Primarily obsessional obsessive–compulsive disorder

In the 1960s and 1970s, several psychologists and psychiatrists noted that some OCD patients did not have overt compulsions.{{Cite book |last1=Clark |first1=David A. |title=Obsessive-Compulsive Disorder: Subtypes and Spectrum Conditions |last2=Guyitt |first2=Brendan D. |publisher=Elsevier |year=2008 |isbn=9780080447018 |pages=53–75 |chapter=Pure Obsessions: Conceptual Misnomer or Clinical Anomaly?}} In 1971, psychologist Stanley Rachman wrote that obsessions without physical compulsions presented a challenge for behavioral treament of OCD. He indicated that these obsessions were often associated with "obsessional rumination".{{Cite journal |last=Rachman |first=Stanley |author-link=Stanley Rachman |date=August 1978 |title=Obsessional ruminations |url=https://linkinghub.elsevier.com/retrieve/pii/0005796771900088 |journal=Behaviour Research and Therapy |language=en |volume=9 |issue=3 |pages=229–235 |doi=10.1016/0005-7967(71)90008-8|pmid=5095078 |url-access=subscription }} Sir Aubrey Lewis similarly argued in 1966 that obsessional ruminations were a subtype of obsessive symptoms, one that entailed mental questioning and search.{{Cite book |last=Lewis |first=Aubrey |author-link=Aubrey Lewis |title=Price's Textbook of the Practice of Medicine |date=1 November 1966 |publisher=Oxford University Press |editor-last=Scott |editor-first=Ronald Bodley |chapter=Obessional Disorder |doi=10.1111/j.1742-1241.1966.tb07092.x}}

Early treatment for pure obsessions involved a thought stopping technique, where patients were instructed to ruminate about their obsession, before the therapist would order them to stop with a vocal command. In some cases, these commands were accompanied by an adversive stimulus.{{Cite journal |last1=Stern |first1=R.S. |last2=Lipsedge |first2=M.S. |last3=Marks |first3=I.M. |date=November 1973 |title=Obsessive ruminations : a controlled trial of thought-stopping technique |url=https://linkinghub.elsevier.com/retrieve/pii/0005796773901265 |journal=Behaviour Research and Therapy |language=en |volume=11 |issue=4 |pages=659–662 |doi=10.1016/0005-7967(73)90126-5|pmid=4777659 |url-access=subscription }} Thought stopping was heavily advocated for by psychologist Joseph Wolpe,{{Cite book |last=Wolpe |first=Joseph |author-link=Joseph Wolpe |title=Psychotherapy by Reciprocal Inhibition |publisher=Stanford University Press |year=1958 |isbn=9780804705097 |edition=Orig. ed. 1958, [Reprinted] |location=Stanford, California}}{{Cite book |last=Wolpe |first=Joseph |author-link=Joseph Wolpe |title=Life Without Fear: Anxiety and Its Cure |publisher=New Harbinger Publications |year=1988 |isbn=9780934986496 |edition= |location=Oakland, California}} but its efficacy was modest at best. A 1989 meta-analysis found that, across several studies, less than half experienced a reduction in obsessions and only around 12% reported improvements in their distress ratings.{{Cite journal |last1=Salkovskis |first1=Paul M. |author-link=Paul Salkovskis |last2=Westbrook |first2=David |date=1989 |title=Behaviour therapy and obsessional ruminations: Can failure be turned into success? |url=https://linkinghub.elsevier.com/retrieve/pii/0005796789900739 |journal=Behaviour Research and Therapy |language=en |volume=27 |issue=2 |pages=149–160 |doi=10.1016/0005-7967(89)90073-9 |pmid=2930440|url-access=subscription }}

Primarily obsessional OCD has been called "one of the most distressing and challenging forms of OCD."{{cite book|first1=Bruce|last1=Hyman|first2=Troy|last2=DeFrene|title=Coping with OCD|date=2008|publisher=New Harbinger Publications|location=Oakland, California|ISBN=978-1572244689|page=58}}{{Cite web |last=Shah |first=Yusra |date=2025-01-31 |title='Pure O' OCD: Signs, symptoms and treatment |url=https://www.treatmyocd.com/blog/pure-obsessional-ocd# |access-date=2025-03-06 |website=NOCD |language=en-US}} People with this form of OCD have "distressing and unwanted thoughts pop into [their] head frequently," and the thoughts "typically center on a fear that you may do something totally uncharacteristic of yourself, something... potentially fatal... to yourself or others." The thoughts "quite likely, are of an aggressive or sexual nature."

