Some people with OCD have visible compulsions. Like in contamination OCD, compulsions include washing hands repeatedly. Or ‘just right’ OCD will have the person repeating an activity till it feels ‘just right’ to him. However, there are manifestations of OCD which have no apparent compulsions. There’s no washing, no repetitions, no counting, nothing. Just intrusive thoughts tormenting the person. This kind of OCD is called Pure-O OCD. Which is believed to be OCD with only obsessive thoughts and no compulsions.

Does that mean that in Pure-O, there are no compulsions at all? Not really. In all manifestations of OCD, there are some compulsions for sure. They may remain hidden or unidentified, since they don’t result in direct, visible ritualistic behaviour. But compulsions definitely exist.

Some of the types of Pure-O OCD are:

  1. Harm OCD: In this manifestation, the sufferer may obsess about harming someone. It could be specific people, random people, kids, or even self. In the presence of these people, an obsession can strike that they are stabbing the person, or hitting them on the head with a hammer, or some such violent thought, causing them distress. One of the chief fears associated with this type is, what if I actually cause harm done day? Or, what if I am a psychopath?
  1. Religious OCD: This type of OCD strikes the believers. Their desire to do right by God is so strong that they begin to fear doing anything wrong, which may be considered a sin by God and may lead to their getting punished. This can include thoughts like spitting at God, having sex with God, throwing garbage at God, etc. Their devotion to God becomes their bane. Worse, if they think someone from the family will be punished. The guilt in that case can eat them up.
  1. Scrupulosity OCD: Here the sufferer may worry about the morality or ethics of things, and may become obsessed with the rights and wrongs. So he may find using abuses wrong, which could extend to even innocent usage of words like idiot or stupid. He may find himself unable to lie, or even use exaggerations like calling someone perfect. He could also develop hyper responsibility and begin to feel responsible to try and set things right, even things which may not concern him either too much, or at all.
  1. Sexual intrusive thoughts: Sometimes the intrusive thoughts take the form of sexual thoughts or images about other people, including family members, friends, kids, or even God. This leads the person to hate himself for being depraved.
  1. Another manifestation of the above is getting intrusive thoughts of having sex with people of the same gender, leading them to feel that they’re homosexual, or of the opposite gender. This may extend to them getting like they ought to be wearing clothes of the opposite gender too, when in fact they want to wear clothes of their own gender.
    Thoughts of having sex with kids make them feel that they’re paedophiles, and thoughts of having sex with family members make them feel that they’re incestuous, both of which make them hate themselves.
  1. Relationship OCD: Sudden doubts creep in about whether they love their significant other or not. Or whether the significant other loves them or not. They begin to look at every action of theirs and that of their partner to check if there’s affection, arousal, etc. It causes them distress if something when things don’t go as their mind decides for them in the relationship.
    If they doubt their love for their spouse, they begin to notice small flaws such as their height, weight, etc, and make it a reason to evaluate their affection towards them constantly.
  1. Somatic OCD: This involves bodily functions like breathing, swallowing, staring, and the person focuses strongly on these actions, often believing that if they do not focus on their breathing, they would stop breathing. Staring gets a person to stare at things from the corner of their eyes.
    And sometimes, on account of social anxiety when the person is not able to make eye contact, the stare roves to other parts of the body, including sometimes to private parts of the opposite person, making him feel like a pervert.

All these forms of OCD are examples of Pure-OCD that can cause significant distress if the hidden compulsions are not identified and dealt with.