Have you ever heard of "Pure O"? It's a term used to describe a type of OCD where the sufferer has no compulsions, but only obsessions. Obsessions are the unwanted, and often frightening thoughts that enter a person's mind, and they can cause an incredible amount of distress. Compulsions are what a person does to try to either get rid of or neutralize the terrifying obsessions - like washing their hands or turning the light switch off and on multiple times. (For a broader, but brief, explanation of the basics of OCD, including more detail on obsessions and compulsions, please see my tab entitled "So, What Is OCD?".) Many people use the term "Pure O" to describe themselves if they are consumed with horrible obsessions and they appear to have no compulsions. For example, Scrupulosity is a sub-type of OCD that at times is placed under the category of "Pure O." People with intrusive thoughts are commonly labeled "Pure O," as well.
After speaking with many OCD sufferers over the years, including several who consider themselves "Pure O," I am convinced that the term "Pure O" is not accurate. I have come to the conclusion that every OCD sufferer has compulsions of some type. Many times, the compulsions will only be mental, and because they are not physical, the sufferer (and often their therapist, if he or she is not properly trained or has limited experience with OCD) will not recognize that these compulsions exist. Moreover, if you look very closely, I suspect that most of these people also have at least some physical compulsions as well.
One of the reasons that I cringe every time I hear the term "Pure O" is that it can (incorrectly, in my opinion) reinforce the idea that the person does not have compulsions. And more importantly, it may give the idea that ERP (Exposure and Response Prevention) would not be effective for this type of OCD. I have heard more than one sufferer express their dismay that ERP won't work for them, because they think that they have no compulsions to attack with ERP.
First, it is important to recognize the compulsions. If a person tries to keep on thinking about something in a certain way, or the "right" way - that is probably a mental compulsion. Re-thinking things over and over again, to try to remember what really happened, is probably a mental compulsion. Avoiding looking at someone or something, or looking away from someone or something, because it is triggering is - yep, you guessed it, probably a compulsion (and I would say that qualifies as a physical compulsion). Leaving a room because something or someone in that room is triggering - physical compulsion. Praying over and over again to get it just right - mental compulsion. Having to be seated a certain way or in a certain position while compulsively praying - physical compulsion. Confessing things to people over and over again to reduce anxiety - physical compulsion. Avoiding going to church because it triggers fears - physical compulsion.
Essentially, anything a person actively does (mentally or physically) to minimize the pain and anxiety of the scary thoughts, is a compulsion. If the patient and therapist can identify the compulsions and separate them from the obsessions, then a plan of action can be taken to create and tailor specific ERPs to fight the OCD.
I truly believe "Pure O" sufferers are absolutely not beyond help and that there is hope for this type of OCD too.