The nature and type of primarily obsessional OCD vary greatly, but the central theme for all affected is the emergence of a disturbing, intrusive thought or question, an unwanted/inappropriate mental image, or a frightening impulse that causes the person extreme anxiety because it is antithetical to closely held religious beliefs, morals, or societal norms.{{cite book|title=The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder|first1=Bruce M.|last1=Hyman|first2=Cherry|last2=Pedrick|pages=16-23|date=2010|publisher=New Harbinger Publications|location=Oakland, California|ISBN=978-1572249219}} The fears associated with primarily obsessional OCD tend to be far more personal and terrifying for the affected individual than the fears of someone with traditional OCD. Pure O fears usually focus on self-devastating scenarios that they feel would ruin their life or the lives of those around them. An example of this difference could be that someone with traditional OCD is overly concerned or worried about security or cleanliness, whereas someone with Pure O may be terrified that they have undergone a radical change in their sexuality (e.g., might be or might have changed into a pedophile), that they might be a murderer, or that they might cause any form of harm to a loved one or an innocent person or to themselves, or that they will go insane.

They will understand that these fears are unlikely or even impossible but the anxiety felt will make the obsession seem real and meaningful. While those without primarily obsessional OCD might respond to bizarre, intrusive thoughts or impulses as insignificant and part of a normal variance in the human mind, someone with Pure O will respond with profound alarm followed by an intense attempt to neutralize the thought or avoid having the thought again. The person begins to ask themselves constantly, "Am I really capable of something like that?" or "Could that really happen?" or "Is that really me?" (even though they usually realize that their fear is irrational, which causes them further distress)[https://books.google.com/books?id=mOH0L6NYg6kC&pg=PA94 Obsessive–compulsive disorder By Frederick M. Toates, Olga Coschug-Toates, 2nd Edition 2000, Pages 94-96] and puts tremendous effort into escaping or resolving the unwanted thought. They then end up in a vicious cycle of mentally searching for reassurance and trying to get a definitive answer.The American Psychiatric Publishing textbook of psychiatry, By Robert E. Hales, Stuart C. Yudofsky, Glen O. Gabbard, American Psychiatric Publishing, includes Purely Obsessional OCD in its definition of O.C.D.

Common intrusive thoughts/obsessions include themes of:

