Guides
Pure O, and why the name is the problem.
Nothing to see. No washing, no locks, no counting the stairs. You sat on the same train as everybody else and lost the whole journey, and got off looking exactly like a person who had been reading.
Somewhere early on you read that this condition is about handwashing, decided it was not yours, and went looking for a word that fit. Pure O fits. It is also the reason a lot of people spend years doing the treatment wrong, and this page is about why.
What the name says.
Pure O is short for purely obsessional. It is not a clinical category and it is not on any checklist. It is a word people reached for to describe the version of this where nothing is visible: the obsessions are the whole of what anybody can see, so the compulsions must be missing.
Half of that is right. An obsession is unwanted and intrusive by definition, and the arriving is not something anybody chooses IOCDF. If yours arrive in a quiet room with nothing to show for them afterwards, that is a real description of a real experience, and the word has earned its place for getting people to a page like this one.
The other half is where it costs. The compulsions did not go missing. They went indoors.
The compulsions you cannot see.
The symptom checklist clinicians work through has a group for mental rituals, listed among the compulsions and not among the thoughts Y-BOCS. They were named and grouped decades ago. Most people recognise three or four of these immediately and have never once counted them.
Reviewing the tape
Going back over a conversation, a memory, an hour of your own behaviour, looking for the pass that settles it. Nothing about this looks like a compulsion from outside. From inside it has a start, a shape and an end, like any other.
Checking how you feel
Turning your attention inward to take a reading. Does this still feel right, did that land the way it should, what is my body doing. The instrument is the thing being measured, which is why the reading never settles.
Answering it yourself
Running the argument once more and arriving at the reassuring conclusion, silently, on the way past. This is asking somebody for reassurance with nobody else in the room, and it works for about as long.
Swapping the thought out
Replacing the bad image with a good one. Saying a word, a phrase or a prayer to cancel it. Getting through a doorway on a better thought than the one you arrived with.
Counting, repeating, getting it right
Repeating something internally until it comes out clean. Starting again because your attention wandered in the middle and so it did not count.
Comparing against the file
Holding the thought up against every previous version to see whether this one is worse, or newer, or means something the others did not.
The quietest is the reviewing, which has a clinical name when it is done internally, rumination, and works the way the out-loud kind does NOCD. Nobody hears that door close, including you, which is most of why it never gets counted. Its own page has the test that separates going round from working something out.
Why the distinction is worth this much fuss.
This is not a tidy-up of somebody’s vocabulary. It decides whether the treatment with the best evidence behind it is available to you.
The practice published clinical guidance recommends first has two halves NICE CG31. You face what sets the loop off, and you leave out the move that settles it afterwards IOCDF. The second half is the half that does the work.
So somebody who believes they have no compulsions has concluded, reasonably, that there is nothing to leave out. The practice has no second half for them. They try the facing part on its own, sit with the thought while quietly reviewing it the entire time, get nowhere, and decide the treatment does not work on this.
What was actually happening is that the compulsion was running throughout, indoors, uncounted. The reason to insist on the word is not accuracy for its own sake. It is that naming the move is what makes it something you can decline.
What helps.
Same ladder as everybody else, with the rungs written in terms of what you do rather than what anybody could watch you do.
Name the move rather than the subject
Three or four words, silently. Reviewing. Checking how I feel. Answering it. Naming takes a second and settles nothing, which is the point: you are labelling the action, not deciding the question.
Stop in the middle, not at the end
The end of a mental round is where the settled feeling sits, so finishing it is the compulsion completing. Leave the sentence unfinished and go back to your afternoon.
Do not tidy it up on the way out
Running the logic one last time, landing the version that calms it, telling yourself the conclusion quickly before you stand up. That is the round, finished quietly. The question has to still be open when you walk away.
Let the reading stay unread
Checking how you feel is a rung like any other. Notice the urge to take the measurement, and leave the instrument alone for a minute longer than is comfortable.
Count the mental ones when you write your ladder
A ladder built only of things other people could see will miss most of what you actually do. The invisible moves belong on it, with the same rungs and the same order.
Nobody starts at the top. Practice runs up a ladder of small rungs, chosen in a calm hour and repeated until they turn boring IOCDF. A rung that feels too big is a sign to cut it in half rather than to push through it.
The from-scratch explainer walks through both halves, and the page on reassurance takes the ladder apart step by step. Where the thing being faced cannot be arranged in the world, which is common when it all happens in your head, clinicians use a written script, and imaginal exposure is the page on how that works and how it goes wrong.
The themes these moves attach to have pages of their own, and most people recognise more than one: harm, relationships, sexual orientation, scrupulosity and existential. Each asks six questions about what you do, and hands back what you said with no score at the end.
Where to get help with this.
A therapist trained in exposure and response prevention is the best thing there is, and nothing on this page replaces one. Mental compulsions are the ones a trained person is most useful for, because they are the hardest to catch yourself doing. The resources page lists official places to look, free to everyone, and we are honest on the evidence page about what is and is not established, including about this app.
That is also what Maybe is for, in the months while you are waiting or the hours between sessions. Short lessons show you the ropes, then a coach helps you practise it when it hits, at whatever hour it hits. Your ladder is built from the words you actually use, and everything you write is sealed on your device before it is sent, so nobody can read it, us included.
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