For OCD Awareness Week (13 to 19 October), Paul Carter from Civil Service HR interviewed leading OCD therapist Katie d’Ath to raise awareness of a form of Obsessive Compulsive Disorder known as Purely Obsessional OCD, or Pure O.
Those who suffer from it wish they were ‘a little bit OCD’, as once Pure O lays its roots in your mind, the repeated, intrusive and uncontrollable thoughts just keep growing until they have taken over your life.
Understanding the symptoms of this debilitating condition can help sufferers discuss how they are feeling, feel supported in the workplace and access effective treatment.
What is Pure O?
Katie: Pure O is a term given to OCD where people have intrusive, unwanted and upsetting thoughts, images, urges or sensations, without any obvious behavioural compulsions. These intrusions often, but not exclusively, revolve around sexuality, responsibility, violence, faith, health or romance.
The thoughts, images and sensations are at odds with the sufferer’s values and identity. They are, therefore, deemed ‘intrusive’, and tend to be distressing. To manage the distress, people carry out internal compulsions to stop the thoughts. For example, by:
- changing or rationalising the thoughts
- seeking evidence and reassurance, to prove the thoughts are not true
- counting, praying and repeating words or actions to stop the thoughts
However, while these behaviours sometimes work in the short term, it is the compulsion to fight back against OCD that maintains its vicious cycle. The more you try to stop the intrusions or reassure yourself that they are not true, the more they bother you. In short, the more certainty you strive for, the less certain you will feel.
How can you be 100% sure the obsessional thoughts are Pure O and not you?
Katie: Since OCD has a tendency to attach itself to something that feels very important to you, and at odds with yourself, it can be hard to trust that these thoughts are coming from OCD and do not warrant any attention. There is no way of knowing for sure whether the unwanted thoughts are definitely OCD, but trying to find the answer to this question is part of the OCD trap.
It is easy to misconstrue this onslaught of emotional and physical symptoms as meaning there must be some truth in the thoughts: “They must be true or I wouldn’t feel so bad.”; or to continue to minimise or undo these thoughts, 'just in case' they are not OCD: “What if it isn’t OCD and I haven’t done anything to stop or change these thoughts?”
When OCD is left untreated it tends to slowly escalate. The compulsion to fight the thoughts tend to become less effective, and greater measures are taken to achieve the same short-term reduction in symptoms.
So, the advice is to stop checking and live with the thoughts? What is the best treatment?
Katie: The best treatment for any kind of OCD is specialised Cognitive Behavioural Therapy (CBT) for OCD. Standard CBT is not appropriate for treating OCD as it encourages people to interact with their thoughts through examining, rationalising and testing. These techniques actually make OCD worse, not better.
OCD is a condition that arises from ‘over-control’. Therefore, part of the treatment process is learning to let go of this control and respond to your OCD differently. Our main goal is to help people treat their intrusions as ‘white noise’ – learning not to attach meaning to, or interact with, the thoughts diminishes their power.
CBT for OCD incorporates three primary elements – psychoeducation, cognitive restructuring, and Exposure and Response Prevention (ERP). ERP helps sufferers to gradually face their fears, learn that they can cope and respond differently. An experienced therapist can help you face your fears through things like imaginal exposure and loop tapes. Medication can be used in conjunction with CBT for OCD where deemed appropriate.
What is the prognosis for people with OCD?
Katie: Leaving OCD untreated is rather like trying to dig yourself out of a hole. The more you dig, the deeper you get. OCD is a very treatable condition. With good treatment, hard work and practice some people may find OCD no longer affects them at all, whereas others may find that it still bothers them at times but interferes in their life to a much smaller degree.
Awareness of Pure O is increasing and there is good information available, particularly from charities such as OCD-UK and OCD Action.
Comment by JOANNE TAYLOR posted on
Thank you the this. As far as I am aware intrusive thoughts can also be part of OCPD which I have. I find it frustrating when people assume that I have OCD rather than OCPD. I also find that people tend to act as if it is socially acceptable to make fun of people with OCD. Additionally although people are becoming aware of Mental Health issues they are less able to differentiate as I've also had colleagues mistake my BPD for Bi-Polar and I also find that although people are aware of PTSD particularly in a military context there is little awareness of C-PTSD
Comment by Chris Weeks posted on
Highly insightful Paul, particularly as we recognise the need for control as part of attaining personal wellbeing so there's potentially a conflict there. Will share on Twitter for a wider audience.
Comment by Iona posted on
Thank you Paul for this interview. I had not heard of "Pure O" prior to reading this article - it's great that you can shed some light on this form of OCD. Now I have read this article, I'll hopefully be able to support better those around me who are affected by Pure O.
Comment by Alphonse posted on
Great blog! I think it's hard to articulate to people who haven't have intrusive thoughts just how self-propelling they are. Also anything to challenge the 'obsessive cleaning disorder' perception of OCD is much welcome.
While obsessions about germs and cleanliness can be a feature of OCD, so can hoarding and lack of personal grooming. It's not the behaviours that are the OCD, it's the thoughts and feelings *driving* those behaviours.
Comment by G Thomas posted on
Thank you Katie for sharing with us your personal experience and for helping to increase awareness and understanding. I certainly had a very little knowledge of that there were various forms of OCD or of Pure O. Thank you for increasing my know-how.
As with any visible or non-visible disability, the key to being able to manage it is through the support and understanding that is offered by others. Work place action plans, flexible working patterns, etc. can certainly help to overcome many of the challenges that colleagues face and make them feel more inclusive. Also such levels of support can help to improve self-confidence, reduces fatigue, etc.
I really do hope that your personal story will inspire others to talk about how this affects them and that they can seek support and not suffer in silence.
Comment by Karla posted on
I also can relate to this so much having been diagnosed with OCD. I agree with Bianca as many people assume it is compulsive hand washing etc, as many people with OCD do have this but it is not always the case with everyone. This is really good to read and will raise awareness of this condition which is actually life changing and affects you every day. I struggle to manage my 'Pure O' daily but to know that awareness is being put 'out there' about this condition helps as some of us actually feel like we are just going a little bit 'mad'. Thank you.
Comment by Ruth posted on
Thank you for bringing “Pure O” to the fore here in this really informative explanation about how this form of OCD affects people. It's the hidden form of OCD as there are no visible "compulsive behaviours". Very difficult to deal with and can be a challenge to overcome. The more this condition is spoken about and explained, the more we can confront the stigma and overcome the fear of having open conversations around this debilitating condition.
Comment by Bianca posted on
The majority of people only think of OCD as compulsive hand-washing or counting/organising things but it can take the form as described above. Pure O is something that affects me every day and although I am getting better at sorting the thoughts from my true identity, it is an exhausting process which causes me to doubt myself all the time as I am constantly trying to change/stop/rationalise my thoughts.
Thank you for this awareness-raising post.