Purely Obsessive: Is It a Diagnosis or a Distraction?

Posted by Phil Cardenas on May 20, 2013

Is it possible to be obsessive without being compulsive? For a number of years, persons studying Obsessive Compulsive Disorder (OCD) raised that question when subjects who were diagnosed as obsessive did not exhibit overt compulsive behaviors such as repetitive hand-washing, checking door locks, or other visible actions. Further study, however, has suggested that purely obsessive behavior, or “Pure O” as it used to be called, is very rare, if it exists at all.

As a clinical disorder, OCD is marked by obsessions that cause extreme anxiety. While this may appear to suggest  the diagnosis of “Pure O,” clinical experience indicates that such a condition is unlikely. What is more likely is that, because the patient shows no outwardly visible compulsive behavior, hidden compulsions are overlooked or misinterpreted as obsessions when they are actually compulsive reactions to obsessive anxiety.

Compulsive behaviors can be mental as well as physical. Rather than expressing a compulsion outwardly, a person can perform it in the mind. Then is repetitive counting, praying, or expressing things in one’s head rather than out loud an obsession or a compulsion? Does the thought have to be expressed multiple times in sequence to be a compulsion, or is a single thought that pops up frequently just an obsession? Sometimes it’s simply a matter of definition.

Professionals can debate whether a frequently occurring thought is an obsession or a compulsive reaction to underlying anxiety, but the fact is that regardless of how it’s defined, if the condition is disruptive to the conduct of a person’s life, it needs to be treated, and the treatment is generally the same. 

The goal of treatment is to reduce or eliminate the condition that causes distress. This can be done with therapy, with anti-anxiety medications, or with a combination of both. Cognitive Behavioral Therapy, or CBT, is a therapeutic process designed to desensitize the patient from the triggers that cause chronic anxiety, which is the real problem whether it manifests itself in easily-recognized compulsions or not. 

One in 40 adults in the US has OCD, so if you’re concerned that you may be affected by it, the most important thing is to consult a behavioral specialist for diagnosis. You can learn more about OCD, its treatment options, and tap into many other resources by visiting BeyondOCD.org. Beyond OCD is the leading provider of consumer-friendly resources to help sufferers cope with and conquer Obsessive Compulsive Disorder. Beyond OCD is a non-profit organization whose mission is to increase public and professional awareness of OCD, to educate and support people with OCD and their families, and to encourage research into new treatments and a cure.


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