The thoughts keep coming:
"What if I lose control and hurt someone I love"
"What if I said or did something unforgivable?"
"What if I don't actually love the person I'm with?"
Graphic. Disturbing. Against everything you value. Your stomach drops.
Immediately, you start reviewing: "Why would I think that? What does this mean about me? Have I ever done anything like that before?"
You Google the thought. You check your feelings. You ask someone close to you if you're a good person. Each time, it works—for maybe an hour. Then the thought returns, often stronger than before.
Meanwhile, to everyone else, you look fine. They have no idea you're running a mental marathon, trying desperately to prove you're not the person your thoughts suggest you might be.
If this sounds familiar, you're likely dealing with what's sometimes called "Pure O" or purely obsessional OCD—a pattern where the compulsions happen (almost) entirely in your mind, making them invisible to others and often even to yourself.
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What Makes These Thoughts Different
Everyone has strange or unwanted thoughts occasionally. The difference with this pattern is what happens next.
Most people have an intrusive thought—"What if I swerved into oncoming traffic?"—and dismiss it as mental noise. But with this pattern, that thought feels urgent, meaningful, dangerous. Your mind tells you this requires immediate attention.
What tends to happen:
The thought feels shocking, but also meaningful. Your mind tells you: "This must mean something important about who I really am. Why else would I think this?"
You feel compelled to figure out what it means—right now
You start mental rituals: analyzing, reviewing, seeking certainty
These rituals provide brief relief, then the thought returns
The cycle repeats, sometimes for hours each day
The thoughts themselves aren't the problem.
It's what you do in response to them that keeps you captured.
The Compulsions You Don't Recognize as Compulsions
The term "Pure O" is somewhat misleading. It suggests purely obsessional—thoughts without compulsions. But that's not entirely accurate.
You have compulsions. They're just invisible.
When mental compulsions start, they feel important, needed, and protective. They're trying to solve the problem.
"If only I can think about this the right way, I can solve this and not worry about it anymore."
This is part of what makes this pattern so exhausting—you're working hard all day, but the work itself is the trap.
Common mental compulsions:
Mental reviewing: Replaying conversations, events, or past behavior to check if you did something wrong
Analyzing and debating: Going over the thought repeatedly—"Would I really do that? What kind of person thinks this?"
Checking feelings: Scanning your body for the "right" feeling—do you still love your partner? Do you feel disgusted enough by the thought?
Reassurance-seeking: Searching online for answers, asking loved ones if you're a good person, reading forums to see if others have the same thoughts
Neutralizing: Trying to "cancel out" a bad thought with a good one, or repeating phrases to feel safe
These mental actions feel like they should help. But they're actually feeding the pattern that keeps you stuck.
What the Thoughts Are About
This pattern can attach to almost anything, but it tends to target what matters most to you. The more deeply you care about something—your values, your relationships, your identity—the more material it has to work with.
Some common themes:
Harm Obsessions
"What if I lose control and hurt someone I love?" These thoughts can be graphic and violent, precisely because causing harm is the last thing you would ever want.
Sexual or Taboo Thoughts
Unwanted images or thoughts involving taboo scenarios that violate your deepest values. The shame around these can be crushing.
Relationship Obsessions
"Do I really love my partner? What if I'm with the wrong person? Am I leading them on?" Constantly checking your feelings, comparing your relationship, seeking certainty you can never find.
Sexual Orientation or Identity Questions
Obsessive doubt about sexual orientation or gender identity. The issue isn't the identity itself—it's that you can't stop asking the question.
Religious or Moral Scrupulosity
Religious: "Have I sinned? Am I going to hell? Did I offend God?" Mental checking, repetitive prayer, an unshakeable sense of moral contamination.
Moral/Ethical: "Am I a fundamentally bad person? Did I do enough to help? Am I complicit in harm?" Constant moral self-interrogation, reviewing past actions for ethical failures, needing certainty about your goodness.
The pattern: OCD doesn't waste time on things you don't care about. It targets what's most important to you, then uses your conscientiousness against you.
If you're recognizing yourself in these patterns—and especially if you've tried addressing the symptoms but not what's underneath them—I'd be glad to talk about how we might work together. Contact me to discuss OCD therapy.
Why Smart, Conscientious People Get Trapped
The ironic thing is that this pattern tends to show up in people who are thoughtful, analytical, and deeply responsible. Your capacity for self-reflection—usually a strength—becomes the mechanism that keeps you captured.
Your brain presents a disturbing thought, then says:
"A good person would never think this unless something was deeply wrong. You need to figure this out immediately."
So you do what any reasonable, conscientious person would do: you try to solve the problem. You analyze. You review your past. You seek certainty.
