Why "71º & Sunny?"

I consider 71º to be the perfect temperature. Not too cold and not too hot. I also love perfect sunny days. The vast majority of days are not 71º & Sunny and yet, all days were created by God's hand and they are still gifts, even if they don't fit my ridiculous definition of perfection. My struggle with OCD has at times imprisoned me in an impossible attempt to achieve perfection. I'm now learning to love all kinds of days that don't even come close to 71º & Sunny.

Please leave me a comment below. I really want to know what you are thinking!

Monday, April 27, 2015

The Misnomer of "Pure O"

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.

20 comments:

  1. Monique, this is a very fascinating and informative post. Thank you so much for sharing.

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    1. It is my pleasure, Linda! Thanks for taking the time to read. : )

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  2. I feel hopeless. First I am OCD then the next counselor says I'm not OCD. The reason being I don't appear to have to have the compulsions. Every obsessive and compulsive thought is in my mind. I'm in the Midwest and have given up on getting the help I need.

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    1. I'm not sure where you're at in the Midwest, but Dr. Chris Donahue is an amazing ERP therapist in Minnesota. He also does Skype appointments with people who aren't able to meet in person. He changed my life.

      https://therapists.psychologytoday.com/rms/name/Christopher_B_Donahue_PhD,LP_Saint+Paul_Minnesota_167842

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    2. Oh Shirley, I'm so sorry you are feeling this way. The counselors that said you weren't OCD - were they OCD experts? Because if they weren't, well, perhaps they are mistaken? It sounds to me like you are pretty certain that you have OCD according to your symptoms.

      Like Jackie said, there are several centers that offer Skype treatment for people who don't have access to ERP (with experienced providers) in their area. In addition to Jackie's suggestion, here are a few others places that I know of for sure:
      Edna Foa (who is a legend in the OCD world) is the director of a center that offers Skype therapy: http://www.med.upenn.edu/ctsa/

      The Center founded by Jon Grayson offers Skype (see his book under my "Helpful Books" list on the right) Note: He is no longer at this center:
      http://www.ocdphiladelphia.com/clinicians

      This is his new center and I wonder if he continues to provide Skype through here: http://laocdtreatment.com

      Jon Hershfield and Tom Corboy's center does Skype: http://www.ocdla.com/index.html

      I'm pretty sure Steven Seay does Skype, and he is licensed to practice in Florida and Missouri. You can see his blog under "My Blog List."

      Steven Phillipson's center offers Skype: http://www.ocdonline.com

      I don't know anything about this therapy center, but they offer Skype treatment worldwide. I believe they are located in England. They seem to specialize in OCD, so I figured it was worth mentioning here: http://ocdtreatmentcentre.com/contact-us/

      Looks like Jon Hershfield is part of a 2nd group as well that offers Skype: http://ocdspecialists.com/jonathan-hershfield-mft/

      Don't know anything about this group in Louisville, Kentucky, but seems interesting: http://www.louisvilleocdclinic.com/online-help-for-ocd.php

      I guess the point I am trying to make is don't give up hope. Keep calling. You deserve to find good help. These are just a few places to get you started. I'm sorry I couldn't put actual links in the comment, but blogger won't let me do that.

      In the meantime, I came across an interesting blog post, ironically, from a fellow blogger of mine, Janet, at OCD Talk. She had a guest blogger one day, Seth Gillian, and he wrote a great article and answered a TON of questions about Pure O at the bottom of the article. You may want to check it out to help you in the meantime. https://ocdtalk.wordpress.com/2012/09/14/mental-rituals-ocd-and-erp/

      Lastly, there is a free online OCD program that you might find helpful: http://ocdchallenge.com

      Please let me know if there is anything I can help you with. Wishing you all the best.

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    3. Hi Shirley,
      Have you checked out these above links? These are some really great resources. Also, I'm sure you already know this, but if you suspect you have OCD, it's best to find a specialist who treats OCD who has a Ph.D...not just someone who has a broad range and who doesn't have the qualifications. Not many people are skilled at it, but it looks like you are in luck with all the specialists in your area.

