Unwanted thoughts and mental compulsions - understanding ‘Pure O’

No time to watch the video? Below is the Soundcloud audio version. You can also get the podcast on your iPhone here or check out Spotify here.

In this episode, hear India discuss:

• how Pure O differs from the OCD you’ve previously heard about

• thought neutralizing, counting and ‘lucky’ numbers

• chewing, blinking, and other secondary subtype obsessions 

• what does relationship OCD (ROCD) look and feel like?

• treatment methods for Pure O 

• is it important for a therapist to spot Pure O versus traditional OCD?

• why therapists can struggle with if they’re not experts in OCD

• when India’s OCD started and how it manifested

• the positive aspects of living with OCD

• why India only recruits therapists who have personal experience of OCD

‘A bizarre, complicated, cross-matrix of obsessions’

When India Haylor was 11, she thought people she cared about would die unless she carried out certain rituals and behaviors. 

It began after her aunt passed away.

“I can remember going to bed the night before and seeing shadows on my wall, and then the next day connecting her dying with the shadows I'd seen before I went to sleep, “ she told me.

From that point on, India could not go to sleep unless the walls were completely void of shadows.

“I also remember coughing three times before I went to sleep so I didn't die.”

The urge to perform compulsions in response to mental obsessions is a key part of obsessive compulsive disorder (OCD). 

India - now a highly experienced professional psychotherapist and OCD specialist who has been working in OCD for over 17 years across centers in London and New York - overcame her childhood fear of shadows and now dedicates her career to helping others.

She founded OCD Excellence - a body that also trains OCD specialists. One requirement for any new trainee is that they must have personal experience of living with the disorder.

“That's really our USP that drives me forward,” she told me, adding that her view is controversial.

“I really believe that it [OCD] is a bizarre, complicated, cross-matrix of obsessions and compulsions that can't really be completely understood by someone that doesn't have it.”

OCD might make you think of people washing their hands over and over - or checking the front door is locked again and again. That’s considered the ‘traditional’ type; one in which compulsions and behaviors - that the sufferer does in order to, for example, stay safe or keep others safe - are physical.

In healthHackers episode 54, I asked India to tell me about a lesser known set of symptoms that fall under the Obsessive Compulsive Disorder diagnosis but are referred to as Pure O or Purely Obsessional. 

With Pure O, the compulsions aren’t physical; she explained.

“They’re all going on inside… things like checking, repeating, counting, praying,” she told me.

For example, someone with an irrational fear of becoming unwell may make themselves think of the healthiest person they know every time they have a ‘bad’ thought about their health. The purpose of the compulsion is to ‘neutralize’ the negative thought. There are many manifestations of Pure O compulsions.

“We have people who go over in their head what they're going to say before they say it. So there will be a distinct pause. …What they're doing is they're ordering and arranging what they're going to say, which will be based on various criteria, some can be, I can't say those words, some will be the order they say the words, or they might be filtering out the words, they don't want to say… They don't say because they're associated with negative things.“

By the time clients come to see India, they are spending “a huge proportion of their day obsessing,” she said.

One known subtype or theme of both traditional OCD and Pure O is that of relationships.

“I’ll say to them: ‘How much of the day are you spending thinking about your relationship?’ They could say to me, ‘Oh, 90 to 95%. It only goes when I'm asleep’.”

India explained that obsessive thinking around a relationship can include self-questioning thoughts, like: ‘Is this person right for me?’, ‘Am I in love?’, or ‘What other opportunities are there for me?’.

How do you treat Pure O?

Given that Pure O’s life-disrupting compulsions are mental, not physical, how does a therapist help a client get past them?

“This separates the men from the boys in terms of therapy. You've really got to concentrate quite hard on their drivers,” India told me.

“The tighter a person with OCD holds their beliefs, the more driven they are and the stronger the compulsions are,” but India said there are behavior-based options like learning to interrupt the thought, anxiety management, and observing the thoughts.

“You can also do physical exposure work,” she said, adding, “You can expose them to maybe movies about their fear, or videos or scenarios. You can still do all that and get them to write things down that are very triggering.”

Watch or listen to episode 52 to hear India talk about treatment and where to get help.

India compares herself and others with OCD to top-of-the-range sports cars. She said: “like a Ferrari - they're highly sensitized, high performing people, but they're really not learning how to drive their car. So when they crash, it tends to have more implications.”

While OCD has no known cure (yet), India wants people to know that it is “incredibly manageable” and those with the disorder often have wonderfully positive traits.

“People with OCD are highly intuitive, they’re sensitive… generally quite intelligent and they also care a great deal about others, and they're artistic, they're creative, they're perfectionists,” she said.

“When I’ve helped some celebrities and successful people - they're using a lot of their OCD and they don't realize it in their career.”

If a cure ever became available, India told me she’s not sure she would want to take it up.

“I’m good friends with my OCD. I celebrate it. I'm there with it. I know that the positive aspects I use every day to my advantage as a therapist.”

Follow OCD Excellence on Instagram.

Visit the website. Read India’s blog post about Pure O.

Get help from OCD Action (UK) or the International OCD Foundation. 

🟥Common sense caution: Anything you hear or see within healthHackers content should not be considered personal or medical advice. You’ve all heard it before, so you know the score - always talk to your own health provider about your concerns.👌