If you’ve been diagnosed with OCD or recognise yourself in any of the above descriptions, it’s crucial to note that obsessions in OCD are ego-dystonic. This means “the thought or impulse clashes with your sense of self,” says Dr. King. “It feels alien, wrong, distressing. You don’t want it.” That’s why an OCD sufferer will do anything to try to “get rid” of the thought — unfortunately, though, performing compulsions only keeps them trapped in the OCD cycle.

So if engaging in compulsive behaviour doesn’t work to reduce distress, what does? Whether someone is suffering from Pure O OCD or “traditional” OCD, i.e. where the compulsions are more outwardly obvious, the treatment is often the same: Exposure and Response Prevention (ERP) is considered the gold standard. “ERP involves gradually and safely facing the feared thought or situation, while resisting the urge to engage in compulsions,” explains Dr. Touroni. “Over time, this retrains the brain to tolerate uncertainty and reduces the power of the obsession.”

In “traditional” OCD treatment, where compulsions are visible, exposures might look like the patient refraining from washing their hands after being on public transport, or actively cooking with a sharp knife. By contrast, “Pure O often requires imaginal exposure — deliberately thinking or writing about the feared scenario,” says Dr. King. “For example, someone with Harm OCD might write a story in which they hurt someone and sit with that discomfort, without ‘undoing’ it with reassurance or checking.”

While there’s amazing evidence for ERP being a really effective treatment for OCD, I personally found it quite traumatising and had to swap it for gentler modalities such as Internal Family Systems (IFS), which is also known as parts work. I think it’s important to trust that you know yourself and your needs best, and to seek out a therapist who aligns with your needs.

“I’ve worked with many clients who’ve felt re-traumatised by ERP,” says Dr. King. “If someone has a background of complex trauma, or if their compulsions are wrapped up in survival responses, jumping into ERP too fast can backfire.” In those cases, the therapist would focus first on nervous system regulation, utilising modalities such as IFS and EMDR (Eye Movement Desensitisation and Reprocessing).

Courtesy of Iris Goldsztajn