Obsessive compulsive disorder can have widely varying symptoms. If compulsions are absent, the condition is sometimes called “pure O” OCD. For those that suffer from sexual, violent, blasphemous or racist intrusive thoughts, it can feel unimaginable to tell anyone about their obsessions.
The “Pure O” variant of OCD
Obsessive-compulsive disorder (OCD) affects 1 to 2% of the population. That means in the U.S. alone, somewhere between three and seven million people have it. That’s a big group! OCD can look very different from one person in this group to the next.
What all these people have in common is that they experience obsessions and/or compulsions. Most have both. Those that experience only obsessions are sometimes said to have “pure O” OCD. This is not a formal category of OCD, but it’s a useful construct. Why? Because when most people think of OCD, they think of someone washing their hands constantly or fastidiously rearranging their desk. People with “pure O” OCD do not do anything outwardly that gives away their condition. But what are these obsessions, exactly?
What are obsessions?
Obsessions are thoughts that cause immediate anxiety. They are often described as intrusive and repetitive by those who have them.
We’ve touched upon violent obsessions that might be common for those with OCD in a previous post about fears of stabbing someone. I want to take some time to address other ‘bad’ thoughts that people sometimes have but feel they must keep to themselves.
Types of intrusive thoughts
Usually these obsessive or intrusive thoughts fall into three broad categories: violent, sexual or blasphemous. However, they can involve themes of other types of taboo behavior and attitudes (e.g., racist intrusive thoughts, homophobic intrusive thoughts, etc.) They can also present as images or impulses that can be repetitive and upsetting.
Examples would be thinking of or visualizing one of the following: pushing someone onto train tracks, wanting to have sex with a child or family member, or shouting blasphemous words while in a place of worship. Some postpartum mothers report having distressing thoughts of smothering their baby.
Racist intrusive thoughts
One type of obsessional thinking that people report having more often in recent years is racist intrusive thoughts. These can take the form of thinking, “I hate (racially defined group)!” — even though you harbor no such feelings. The obsessions can also be impulses. For example, when walking by someone who apparently belongs to given ethnic or racial group, an impulse could arise to yell something hurtful at them. One might even have the impulse to attack the person. These obsessions are typically followed by anxiety and dismay, as the person with OCD wonders if these impulses and thoughts are indicative of their true character.
The experience of having intrusive thoughts
These recurrent and intrusive thoughts and images are appalling to the person having them. Many people with obsessions come to feel they are alone in their suffering and could never mention the thoughts to anyone.
If you experience any of these disturbing thoughts, feelings or urges, you have likely wondered, how do I know I would never act on such thoughts? How do you know you are not actually a murderer or pedophile or racist (or anything else that you deem horrifying)?
People with “pure O” OCD want to be sure about these fears. The truth is, no one can be one hundred percent certain that one of these awful situations would NEVER happen. In fact, the notion that there is even the slightest doubt is usually enough to torment someone who is suffering from these violent, blasphemous, or sexual thoughts.
However, as psychologists like to say, the best predictor of future behavior is past behavior. If you have never acted on your a given feared thought, it is unlikely that you would do so in the future. More importantly, if you are plagued by a fear of acting on these thoughts, these thoughts are more likely a manifestation of OCD rather than a sign of impending criminal or immoral behavior.
Why do people have intrusive thoughts?
it’s only natural to wonder why people are afflicted with such thoughts. In his book Imp of the Mind, author and psychologist Dr. Lee Baer discusses how there are evolutionary reasons and societal taboos that shaped the urges in our minds to do the worst thing imaginable. Additionally, neurobiological factors may predispose an individual to these obsessions. There are also personality traits that may increase one’s sensitivity to “bad thoughts”.
Telling yourself, “Stop!” — A bad strategy for “Pure O”
People who are tormented by their “badness” may have tried suppressing their thoughts. However, research has shown that thought suppression does not work. To explain: what if I asked you to STOP thinking about a polka-dotted zebra. Stop already! Most likely, you would have trouble keeping your mind off of the image of this creature. This example illustrates the kind of trap that “pure O” OCD creates for people.
Let’s say, however, that you chose a different strategy, and allowed yourself to think of and acknowledge this polka-dotted wonder. What would happen? Inevitably, your mind would become used to the image and would soon wander to other things.
Dr. Baer aptly names this form of OCD a “silent epidemic”, as many people think they are the only ones who suffer from such horrifying thoughts. The gold standard treatment for obsessions of this sort is exposure and response prevention (ERP).
This type of therapy is typically successful in bringing relief to those suffering from bad thoughts. Cognitive therapy is another therapy can help. It strives to identify and address cognitive distortions that play into obsessive thoughts.
“Pure O” OCD doesn’t have to create suffering forever. With the right therapy, people can make great improvements in managing their thoughts effectively.
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