• Responsibility: with an excessive concern over someone's well-being marked specifically by guilt over believing they have harmed or might harm someone, either on purpose or inadvertently.{{cite web |url=http://www.ocdonline.com/articlephillipson2.php |title=OCD ONLINE - Guilt Beyond a Reasonable Doubt |website=www.ocdonline.com |url-status=dead |archive-url=https://web.archive.org/web/20050322165724/http://www.ocdonline.com/articlephillipson2.php |archive-date=2005-03-22}}
• Sexuality: including recurrent doubt over one's sexual orientation (also called HOCD or "homosexual OCD"). People with this theme typically display symptoms different from those of people experiencing an actual crisis in sexuality. One major difference is that people who have HOCD report being attracted sexually towards the opposite sex prior to the onset of HOCD, while homosexual people whether in the closet or repressed have always had such same-sex attractions.{{Cite web |url=http://www.neuroticplanet.com/hocd.php |title=NeuroticPlanet: OCD and Homosexuality Obsessions (HOCD) |access-date=2011-11-11 |archive-url=https://web.archive.org/web/20160131193204/http://neuroticplanet.com/hocd.php |archive-date=2016-01-31 |url-status=dead }} The question "Am I gay?"{{Cite book|url=https://books.google.com/books?id=gu4hDgAAQBAJ&q=gay|title=Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts|last1=Winston|first1=Sally M.|last2=Seif|first2=Martin N.|date=2017-03-01|publisher=New Harbinger Publications|isbn=978-1-62625-436-7}} takes on a pathological form. Many people with this type of obsession are in healthy and fulfilling romantic relationships, either with members of the opposite sex, or the same sex (in which case their fear would be "Am I straight?").Obsessive-compulsive related disorders By Eric Hollander, pages 140-146Homosexuality Anxiety: A Misunderstood Form of OCD http://www.brainphysics.com/research/HOCD_Williams2008.pdf {{Webarchive|url=https://web.archive.org/web/20150923194305/http://www.brainphysics.com/research/HOCD_Williams2008.pdf |date=2015-09-23 }}{{Cite journal|last1=Bhatia|first1=Manjeet S.|last2=Kaur|first2=Jaswinder|date=January 2015|title=Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report|journal=Journal of Clinical and Diagnostic Research |volume=9|issue=1|pages=VD01–VD02|doi=10.7860/JCDR/2015/10773.5377|issn=2249-782X|pmc=4347158|pmid=25738067}}{{Cite book|url=https://books.google.com/books?id=GBTBPcvj9mAC&q=related:vuEAurYDYZ8J:scholar.google.com/&pg=PA195|title=Leading-Edge Health Education Issues|last=Sebeki|first=Lennard V.|date=2008|publisher=Nova Publishers|isbn=978-1-60021-874-3}}{{Cite journal|last1=Williams|first1=Monnica T.|last2=Farris|first2=Samantha G.|date=2011-05-15|title=Sexual orientation obsessions in obsessive–compulsive disorder: Prevalence and correlates|journal=Psychiatry Research|volume=187|issue=1|pages=156–159|doi=10.1016/j.psychres.2010.10.019|pmid=21094531|pmc=3070770|issn=0165-1781}}{{Cite journal|last1=Williams|first1=Monnica T.|last2=Crozier|first2=Marjorie|last3=Powers|first3=Mark|date=2011-02-01|title=Treatment of Sexual-Orientation Obsessions in Obsessive–Compulsive Disorder Using Exposure and Ritual Prevention|journal=Clinical Case Studies|volume=10|issue=1|pages=53–66|doi=10.1177/1534650110393732|issn=1534-6501|pmc=3230880|pmid=22162667}}
• Pedophilia: sexual themes in OCD can also involve the fear that one is a pedophile. This is typically accompanied by significant distress and fear that one might actually act on pedophilic urges.{{cite journal |vauthors=Bruce SL, Ching TH, Williams MT |title=Pedophilia-Themed Obsessive–Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention |journal=Arch Sex Behav |volume=47 |issue=2 |pages=389–402 |date=February 2018 |pmid=28822003 |doi=10.1007/s10508-017-1031-4 |s2cid=207092958 }}
• Violence: which involves a constant fear of harming oneself or loved ones.Akhtar, S., Wig, NA, Verma, VK, Pershad, D., & Verma, SK A phenomenological analysis of symptoms in obsessive-compulsive neurosis. 1975
• Racism: intrusive thoughts or impulses related to racism or race.{{cite web|url=https://www.ocdtypes.com/racist-ocd.php |title=Racism and Racist Themed OCD |publisher=New England OCD Institute |accessdate=2023-09-24}}{{cite web|url=https://www.treatmyocd.com/blog/what-is-race-ocd-overview-symptoms-treatment-options |title=What Is Race OCD? Overview, Symptoms and Treatment Options |date=15 May 2021 |publisher=NOCD |accessdate=2023-09-24}}
• Religiosity: manifesting as intrusive thoughts or impulses revolving around blasphemous and sacrilegious themes.Use of factor analysis to detect potential phenotypes in obsessive–compulsive disorder, Psychiatry Research, Volume 128, Issue 3, Pages 273-280 D.Denys, F.de Geus, H.van Megen, H.Westenberg
• Health: including consistent fears of having or contracting a disease (different from hypochondriasis) through seemingly impossible means (for example, touching an object that has just been touched by someone with a disease) or mistrust of a diagnostic test.
• Relationship obsessions (ROCD): in which someone in a romantic relationship endlessly tries to ascertain the justification for being or remaining in that relationship. It includes obsessive thoughts such as "How do I know this is real love?", "How do I know he/she is the one?", "Am I attracted enough to this person?", "Am I in love with this person, or is it just lust?", "Does he/she really love me?", and/or obsessive preoccupation with the perceived flaws of the intimate partner.{{cite journal|last=Doron|first=Guy |author2=Derby, D. |author3=Szepsenwol, O. |author4=Talmor, D. |title=Flaws and All: Exploring Partner-Focused Obsessive-Compulsive Symptoms|journal=Journal of Obsessive-Compulsive and Related Disorders|year=2012|issue=4|pages=234–243|doi=10.1016/j.jocrd.2012.05.004|volume=1}}{{cite journal|last=Doron|first=Guy |author2=Derby, D. |author3=Szepsenwol, O. |author4=Talmor, D. |title=Tainted Love: exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts|journal=Journal of Obsessive-Compulsive and Related Disorders|year=2012|issue=1|pages=16–24|doi=10.1016/j.jocrd.2011.11.002|volume=1}} The agony of attempting to arrive at certainty leads to an intense and endless cycle of anxiety because it is impossible to arrive at a definite answer. The partner will have seriously troubling thoughts about what their significant other could be doing, especially in the possible and usual form of cheating. Although these thoughts are not triggered by the affected individual, and are indeed spontaneous, the partner will denigrate themselves for thinking in such a way that makes the other look bad. There is uncontrollable constant guilt, fear, and distressing thoughts of what will happen.
• Existential: involving persistent and obsessive questioning of the nature of self, reality, the universe, and/or other philosophical topics.{{Cite web|url=https://www.intrusivethoughts.org/ocd-symptoms/existential-ocd/|title=Existential OCD|website=Intrusive Thoughts|access-date=2019-03-04}}
• Somatic Function: thinking about basic human functions such as breathing, blinking, or swallowing.{{Cite web |title=What to Know: Pure Obsessional OCD Symptoms & Care |url=https://www.gatewayocd.com/pure-obsessional-ocd-symptoms-and-treatment/ |access-date=2025-03-06 |website=The Gateway Institute |language=en-US}}

