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I specialize in a particular type of OCD known as “Pure O” or purely obsessional OCD. My clients with Pure O often go for years undiagnosed with OCD because they have a storm of “what if” thoughts swirling around in their heads and the way they respond isn’t through hand-washing or double-checking the way it typically is when we think of OCD. Instead, they respond by ruminating, researching, and/or asking for reassurance.

We all have bizarre, disgusting, offensive, and twisted thoughts. For most people, these thoughts last for one moment and then go away. We don’t worry about them because we know they don’t reflect what we really think or feel or want. They are just random thoughts or images. If you’re dealing with Pure O, however, then you make meaning of these thoughts and wonder what having them says about you. Whenever you are triggered, you get flooded with “what if” thoughts and start creating a story in your head that makes you doubt yourself and what you know to be true.

Many people with Pure O suffer in silence. This is not only because they may not recognize what they are experiencing to be OCD but also because they are often too ashamed of the content of their “what if” thoughts to ask for help.

Some subtypes of Pure O include:

Sexual Orientation OCD:

  • Constant obsessions about your sexual orientation (ex: “Am I gay?”)

  • Afraid that you are in denial or somehow suppressing your true feelings

  • Fears that you will “turn” gay or straight, and that your relationships will fall apart

  • Obsessing over whether you acted in a way that was “gay” or “straight” with others

  • Hyperawareness of your body’s responses to certain people, images, or situations

Relationship OCD:

  • Doubts about your relationship (ex: “How do I know I really love this person?”)

  • Fears that you are not good enough for your partner

  • Questioning whether your partner really is “the one”

  • Pinpointing a “flaw” and deciding you couldn’t possibly be with someone who has it

Harm OCD:

  • Intrusive thoughts about harming yourself or others that make you question yourself (ex: "What if I secretly want to kill my family?”)

  • Fears that you will hurt yourself or others impulsively

  • Fixating on the idea that you could have inadvertently harmed someone and don’t know it

  • Fears that you are hiding your true nature from yourself and that you are truly aggressive and viscous

Existential OCD:

  • Ruminating about philosophical questions that cannot be answered (ex: “Am I real?”)

  • Questioning about the nature of self or reality

  • Fixating on the purpose and meaning of life

  • Obsessing over the concept of free will

Pedophile OCD

  • Unwanted harmful or sexual thoughts about children that make you question yourself (ex: “What if I am a pedophile?”)

  • Worrying that you might harm a child

  • Worrying that you harmed a child in the past and are in denial

  • Hyperawareness of your body’s responses around children

Scrupulosity OCD

  • Intrusive thoughts about violating your own religious or ethical beliefs that make you question yourself (ex: “What if I offended God? Am I immoral?”)

  • Fear of living in sin

  • Fear of doing something that violates or violated your ethical beliefs

  • Fear of praying incorrectly

  • Fear of going to hell

If you have Pure O, you ruminate compulsively and are desperate for some certainty, but no amount of research or reassurance seems to help. The anxiety that comes along with having these thoughts is agonizing and so you start avoiding certain things because you are afraid of bringing these thoughts on. For example, you avoid spending time with your young nieces and nephews because being around them brings up so much anxiety about the possibility of being a pedophile. Or perhaps you’re a new mom who has started to avoid being alone with your baby because you’re worried that you’ll be flooded with thoughts about hurting him and the shame and fear you know you’ll feel will be unbearable. Or maybe you avoid being in serious relationships because you know eventually you’ll start wondering if you really love your partner and will start compulsively researching articles on love or comparing your relationship to others and the doubt will get so loud that you won’t even be able to connect with this person when you’re around them anymore.

That’s the worst part of Pure O— you start missing out on life and distancing yourself from others because you’re so afraid of stirring up the anxiety.

In addition to having extensive training in Exposure and Response Prevention (ERP), I am one of the few therapists in this country who practices Inference-based Therapy (IBT), a cognitive behavioral therapy that can be used in conjunction with or provide a human alternative to ERP. The goal of IBT (also referred to as I-CBT) is to help you learn to trust yourself. OCD robs you of that. It makes you doubt who you are, what you really think, and how you really feel, both physically and emotionally.

In our first session, I will try to put you at ease by letting you know that I’ve heard it all and that none of your “what if” thoughts will shock me. Then, as we get to know each other, I will get a sense of your obsessions, your core fears, how much you’re ruminating, if you are dealing with any other compulsions (such as reassurance-seeking), and what you’ve been avoiding in your life to try to escape the anxiety. Together we will come up with a plan designed specifically for you to stop the suffering and avoiding.

If you are ready to rise above the noise in your head and start living life to the fullest, I can help.

* I want to be clear that sexual orientation OCD (or SO-OCD) is not about convincing someone that their sexuality is right or wrong or that a gay person “should” be straight (or vice versa). This post is meant to explain that one manifestation of OCD can be the endless questioning of one's own sexual identity and the tremendous anxiety and self-doubt that it can create.


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