I’ve recently heard from several people on an online forum that their therapists don’t think they have OCD because they don’t have any outward compulsions. I’ve also seen some references lately on the web about Pure O being a type of OCD where there are no compulsions.

All types of OCD/OCD themes involve compulsions. Pure and simple. I’ve met some people who thought they only had intrusive thoughts and thought they didn’t have compulsions but after a bit of going back and forth their compulsions became apparent and those people learned they are like everyone else.

There are two broad types of OCD compulsions: Overt compulsions and covert compulsions. Overt means: done or shown openly; plainly or readily apparent, not secret or hidden. Covert is the opposite. Overt compulsions are visible and apparent to others, while covert compulsions are hidden. Another way to think of covert compulsions is that they are all done inside the brain, they are mental rituals.

If someone can see you doing a compulsion, it is considered to be overt. If someone can’t see you doing a compulsion, it is considered covert.

There are many types of overt compulsions. The classic compulsion of washing hands repeatedly is overt. So is counting, checking that appliances are turned off, tapping a door frame a certain number of times or decontaminating an object with antibacterial cleaner. Less apparent overt compulsions include reassurance seeking from others, Googling and confessing.

Covert compulsions are less known, even by sufferers. Some sufferers are not aware that what they do are covert compulsions. The biggest covert compulsions, which is indeed the most common compulsion of any type, is ruminating. Ruminating is a catch all word that describes going over intrusive thoughts in the head, again and again, and not getting anywhere with the work. No one else can ‘see’ ruminating going on, even though it can be done for hours and hours a day.

Analyzing intrusive thoughts, trying to figure out if an intrusive thought is true or not, trying to determine if the thoughts are wanted or not or liked or not, scouring the memory for information, are all examples of covert compulsions.

Pure O does not mean there are no compulsions present. That’s the way it used to be perceived but nowadays we look at it differently. Pure O simply means that most (usually not all) of the compulsions done are covert, rather than overt. Pure O also generally covers certain OCD themes, such as obsessions dealing with sexual orientation, pedophilia, false memory and a few others. Those themes tend to lend themselves to covert compulsions.

OCD is where a sufferer is inundated with obsessions that cause distress and leads to compulsions done to alleviate the distress. It doesn’t matter if the compulsions are covert; they’re still compulsions.