There is no such diagnosis in DSM-5. The only diagnosis existing in DSM-5 is obsessive–compulsive disorder. According to DSM-5 compulsions can be mental, but they are always repetitive actions like "praying, counting, repeating words silently".{{cite book|title=Diagnostic and statistical manual of mental disorders (DSM-5)|year=2013|isbn=978-0-89042-555-8|location=Arlington|publisher=American Psychiatric Publishing|page=237}} DSM-5 does not have any information that searching an answer for some question can be associated with OCD.{{cite book|title=Diagnostic and statistical manual of mental disorders (DSM-5)|year=2013|isbn=978-0-89042-555-8|location=Arlington|publisher=American Psychiatric Publishing|pages=235–264}}

Those with primarily obsessional OCD might appear typical and high-functioning, yet spend a great deal of time ruminating, trying to solve or answer any of the questions that cause them distress. Very often, individuals with Pure O are dealing with considerable guilt and anxiety. Ruminations may include trying to think about something 'in the right way' in an attempt to relieve this distress.

For example, an intrusive thought "I might have just killed Bill with this steak knife" is followed by a catastrophic misinterpretation of the thought, i.e. "How could I have such a thought? Deep down, I must be a psychopath."[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292450/ The Treatment of Obsessions by Stanley Rachman. Oxford University Press, New York, N.Y., 2003 Reviewed by Dean McKay, Ph.D., A.B.P.P. Fordham University, Bronx, New York] This might lead a person to continually surf the Internet, reading numerous articles defining psychopathy. This reassurance-seeking ritual will provide no further clarification and could exacerbate the intensity of the search for the answer. There are numerous corresponding cognitive biases present, including thought-action fusion, over-importance of thoughts, and need for control over thoughts.

The most effective treatment for primarily obsessional OCD appears to be cognitive-behavioral therapyConcepts and Controversies in Obsessive–Compulsive Disorder Source: Springer Science, Business Media Author(s): Abramowitz, Jonathan S.; Houts, Arthur C. (more specifically exposure and response prevention (ERP) as well as cognitive therapy (CT)G.S. Steketee, R.O. Frost, J. Rhéaume and S. Wilhelm, Cognitive theory and treatment of obsessive–compulsive disorder. In: MA Jenike, L Baer and WE Minichiello (Eds.), Obsessive–Compulsive Disorder: Theory and Management. (3rd ed., pp 368-399) Chicago: Mosby. which may or may not be combined with the use of medication, such as SSRIs.{{cite web |url=http://www.ocdonline.com/definecbt.php |title=OCD ONLINE - What is Cognitive-Behavioral Therapy for O.C.D.? |website=www.ocdonline.com |url-status=dead |archive-url=https://web.archive.org/web/20050322170126/http://www.ocdonline.com/definecbt.php |archive-date=2005-03-22}}Understanding and Treating Obsessive–Compulsive Disorder: A Cognitive-Behavioral Approach, Lawrence Erlbaum Associates, Inc.; 1 edition (September 2, 2005) People with OCD without overt compulsions are considered by some researchers to respond less to ERP compared to others with OCD and therefore ERP can prove less successful than CT.Purdon, C.A. & Clark, D.A. (2005). Overcoming Obsessive Thoughts: How to gain control of your OCD. Oakland, CA: New Harbinger.Obsessive Compulsive Disorder Research, By B. E. Ling, 2005. Nova Science Pub Inc. Page 128

Exposure and Response Prevention for Pure O is theoretically based on the principles of classical conditioning and extinction. The spike (intrusive thought) often presents itself as a paramount question or disastrous scenario followed by a compulsive response of fear, worry, questioning and rumination.(e.g., WHAT IF I actually want to harm someone? WHAT IF I committed a sin?).

