“Pure O” and OCD Mental Compulsions: Why Screeners Can Miss It
- Ryan Burns
- 6 days ago
- 8 min read
Last reviewed: 02/19/2026
Reviewed by: Dr. Kiesa Kelly
If you’ve ever thought, “I don’t do compulsions, I just can’t stop thinking,” you’re not alone. Many people who search for pure ocd symptoms are describing OCD mental compulsions that happen internally: reviewing, replaying, mentally checking, or doing reassurance loops in your head.
Because these rituals are silent (and often hard to describe), quick screeners can under-capture them, especially if the questions focus on visible behaviors like washing or checking doors. The good news: once you can name the pattern, you can get more accurate support.
In this article, you’ll learn:
What people usually mean by “Pure O” and why it’s a nickname, not a diagnosis
Common mental rituals OCD can turn into “compulsions in your head”
Rumination vs OCD: how to tell problem-solving from a ritual
Why reassurance seeking OCD can hide in plain sight
What a good evaluation looks for, and next steps if you’re in Tennessee
🧠 Key takeaway: “Pure O” rarely means “no compulsions.” It usually means compulsions are happening internally as mental rituals meant to reduce distress or get certainty.[1][2]
What People Mean by “Pure O”
“Pure O” is short for “purely obsessional.” People use it when OCD shows up mostly as intrusive thoughts, images, urges, or doubts, without obvious outward rituals.
Clinically, OCD is defined by obsessions and/or compulsions. And compulsions can be behaviors or mental acts (like praying, counting, repeating words silently, reviewing, or checking mentally).[1]
Compulsions are still there — they’re just internal
When OCD is “in your head,” the compulsions are often too. Research suggests the “pure obsessional” idea is often a misnomer because taboo/unacceptable obsessions tend to cluster with mental rituals and reassurance seeking.[2]
Internal rituals can be harder to recognize because they feel like “thinking,” not “doing.” But if the thinking is repetitive, driven, and designed to reduce distress or prevent a feared outcome, it may function like a compulsion.[1][2]
Why the label can be helpful (and where it can confuse)
The label can help people feel seen, especially when they’ve been told, “That’s just anxiety” or “Everyone has weird thoughts.” It can also prompt a more accurate conversation about intrusive thoughts compulsions and mental rituals.
Where it can confuse: it may reinforce the myth that OCD requires visible rituals. That myth can delay help, increase shame, and lead people to underestimate how much time they’re spending on ocd checking in head or mental rituals ocd.[2][3]
OCD Mental Compulsions: Common Internal Rituals
Mental compulsions aren’t “fake” or “less serious.” In a longitudinal study, people with primary mental rituals tended to show greater severity and lower functioning at intake, with a more chronic course over follow-up.[3]
Here are a few common patterns.
Reviewing, replaying, and “figuring it out”
This can look like:
Replaying conversations to prove you didn’t do something wrong
Mentally reviewing memories to check whether you “really” felt or meant something
Trying to “solve” whether a thought means anything about you
Example: You have an intrusive harm thought. You spend the next hour replaying your day to confirm you’re safe and would never act on it. The review reduces anxiety briefly, but the doubt returns, and the loop gets stronger.[2][4]
🔍 Key takeaway: If the goal is certainty or relief (not learning), “figuring it out” can become a ritual that trains OCD to ask the question again.[4]
Neutralizing thoughts / “canceling out”
Neutralizing is a mental ritual meant to “undo” a thought. It can include:
Silent prayers or “good thought” replacements
Repeating a phrase until it feels clean or complete
Mentally arguing with the thought to prove it’s untrue
People often describe this as trying to get back to “safe” in their mind. OCD may temporarily quiet down, but the brain learns that the intrusive thought was dangerous and needed neutralizing.[1][4]
Mental checking for certainty
Mental checking is ocd checking in head: scanning your memory, your body, or your intentions to answer “What if?” questions.
