Purely Obsessional OCD - Common Themes

Common Themes

The nature and type of Purely Obsessional OCD varies greatly, but the central theme for all sufferers is the emergence of a disturbing intrusive thought or question, an unwanted/inappropriate mental image, or a frightening impulse that causes the person extreme anxiety because it is antithetical to closely held religious beliefs, morals, or societal mores. The fears associated with purely obsessional OCD tend to be far more personal and terrifying for the sufferer than what the fears of someone with traditional OCD may be. Pure O fears usually focus on self-devastating scenarios that the sufferer feels would ruin their life or the lives of those around them. An example of this difference could be that someone with traditional OCD is overly concerned or worried about security or cleanliness. While this is still distressing, it is not to the same level as someone with purely obsessional OCD who may be terrified that they have undergone a radical change in their sexuality (i.e.: might be or might have changed into a pedophile or become homosexual), that they might be a murderer or that they might cause any form of harm to a loved one or an innocent person, or that they will go insane. They will understand that these fears are unlikely or even impossible but the anxiety felt will make the obsession seem real and meaningful. While those without Purely Obsessional OCD might instinctively respond to bizarre intrusive thoughts or impulses as insignificant and part of a normal variance in the human mind, someone with Purely Obsessional OCD will respond with profound alarm followed by an intense attempt to neutralize the thought or avoid having the thought again. The person begins to ask themselves constantly "Am I really capable of something like that?" or "Could that really happen?" or "Is that really me?" (even though they usually realize that their fear is irrational, which causes them further distress) and puts tremendous effort into escaping or resolving the unwanted thought. They then end up in a vicious cycle of mentally searching for reassurance and trying to get a definitive answer.

Common intrusive thoughts/obsessions include themes of:

• Responsibility: with an excessive concern over someone's well-being marked specifically by guilt over believing they have harmed or might harm (either on purpose or inadvertently) someone.
• Sexuality: including recurrent doubt over one's sexual orientation (also called HOCD or "homosexual OCD"). People with this theme display a very different set of symptoms than those actually experiencing an actual crisis in sexuality. One major difference is that people who have HOCD report being attracted sexually towards the opposite sex prior to the onset of HOCD, while homosexual people whether in the closet or repressed have always had such same sex attractions for lifelong. The question "Am I gay" takes on a pathological form. Many people with this type of obsession are in healthy and fulfilling romantic relationships, either with members of the opposite sex, or the same sex (in which case their fear would be "Am I straight?").
• Violence: which involves a constant fear of violently harming oneself or loved ones or persistent worry that one is a pedophile and might harm a child.
• Religiosity: manifesting as intrusive thoughts or impulses revolving around blasphemous and sacrilegious themes.
• Health: including consistent fears of having or contracting a disease (different from hypochondriasis) through seemingly impossible means (for example, touching an object that has just been touched by someone with a disease) or mistrust of a diagnostic test.
• Relationship obsessions (ROCD): in which someone in a romantic relationship endlessly tried to ascertain the justification for being or remaining in that relationship. It includes obsessive thoughts to the tune of "How do I know this is real love?" "How do I know he/she is the one?" "Am I attracted enough to this person?" or "Am I in love with this person, or is it just love?" "Does he/she really love me?" and/or obsessive preoccupation with the perceived flaws of the intimate partner The agony of attempting to arrive at certainty leads to an intense and endless cycle of anxiety because it is impossible to arrive at a definite answer.