On the other hand, a therapeutic response (one that will help interrupt the cycle of obsessing) is one that answers the spike (intrusive thought) in a way that leaves ambiguity. With a therapeutic response, the subject accepts the possibility and is willing to take the risk, of the feared outcome rather than attempt to (temporarily and repeatedly) reassure oneself that the feared occurrence will not happen.

For example, the spike/intrusive thought would be, "Maybe I said something offensive to my boss yesterday." A recommended response would be, "Maybe I did. I'll live with the possibility and take the risk he'll fire me tomorrow." Although resisting the need to reassure oneself and perform compulsions will initially cause anxiety to increase, refusing to practice compulsions over an extended period of time will eventually cause anxiety around their intrusive thoughts to decrease, making them less prevalent (e.g. they will begin to occur less often), and less distressing when they do occur. Using this procedure, it is imperative that the distinction be made between the therapeutic response and non-therapeutic response (rumination). The therapeutic response does not seek to answer the question but to accept the uncertainty of the unsolved dilemma.

Acceptance and commitment therapy (ACT) has also been used as a therapy for Pure O,{{Cite journal |last1=Soondrum |first1=Tamini |last2=Wang |first2=Xiang |last3=Gao |first3=Feng |last4=Liu |first4=Qian |last5=Fan |first5=Jie |last6=Zhu |first6=Xiongzhao |date=2022-05-17 |title=The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis |journal=Brain Sciences |language=en |volume=12 |issue=5 |pages=656 |doi=10.3390/brainsci12050656 |doi-access=free |issn=2076-3425 |pmc=9139700 |pmid=35625042}}{{Citation |last1=Smith |first1=Brooke M. |title=Acceptance and Commitment Therapy for OCD |date=2017 |work=The Wiley Handbook of Obsessive Compulsive Disorders |pages=596–613 |url=https://onlinelibrary.wiley.com/doi/10.1002/9781118890233.ch33 |access-date=2025-04-21 |publisher=John Wiley & Sons, Ltd |language=en |doi=10.1002/9781118890233.ch33 |isbn=978-1-118-89023-3 |last2=Bluett |first2=Ellen J. |last3=Lee |first3=Eric B. |last4=Twohig |first4=Michael P.|url-access=subscription }} with a 2023 study finding that ACT was particularly effective in reducing OCD symptoms related to intrusive thoughts.{{Cite journal |last1=Lee |first1=Sang Won |last2=Choi |first2=Mina |last3=Lee |first3=Seung Jae |date=2023-10-25 |title=Is Acceptance and Commitment Therapy Effective for Any Obsessive-Compulsive Symptom Dimensions? |journal=Psychiatry Investigation |language=en |volume=20 |issue=10 |pages=991–996 |doi=10.30773/pi.2023.0109 |issn=1738-3684 |pmc=10620332 |pmid=37899223}} Evidence suggests that metacognitive therapy (MCT), another treatment for OCD,{{Cite journal |last1=Exner |first1=Cornelia |last2=Kleiman |first2=Alexandra |last3=Haberkamp |first3=Anke |last4=Hansmeier |first4=Jana |last5=Milde |first5=Christopher |last6=Glombiewski |first6=Julia Anna |date=2024-06-01 |title=Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder – A non-inferiority randomized controlled trial |url=https://linkinghub.elsevier.com/retrieve/pii/S0887618524000495 |journal=Journal of Anxiety Disorders |volume=104 |pages=102873 |doi=10.1016/j.janxdis.2024.102873 |issn=0887-6185|doi-access=free }}{{Cite journal |last1=Department of Psichiatry, Firat University School of Medicine, Elazig, Turkey |last2=Atmaca |first2=Murad |date=2022-09-05 |title=Metacognitive Therapy in Patients with ObsessiveCompulsive Disorder: A review |journal=Alpha Psychiatry |volume=23 |issue=5 |pages=212–216 |doi=10.5152/alphapsychiatry.2022.22840 |pmc=9623217 |pmid=36426268}} effectively reduces Pure O symptoms.{{Cite journal |last1=Andouz |first1=Zahra |last2=Dolatshahi |first2=Behrouz |last3=Moshtagh |first3=Nahaleh |last4=Dadkhah |first4=Asghar |date=2012 |title=The efficacy of metacognitive therapy on patients suffering from pure obsession |journal=Iranian Journal of Psychiatry |volume=7 |issue=1 |pages=11–21 |issn=2008-2215 |pmc=3395965 |pmid=23056112}}

Mindfulness-based stress reduction (MBSR) may also be helpful for breaking out of rumination and interrupting the cycle of obsessing.