Common forms include:
Checking whether you felt “enough” love, attraction, certainty, faith, or calm
Checking whether you had the “right” reaction to a thought
Checking whether you could tolerate uncertainty (ironically making it worse)
🧩 Key takeaway: Mental checking is still checking. The form changes (internal vs external), but the function is the same: chasing certainty and reducing distress short-term.[1][4]
Rumination vs OCD: What’s the Difference?
“Rumination” is repetitive thinking. Everyone ruminates sometimes. In OCD, rumination can be part of the disorder when it becomes a ritualized attempt to neutralize doubt.
Rumination as problem-solving vs rumination as ritual
A quick way to tell the difference is to ask:
Am I thinking to take a practical action, or to feel “sure”?
Does this thinking expand options, or narrow into the same loop?
Do I stop because I chose to, or because it finally “feels right”?
Research suggests rumination can help maintain obsessive–compulsive symptoms, especially when unwanted intrusive thoughts are interpreted as meaningful or threatening.[5]
The feeling of “I can’t stop until it feels right”
That “not done yet” sensation is a classic OCD signature. Even when you know the answer logically, your body may not feel settled. OCD then demands one more check, one more replay, one more mental test.
🧠 Key takeaway: Rumination becomes an OCD ritual when it’s repetitive, driven, and aimed at reducing anxiety or achieving certainty rather than solving a real-world problem.[1][5]
Why Screeners Sometimes Under-Capture Mental Compulsions
Screeners can be helpful starting points, but many were designed around common, visible rituals. Even strong tools can miss nuance when they’re brief, self-administered, or interpreted narrowly.
People don’t label internal rituals as compulsions
Many people answer “no” to items like “checking” or “repeating” because they picture door-checking or handwashing. They may not realize that silent review, reassurance seeking, and mental checking count as compulsions too.[1][2]
That’s one reason clinicians often use structured interviews (like the Yale-Brown Obsessive Compulsive Scale, or Y-BOCS) alongside history and functional impact, rather than relying on a single screener.[6]
Avoidance and reassurance hide in plain sight
Two common “invisible” patterns:
Avoidance: skipping triggers, topics, places, or even relationships to prevent intrusive thoughts
Reassurance seeking OCD: asking others (or Google) to confirm you’re safe, good, not “really” X, or not at risk
Reassurance seeking is strongly linked to OCD symptoms and has been conceptualized as a type of checking behavior.[7][8]
Some measurement research notes that existing self-report tools may not capture the full range of rituals people use, which can matter for both severity and treatment planning.[9]
🗣️ Key takeaway: If your “compulsions” are mostly reassurance, avoidance, and internal rituals, a quick questionnaire may underestimate what you’re carrying day to day.[7][9]
Signs It’s Worth Getting Support
Only a qualified clinician can diagnose OCD, and online tools are not a substitute for care. But these signs can help you decide whether it’s time to talk with someone.
Time sink + distress + interference
Consider getting support if your intrusive thoughts and rituals:
Take significant time (even if it’s “just thinking”)
Create distress, guilt, or shame
Interfere with sleep, work/school, parenting, relationships, or faith life
Avoiding life to prevent triggers
Avoidance can look like “being careful,” but over time it shrinks your world. If you’re restructuring your day to prevent a thought, it may be OCD running the schedule.[1]
Shame and secrecy (normalize + reduce stigma)
Many people with “Pure O” themes feel deeply ashamed and isolated, especially with taboo content. Having an intrusive thought is not the same as endorsing it or wanting it. OCD often targets what you care about most.[2][4]
🌱 Key takeaway: The presence of intrusive thoughts does not reveal your character. What matters clinically is the loop: distress, rituals for relief, and growing avoidance.[1][4]
Next Steps (High-Level)
If you’re searching for ocd assessment Tennessee online, consider starting with a reputable screener and then getting a full evaluation when symptoms are persistent or impairing.
