Exploring the unending cycle of a pure-o obsession
One of the common misconceptions about obsessive-compulsive disorder (OCD) is that obsessions could be real or have some basis in reality. However, this is not the case. Instead, obsessions in OCD are exaggerated and distorted perceptions of reality, and they do not reflect the true nature of the person or their situation.
Let me explain…
Suppose a person with OCD has an obsession with germs. Imagine it causes them to wash their hands repeatedly or avoid touching objects they perceive as contaminated. While there may be some basis in reality for concerns about germs and cleanliness, the intensity and frequency of obsessive thoughts and behaviours are not proportional to the actual risk of contracting an illness. Therefore, it does not reflect agreement with fact or reality.
Now let’s consider a pure-o obsession…
For example, suppose Mr X worries he could kill his partner with a knife. Again, there may be some grounds for concerns about knives and killing someone. However, the intensity and frequency of obsessive thoughts and compulsive behaviours are not consistent with the actual risk of the harm obsession being real.
So what if Mr X obsessively worries about his harm obsession, believing it might reflect the reality about his true nature? What then?
When Mr X obsesses that his harm obsession might not be OCD but something sinister or a hidden trait lurking inside him, it means his obsessive worrying is a pure obsession focused on the original harm obsession.
Not ever knowing what’s real and isn’t real is too much to bear, so the goal is to check to get rid of the confusion, especially since the harm obsession seems different to other obsessions, in which case, Mr X thinks, ‘It feels different this time, so how can it be OCD?’
But it feels real due to inferences or situations he thinks could give him a clue to know the truth. But, of course, the checking rituals based on such assumptions make it worse. It leads to further anxiety and meta-worry. In other words, repeatedly ensuring he has no underlying desire to harm his partner perpetuates the original harm obsession, leaving him confused, anxious and uncertain.
So, how else does this happen?
First, according to evidence-based approaches to treatment, OCD minds are wired with the propensity to detect what matters to them. This means that the more they devote their attention to something, the stronger the neural pathways in their brains become, showing OCD has become active and affects the senses and common sense in the here and now.
Initially, the obsession results from doubt, usually preceded by a trigger. Then interactions between thoughts, memories, and other factors such as environment, emotions and life experiences creep in. For example, suppose Mr X remembers a mild-mannered neighbour turning on his wife and murdering her. It’s a personal experience for Mr X, and thus an inference that supports his belief that he may want to do what his neighbour did. It adds credibility to his harm obsession and influences his beliefs about reality. So, he doubts that his original harm obsession is OCD, and his repetitive behaviours to work it out begin exhibiting pure-o over pure-o.
Another critical factor is the quality and intensity of an individual’s emotions related to the original obsession. For example, the individual might describe intrusive, persistent, and distressing thoughts and feelings as real, as though from their authentic self. In addition, they may sometimes experience anxiety, shame, guilt and panic related to their original obsession but question if these emotions are to mask their “true” intentions. This is especially so if the person, in some way, thinks they want to cause harm, as in Mr X’s case. Some even fear that if they cannot harm someone, they cannot stand not knowing if they should. Then, over time, pure-o over pure-o over to get to the “truth” becomes debilitating in their daily lives.
In summary, an obsession with an obsession might be to check if the original one is or isn’t OCD. This pattern forms neural pathways that strengthen and reinforce people’s distorted beliefs over time. In this case, the relationship between their beliefs and emotions can lead to a debilitating state affecting their personal and professional lives. The best solution is to seek help from a specialist for early diagnosis and treatment.
Evidence-based treatments include exposure response prevention (ERP) and inference-based cognitive therapy (IBCT). The first involves activating anxiety by facing your fears and resisting the compulsions to reduce the anxiety. In other words, you build a tolerance for it, which leads to fear-habituation. In contrast, IBCT involves learning how your obsession is about an imaginary or feared self, helping you reorient to reality and reconnect with your authentic self. Therefore, it does not activate anxiety by facing fears and resisting compulsions. Instead, you see the absurdity of doing the rituals from a renewed reality-based perceptive. My book 3 Effective Ways To Treat OCD and Reclaim Your Life discusses these treatments and also deep brain stimulation.