English journalist Bryony Gordon struggled with primarily obsessional OCD. She wrote a book, titled Mad Girl, about her experiences with the disorder.{{Cite web |last=Gordon |first=Bryony |date=2017-01-16 |title=Bryony Gordon: How I walked my way back to sanity |url=https://www.independent.ie/life/health-wellbeing/mental-health/bryony-gordon-how-i-walked-my-way-back-to-sanity/35366629.html |access-date=2025-02-20 |website=Irish Independent |language=en}}

Singers George Ezra, Christian Lee Hutson, and Luke Combs suffer from primarily obsessional OCD.{{Cite news |last=Savage |first=Mark |date=2020-08-31 |title=George Ezra opens up about OCD struggle |url=https://www.bbc.com/news/entertainment-arts-53950320 |access-date=2025-02-20 |work=BBC |language=en-GB}}{{Cite web |last=Dinges |first=Gary |date=January 13, 2021 |title='I still have my moments': Luke Combs opens up about anxiety struggles in Dan Rather special |url=https://www.usatoday.com/story/entertainment/music/2021/01/13/luke-combs-discusses-battles-anxiety-purely-obsessional-ocd/4146922001/ |access-date=2025-02-20 |website=USA TODAY |language=en-US}} Hutson stated that he wrote the song "OCDemon" as a therapeutic exercise.{{Cite web |last=Lesuer |first=Mike |title=Christian Lee Hutson Walks Us Through His Reflective New LP "Quitters" Track by Track |url=https://floodmagazine.com/105759/christian-lee-hutson-quitters-track-by-track/ |access-date=2025-02-20 |website=FLOOD |language=en}}

The 2019 series Pure depicts its protagonist, 24-year-old Marnie, struggling with primarily obsessional obsessive-compulsive disorder.{{Cite web |last=McGurk |first=Stuart |date=29 January 2019 |title=Channel 4's OCD sex terror Pure is too pure for its own good |url=https://www.gq-magazine.co.uk/article/pure-channel-4-review |website=British GQ}} According to The Guardian, sufferers of Pure O generally praised the show's relatability but felt that Marnie's condition was not treated with the appropriate level of gravity.{{Cite news |last=Brethour |first=Dylan |date=2019-02-20 |title='Not rock-bottom distressing enough': Pure reviewed by people with OCD |url=https://www.theguardian.com/tv-and-radio/2019/feb/20/pure-reviewed-by-people-with-ocd-channel-4 |access-date=2025-02-20 |work=The Guardian |language=en-GB |issn=0261-3077}}

The protagonist of Glyn Dillon's 2012 graphic novel The Nao of Brown suffers from primarily obsessional OCD.{{Cite web |last=Mautner |first=Chris |date=2012-10-24 |title=The Now of Glyn: An Interview with Glyn Dillon |url=https://www.tcj.com/the-now-of-glyn-an-interview-with-glyn-dillon/ |access-date=2025-04-21 |website=The Comics Journal |language=en-US}}

{{reflist|2}}

• The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts by Lee Baer, Ph.D.
• The Treatment of Obsessions (Medicine) by Stanley Rachman. Oxford University Press, 2003.
• Brain lock: Free yourself from obsessive-compulsive behavior: A four-step self-treatment method to change your brain chemistry by Jeffrey Schwartz and Beverly Beyette. New York: Regan Books, 1997. {{ISBN|0-06-098711-1}}.
• The OCD Workbook by Bruce Hyman and Cherry Pedrick.
• Overcoming obsessive thoughts. How to gain control of your OCD by David A. Clark, Ph.D. and Christine Purdon, Ph.D.
• Mad Girl by Bryony Gordon. London: Headline, 2016. {{ISBN|1472232089}}.

• [https://iocdf.org/ International OCD Foundation]
• [http://rocd.net/ ROCD Research Unit]

{{Obsessive–compulsive disorder}}

Category:Anxiety disorders

Category:Obsessive–compulsive disorder

{{DEFAULTSORT:Primarily obsessional obsessive-compulsive disorder}}