Suppression: Understanding the Paradoxes in Dealing with Intrusive Thoughts

Rather than attempting to block or suppress intrusive thoughts, it is recommended to acknowledge and embrace them as a normal part of the human experience and to develop coping mechanisms such as mindfulness. Allowing an intrusive thought to exist and regarding it as a reminder or notification, whether friendly or not, are two methods for achieving this goal.

Think of the intrusive thought as receiving a notification on your phone - you can choose to engage with it or simply acknowledge its presence and move on. For example, a person who sincerely wishes to avoid causing harm may experience intrusive thoughts about violence. Rather than attempting to dismiss these thoughts, people can choose to acknowledge and thank their mind for the not-so-gentle reminder. Engaging in acceptance and non-judgment practices can assist individuals in detaching from their thoughts, alleviating distress caused by intrusive thoughts, and diminishing their influence on mental well-being, ultimately fostering a profound sense of peace of mind.


Allowing a thought to exist entails accepting its presence without attempting to alter or eliminate it. It doesn't mean that we agree with the thought, but rather that we acknowledge its existence and choose how to respond to it. This practice can lead to increased mindfulness and emotional regulation. Allowing a distressing thought to exist can be difficult to implement, as it may seem counterintuitive. However, by acknowledging the thought and allowing it to exist without judging it, you can lessen its impact on you. According to this strategy, when we fight or suppress intrusive thoughts, we give them more power and make them more likely to occur.


Pure-O OCD Unveiled: The Emotional Toll, Diverse Struggles, and Paths to Peace

Intrusive thoughts can be unsettling and discordant with our values, leading to feelings of shame, guilt, and self-doubt. Pure-O OCD, a subtype of obsessive-compulsive disorder, presents a complex tapestry of distressing thoughts, vivid images, or urges without visible compulsions. The themes of harm, sexual deviancy, or existential angst can dominate the mental landscape, creating a battleground for relentless questioning and reevaluation.

Stress amplifies the frequency and intensity of these intrusive thoughts, heightening vulnerability and disrupting coping mechanisms. This interplay leads to a cycle where thoughts trigger stress, which reinforces the thoughts, impacting daily functioning and mental well-being. However, these thoughts do not define one's character or moral compass. The struggle lies not in the thoughts themselves but in the attempt to suppress them, which only strengthens their grip.

The journey to peace lies in embracing intrusive thoughts, acknowledging their existence without judgment, and cultivating emotional regulation. This journey is not one of eradication but of mindful coexistence, a path towards a harmonious relationship with the complexities of the mind. By understanding the paradoxes at play, acknowledging the thoughts without judgment, and embracing them as part of the human experience, individuals can reclaim control over their mental well-being.


A reflective look inward

  1. How do you personally relate to the experience of intrusive thoughts described in the article, and in what ways do they align or differ from your own thoughts?

  2. Reflect on a moment in your life when stress or a challenging situation intensified your intrusive thoughts. How did you cope, and what strategies might you adopt moving forward?

  3. Consider the paradoxical effects of attempting to suppress intrusive thoughts. Can you recall instances where resisting these thoughts led to increased distress, and how might embracing them differently impact your well-being?

  4. In what ways do societal norms and personal beliefs contribute to the internal conflict described in Pure-O OCD? How might a broader understanding of intrusive thoughts reshape societal attitudes?

  5. Explore the article's analogy of treating intrusive thoughts like notifications. How might adopting this mindset empower you to navigate intrusive thoughts with greater agency?

  6. Reflect on your own understanding of mental well-being and the impact of stress on intrusive thoughts. How might stress management techniques enhance your ability to cope with these thoughts?

  7. Consider the article's emphasis on accepting intrusive thoughts without judgment. How might practicing non-judgmental awareness influence your relationship with these thoughts?

  8. Reflect on the interconnectedness of thought, emotion, and identity in the context of Pure-O OCD. How might reframing your relationship with intrusive thoughts contribute to a more integrated sense of self?

  9. Explore your reactions to the personal narrative shared in the article. How did it evoke empathy, understanding, or resonance with your own experiences or those of others you know?

  10. In light of the article's insights, consider how your own perspectives on mental health, particularly in the context of OCD and intrusive thoughts, might evolve. What steps could you take to promote a more compassionate and informed approach to mental well-being?



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