Evidence-based care overview (ERP mentioned carefully)
Evidence-based treatment for OCD often includes CBT approaches such as Exposure and Response Prevention (ERP), which involves practicing triggering situations or thoughts while resisting rituals.[10][11]
Not everyone starts in the same place. Some people benefit from more cognitive, inference-focused work first (for example, inference-based CBT, or I-CBT), especially when doubt and “maybe” stories drive the cycle.[12]
What a good clinician looks for (patterns, rituals, reassurance loops)
A strong OCD evaluation doesn’t just list themes (harm, contamination, relationships). It maps patterns:
Triggers (what sets the alarm off)
Obsessions (what shows up)
Compulsions and safety behaviors (including mental rituals)
Avoidance and reassurance loops
How much time it takes and how it affects life
If you’re exploring care, you can also learn more about our specialized therapy services and how we approach OCD treatment.
📝 Key takeaway: Good assessment focuses on function and patterns, not just symptom checklists. Mental rituals, avoidance, and reassurance loops count.[6][9]
Take the Y-BOCS + Explore Next Steps
If you want a structured starting point, you can take the Y-BOCS screening tool and use your results to describe both obsessions and compulsions, including mental compulsions.
Explore OCD services
If you’d like support beyond a screener, explore our OCD therapy options and meet our team to find a fit.
ScienceWorks offers HIPAA-compliant telehealth, including for clients across Tennessee when clinically appropriate. If you’re ready to talk through next steps, you can reach out here.
If you take one thing from this article, let it be this: “Pure O” is not “just thoughts.” It’s often a very real OCD cycle with internal rituals. And once the rituals are named, they become treatable targets.
About ScienceWorks
Dr. Kiesa Kelly, PhD, is a licensed psychologist and the owner of ScienceWorks Behavioral Healthcare. She provides therapy and assessment services, with a focus on specialized, evidence-based care.
Her OCD work incorporates structured assessment and CBT-informed approaches, including Exposure and Response Prevention (ERP) and inference-based CBT (I-CBT), with care delivered in a warm, collaborative style.
References
American Psychiatric Association. What is obsessive-compulsive disorder? [Internet]. Available from: https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
Williams MT, Farris SG, Turkheimer E, Pinto A, Ozanick K, Franklin ME, et al. The myth of the pure obsessional type in obsessive-compulsive disorder. Depress Anxiety. 2011. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3227121/
Sibrava NJ, Boisseau CL, Eisen JL, Mancebo MC, Rasmussen SA. Prevalence and clinical characteristics of mental rituals in a longitudinal sample of obsessive-compulsive disorder. Depress Anxiety. 2011. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3188668/
International OCD Foundation. How to let go of OCD thoughts [Internet]. Available from: https://iocdf.org/blog/2023/06/15/how-to-let-go-of-ocd-thoughts/
Wahl K, et al. Toward a better understanding of who is likely to be affected by rumination in obsessive–compulsive symptoms. 2024. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11485119/
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989. Available from: https://pubmed.ncbi.nlm.nih.gov/2684084/
Halldorsson B, Salkovskis PM. Why do people with OCD and health anxiety seek excessive reassurance? An investigation of differences and similarities in function. J Obsessive Compuls Relat Disord. 2017. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5504131/
Kobori O, Salkovskis PM. Patterns of reassurance seeking and reassurance-related behaviors in obsessive-compulsive disorder. 2013. Available from: https://pubmed.ncbi.nlm.nih.gov/22948342/
Pinciotti CM, Riemann BC, McKay D. Common rituals in obsessive-compulsive disorder and the limits of self-report measurement. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/37470990/
National Institute for Health and Care Excellence (NICE). Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31) [Internet]. Available from: https://www.nice.org.uk/guidance/cg31
Reid JE, Laws KR, Drummond L, Vismara M, Grancini B, Mpavaenda D, et al. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. J Anxiety Disord. 2021. Available from: https://www.sciencedirect.com/science/article/pii/S0010440X21000018
Wolf N, et al. Inference-based cognitive behavioral therapy versus cognitive behavioral therapy for obsessive-compulsive disorder: randomized clinical trial. 2024. Available from: https://pubmed.ncbi.nlm.nih.gov/39427635/
Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional diagnosis or treatment. If you think you may be experiencing OCD symptoms, consider contacting a qualified mental health professional.
