Pure O refers to OCD where there are no physical compulsions. Personally, I dislike the term because mental rituals are still an intentional act, in my opinion. I've observed in my clinical work that clients without physical rituals tend to get a diagnosis much later (if ever) from the origins of their disorder. Thus, the brain has been wired and improvement might take a little longer.
Many clients don't share their mental compulsions (I use the terms "mental rituals" and "mental compulsions" interchangeably) even with their therapist and often think everyone (or many people) thinks this way.
Perhaps the most obvious mental ritual is ruminating. People with OCD get pulled into the feeling that thinking about something will help them arrive at a conclusion or solution. It doesn't. Mental rehearsal is another common compulsion where someone will think about what they will say at a social event. The problem with mental rehearsal (in addition to it taking a person away from being present) is that when events do not go as rehearsed, a squirt of anxiety occurs. It also encourages wiring your brain to "do something" when anticipatory anxiety comes up instead of sitting with the discomfort or self-soothing.
A couple more common mental compulsions are contingency planning and "if/then" statements. Contingency planning could be telling oneself that if they become a sex offender, they will kill themselves or escape to another country. If/then mental compulsions might look like "if I make it to the next level of this video game, then my crush likes me. If I reach the next stop light before it turns red, no one in my family will die today." The lists of mental compulsions are quite extensive and they are a deception of OCD to make you feel less anxious in the moment, but over the long term, aggravate anxiety. To determine if you're thinking patterns are a ritual, ask yourself if you are being present? Is this thought serving you? Are you basing doubt on the "here and now" senses versus imagination? Do you have concrete evidence to support what you are worrying about?
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