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  3. Great post. I am classified as "Pure O," but I KNOW my compulsions: seeking reassurance and repetitive prayer and confession. Until my ERP therapist pointed out that those were compulsions, I don't think I had realized it. I like your definition: "Essentially, anything a person actively does (mentally or physically) to minimize the pain and anxiety of the scary thoughts, is a compulsion."

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    1. Hey Jackie! Thanks for giving that suggestion to Shirley.

      Knowing our compulsions is half the battle, I believe! Mental compulsions can be so incredibly tricky to identify. I'm glad you were able to find such great help. That is one of the biggest frustrations I have - that so many people are unable to find qualified help. But, that is part of the reason we blog, right? To try to get the word out. And I sure appreciate all you do in that regard.

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  4. I learned so much from this post. Thank you for the time and care you put into your blog. It's a great resource.

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    1. Aw, thanks Lauren! That's the best compliment ever. That is the entire goal of my blog - to be a resource.

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  5. Right on, Sunny! My therapist is has never used that term "Pure O" and I have scrupulosity along with many other kinds of OCD and from day one he has broken down my scrupulosity obsessions and the associated compulsions. For every OCD person's obsession, there IS a compulsion.

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    1. Hey Elizabeth - so great to hear from you! I hope you are doing well. How wonderful that your therapist understands how to identify the different obsessions and compulsions. My psychologist was really great at that too. It definitely took me a while (as in several months) to figure out the difference for myself.

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  6. People with mental health conditions are more understanding of other people’s struggles. Whether that be struggling with the same mental health condition, or just struggling in general. Some OCD celebrities allow us to learn the unwritten rules and norms of behavior.

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    1. Yes, I'd certainly like to think that I am more understanding of other people's struggles because of my own!

      I would caution though, that looking at OCD celebrities as a guide might not be the best thing. Not that we can't learn from them, just like we can learn from each other. But they are simply people, just like us, who struggle in the same ways we all do. They don't have any special powers or understanding, just because they happen to be wealthy and well known.

      And I'm going to be honest and say that this comment feels a little like spam. I'm really hoping I am mistaken, because using mental health issues for advertising, well, I think you could imagine how I feel about that. If this is not spam, then please accept my apology and you are welcome to "visit" any time.

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  7. Yes, Yes, Yes, Sunny!! Great post! You have done a great service to many through this post because those who think they have "Pure O," as you say, might feel they can't be helped by ERP therapy. As far as I understand it, most therapists now agree that Pure O doesn't exist, as there are always compulsions with OCD. In my experience, the use of the term "Pure O" (which seems to be dwindling?) has evolved to describe those who typically only have mental compulsions. Personally I'd like to see the term done away with as I believe it causes confusion. OCD is OCD!

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    1. Thanks, Janet! And you hit the nail on the head and perfectly summarized the point of my post - OCD is OCD. No matter the types of compulsions or obsessions. I'm really hoping more therapists will start to understand this. And if at least the sufferers understand this, then they can hold out for a therapist who properly understands it too.

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  8. Hey Sunny, just checking in because I have been missing your posts landing in my inbox. Give us an update when you can? Hopefully the silence is a good thing.
    Xoxo,
    C

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    1. I'm very touched by your thoughtfulness, C, thanks for checking in on me. Sigh. Things have not been great, to be honest. But, I'm getting help and I'm hoping that things will turn around soon. I hope you are doing well, though. Thanks again for your concern. I appreciate it more than I can say.

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    2. Aw, hugs, Monique! I noticed you'd been absent and Tina as well and I haven't been blogging either!

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    3. Hugs back at ya, Kristina! I've been wondering how you are too.

      I've been just trying to keep my head above water, so to speak, so blogging hasn't been on the radar lately. But I'm going to the OCD Conference in a week, so I'm sure I'll have something to say about that!

      I hope you are doing well. Thanks for thinking of me!

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