Anxiety or OCD?

When you think of OCD (Obsessive Compulsive Disorder), do you think of obsessional washing of hands, flicking the light switch 5 times, or refusing to step on sidewalk cracks? If you answered “yes”, you are not alone in that assumption. In the media, this is often how people with OCD are portrayed. While these compulsions can be synonymous with an OCD diagnosis, there is a whole other side to OCD that lives behind the veil. 

Pure O vs. OCD

There is a subtype of Obsessive Compulsive Disorder that is characterized as Purely Obsessional OCD (Pure O). This means that all of the compulsions are happening inside of your mind instead of an act that can be seen by others. A good example is a fear of planes: someone with OCD that has external compulsions may perform a ritual, such as packing their bag a certain way, eating a specific breakfast, showering 3 times, touching the corners of their door frame, etc. in order to feel in control of their fear. However, someone with Pure O may have a lucky phrase they repeat in their mind or ruminate on their fear in a cyclical and constant way. This distinction is so important because I have experienced that many people with Pure O have been misdiagnosed or have invalidated their mental struggles because their compulsions are internal instead of external.

Common Misdiagnosis: Anxiety or OCD

One of the main ways that Pure O can be misdiagnosed is through Generalized Anxiety Disorder (GAD) due to the strong similarities that exist between the two. For example, both diagnoses can be characterized by fears or worries that can feel uncontrollable or overwhelming. However, after further processing the presentation of each diagnosis, we can see several distinct ways to differentiate the two.

GAD is typically more realistic in nature, but is often the “worst-case scenario”. Individuals usually experience physical manifestations of anxiety (upset stomach, still muscles, etc.), and there are no rituals performed in order to control the anxieties. I also picture it like dozens of little voices bouncing around in your head telling you of the things that you did wrong or what could go wrong. 

Characteristics of Pure O

Pure O is characterized by images, thoughts, or urges about specific, unrealistic fixations. An example of this might be an individual constantly picturing someone hacking into their phone and listening to their conversations or reading their texts without any prior indication that this could be happening to them. Pure O is also identified through clear compulsions in order to control this fear. Using the example above, a mental compulsion might be checking every app on one’s phone prior to using it. 

Being informed of these differences and getting a proper diagnosis is a critical step when seeking help from a therapist and developing the best treatment plan for you. Though Pure O often presents similar to anxiety, the goals of anxiety treatment are different than OCD treatment. Anxiety treatment is focused on understanding the origins of anxious thoughts and working to rationalize them. By contrast, treating OCD and Pure O is commonly done through Exposure Therapy, which involves an intensive process of identifying all of the obsessions and using mindfulness to engage with the thoughts in a safe way. Through this method, clients can feel in control through mind and body regulation rather than through compulsive behaviors.

If you think you may be experiencing anxiety or OCD or Pure O and are ready to take your first step toward wellness, schedule an appointment with Megan Pardy today.