And that's exactly what keeps the cycle going.
The rumination—the mental work that feels like responsible self-examination—is itself a compulsion. It's a defense against something deeper.
Sometimes the compulsive thinking is trying to protect you from core emotions that feel dangerous: rage, grief, vulnerability, shame. Sometimes it developed in a family or environment where it genuinely wasn't safe to make mistakes or let your guard down. The pattern made sense at one point. Now it's keeping you stuck.
The rumination that feels like responsible self-examination is itself a compulsion. It's not solving the problem—it's feeding the pattern that keeps you captured.
What Actually Helps (And Why It's Counterintuitive)
If you've been dealing with this for any length of time, you've probably tried:
Reasoning your way out of the thoughts
Researching to find the one explanation that will finally make sense
Seeking reassurance from trusted people
Avoiding triggers
And none of it has worked for more than a few hours.
That's because these strategies ARE the problem.
The Role of Exposure and Response Prevention
Treatment involves learning to do something that will feel completely wrong at first: stop trying to solve the thought.
Exposure and Response Prevention (ERP) helps you:
Allow the thought to be present without pushing it away or analyzing it
Resist the mental compulsions (the reviewing, checking, reassurance-seeking)
Learn through experience that anxiety rises and falls on its own—you don't need to fix it
Over time, your brain learns: "I can have this thought and still be okay. I don't need to spend hours proving I'm not dangerous."
Why Breaking the Compulsion Cycle Isn't Always Enough
ERP is essential. It interrupts the behavioral pattern. But in my experience, that's often not the whole story.
This pattern doesn't develop in a vacuum. For many people, the rumination patterns connect to deeper emotional wounds—experiences of harsh criticism, unpredictability, shame, or trauma—that led to perfectionism, hypervigilance, and chronic self-criticism as ways of trying to stay safe."
This is why additional approaches are often necessary:
Internal Family Systems (IFS): Often, different parts of you are in conflict. One part desperately seeks certainty. Another part is exhausted from the compulsions. Another carries shame or fear. IFS helps us work with these parts compassionately—understanding what each is trying to protect you from, so they don't have to work so hard.
EMDR: When specific traumatic experiences or memories fuel the OCD cycle, EMDR can help process and resolve them so they're no longer triggering the same level of distress.
Experiential Dynamic Therapy: This helps you understand and work through the emotional patterns beneath the OCD—chronic self-criticism, difficulty with anger or vulnerability, unprocessed grief or shame, a nervous system that's been in overdrive for years.
What this means in practice:
Sessions won't just be about resisting compulsions. We'll also make space for understanding why your mind latched onto this pattern, and work with the parts of you that have been holding fear, shame, or hypervigilance for a long time. The goal isn't just symptom relief—it's helping you feel genuinely safer in your own mind and body.
If You're Reading This and Thinking 'That's Me'
You might be wondering: "But what if my thoughts are different? What if I'm the one person who actually is dangerous?"
That question is the OCD.
People who are actually dangerous don't spend hours worrying about whether they're dangerous. They don't feel horrified by their thoughts. They don't desperately seek reassurance that they're good people.
You do all of those things because you care.
And you deserve support that doesn't require you to keep this secret anymore.
Small Steps You Can Take Now
Start noticing the pattern, not just the content
When a thought shows up, notice what you do next. Do you start analyzing? Googling? Seeking reassurance? Just naming the pattern can create a small space.
Try a one-minute pause
Before you Google or seek reassurance, wait one minute. Just notice the urge without acting on it. Not forever—just 60 seconds.
Find a therapist who understands this pattern
Not every therapist is trained in OCD. Some well-meaning therapists can accidentally make this pattern worse by trying to help you "process" or "understand" the thoughts. You want the rumination to end, but you wind up learning to ruminate even better. You need someone who understands that the thoughts aren't the problem—your relationship with them is.
Ready to Work on This?
I work with people experiencing this pattern and other forms of OCD using an integrated approach. We'll use Exposure and Response Prevention (ERP) to interrupt the compulsion cycle, and when it's helpful, we'll also work with Internal Family Systems (IFS), EMDR, and Experiential Dynamic Therapy to address the parts of you in conflict, the emotional wounds, and the nervous system patterns keeping this active.
In our work together, you won't have to convince me you're a good person, and you won't have to keep apologizing for your thoughts. We'll work on both stopping the compulsions and understanding what's underneath them.
I see clients in-person at my McLean office on Chain Bridge Road and virtually throughout Northern Virginia, Maryland, and Washington, DC—including Arlington, Falls Church, Vienna, Tysons, Bethesda, and Georgetown.