Thought-Based OCD

Thought-Based OCD, also called Pure Obsessional (Pure-O), is characterized by less observable compulsions than wash/check OCD. These sufferers get stuck on a distressing thought and can't get unstuck. No amount of "thinking it through" or "talking it out" helps. Actually, analyzing these worries makes it worse. Sufferers practice mental compulsions, avoidance and reassurance seeking to try to gain certainty that the feared scenario is not true/won't happen. Below is an extensive list of sub-types:
  • Relationship OCD
  • Illness/Health OCD
  • Sexual Orientation OCD
  • Harm OCD
  • Pedophilia OCD
  • Sensorimotor OCD
  • Olfactory Reference Syndrome (ORS)
  • Moral Scrupulosity
  • Religious Scrupulosity
  • Interpersonal OCD
  • Existential OCD
  • Hyper-Responsibility OCD
  • Just Right OCD
  • Emotional Contamination OCD
  • Incest OCD
  • Guilt/Regret OCD
  • Animal Abuse OCD
  • Cancel-Culture OCD
  • Real Event OCD
  • False Memory OCD
  • Memory Hoarding
  • STD/Pregnancy OCD
  • Consent OCD
  • Hit and Run OCD
  • Mental Illness OCD

Examples of common obsessions include:

  1. What if don't truly love my partner?
  2. What if this headache means I have a brain tumor?
  3. What if I am gay/straight?
  4. What if I snap and kill someone?
  5. What if I am attracted to children?
  6. What if I can't stop thinking about my blinking?
  7. What if I smell and people are disgusted by me?
  8. What if I am a bad person?
  9. What if I am a sinner?
  10. What if my friends don't like me?
  11. What if there is no meaning to life?
  12. What if a pill falls out of my purse, a child eats it, gets sick and it is my fault?
  13. What if I feel "off" on my first date and he/she doesn't get to know the real me?
  14. What if I made art while menstruating and the buyer is contaminated when they touch it? 
  15. What if I am attracted to my father?
  16. What if I have guilt/regret forever about a decision I made?
  17. What if hurt/molest my pet?
  18. What if someone sees a past post of mine on social media that was inappropriate and I get "cancelled?"
  19. What if I didn't get the "A" on the test honestly?
  20. What if I was molested and the memory is just foggy?
  21. What if I can't remember the details of this party and I lose the memory/happy feeling?
  22. What if I have an STD/STI? What if I got pregnant?
  23. What if I didn't get proper consent before sex and I sexually assaulted him/her?
  24. What if I hit a pedestrian with my car and didn't know it?
  25. What if I have BiPolar Disorder? What if I have Schizophrenia?

Thought-Based OCD is often misdiagnosed as Generalized Anxiety Disorder (GAD). Psycho-Dynamic therapy, while effective for other disorders, is not effective for OCD. OCD is a brain disorder and medical condition. Brain scans have shown that there is a diminished amount of grey matter in the brain of someone with OCD. The low levels of grey matter contribute to difficulty controlling impulses and processing information (making the sufferer more likely to ruminate over certain "bad" thoughts whether they intend to or not.) In this way, OCD is mostly heritable with no root cause. Effective treatment is behavioral in nature and begins with psycho-education about the brain, obsessions and compulsions. Next is cognitive restructuring in which the therapist and client challenge the distorted and irrational thoughts with logic, evidence and experience. The next phase is mindfulness/relaxation and the final one is Exposure and Response Prevention (ERP). Depending on the severity of symptoms, treatment can take anywhere from four months to one year.