Obsessive-compulsive disorder (OCD) involves the presence of both obsessions and compulsions, though both of these features might not be externally visible or present at the same time. For this reason, there is no such thing as OCD without compulsions — or “pure O,” as some people call it online.

People with OCD experience intense intrusive thoughts, or obsessions. They may try to suppress these thoughts, often with external compulsions. However, some people have internal compulsions, which are thoughts or strategies they use to suppress their obsessions. Although they may not be noticeable, these are still compulsions.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) defines these internal compulsions, thoughts, and strategies to suppress obsessive thoughts as part of the spectrum of obsession. In this regard, some form of compulsion is always a part of OCD.

This article explains whether you can have OCD without compulsions.

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People with OCD may not have visible external compulsions, such as handwashing. They may also not have any behavioral compulsions that another person would notice.

However, OCD always involves the presence of either obsessions or compulsions. The DSM-5-TR defines attempts to suppress obsessive thoughts, such as with rituals or specific thoughts, as part of the obsessive component of OCD.

These rituals and thoughts feel compulsory and may accompany other compulsions, such as checking or counting things. Because these attempts to suppress the obsessions are a clinical feature of OCD, the condition cannot occur without compulsions.

With treatment, OCD may evolve not to include compulsions, but even with treatment, many people continue to experience symptoms.

What is OCD?

OCD causes obsessions, compulsions, or both. Obsessive thoughts are intrusive, unwanted, upsetting thoughts that a person tries to suppress with various thoughts or rituals. Compulsions are ritualistic, unwanted behaviors that a person uses to attempt to control the obsessions.

Learn more about OCD.

Pure O” is a term from internet forums and support groups that refers to OCD cases that do not involve compulsions. It is neither a medical term nor a subtype of OCD.

People who use this term do so imprecisely. Some use it to refer to OCD without visible external compulsions. Others use it to refer to cases where someone has the urge to engage in compulsions but controls that urge. There is no scientific evidence to support the existence of a type of OCD that is truly free of compulsions.

People with OCD have:

  • Obsessions: These are intrusive, unwanted thoughts, such as a fear of death or contamination, thoughts of something terrible happening to a loved one, or fear of causing harm to another person.
  • Compulsions: These are ritualistic behaviors that a person engages in to suppress thoughts. Compulsions may be internal, such as praying or distraction, or external, such as handwashing or counting objects.

The obsessive thoughts cause significant distress, and the compulsions may interfere with daily life or relationships.

A person should contact a doctor if they have:

  • obsessions, compulsions, or both
  • intrusive thoughts that upset them
  • OCD that has not responded to treatment
  • significant side effects of OCD treatment

Researchers do not fully understand what causes OCD. However, like with other mental illnesses, there is likely a genetic component. Studies estimate a 45% to 65% heritability rate. Heritability is a measure of the difference in a population that is due to genetics.

Certain personality traits, such as trouble managing uncertainty, magical thinking, and a high sense of personal responsibility, may also play a role.

Some children can develop OCD and other symptoms when they have a streptococcus infection. Doctors call this pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS).

Clinicians diagnose OCD based on symptoms and history. They may also ask about symptoms of other disorders, medication, and medical history to rule out other potential causes.

There is no objective test, such as a blood test, for OCD. However, a clinician may use an objective, studied survey to assess symptoms. The most common such survey is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This survey looks for symptoms of obsessions and compulsions.

Cognitive behavioral therapy (CBT) can help people with OCD learn to manage intrusive thoughts and compulsions. CBT helps people understand and manage problematic thoughts and resist the behaviors these thoughts may lead to.

Clinicians may also prescribe a range of medications. The Food and Drug Administration (FDA) has approved medications such as:

These are a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs), though doctors use much higher doses to treat OCD than to treat depression. Depending on symptoms and outcomes, doctors may also prescribe other drugs, such as antipsychotics.

Support, accommodations at work and school, and a safe environment may also help. Access to ongoing care is important.

Learn more about therapy for OCD.

OCD is a chronic condition that a person may have for their entire life. Symptoms may improve and worsen at various points, with or without treatment, but OCD does not usually go away on its own. With therapy, a person can learn to manage symptoms. Medical treatment with medication may further reduce symptoms.

According to a 2023 article, for 30% of people with OCD, symptoms are more challenging to eliminate. This group either stops treatment or does not find relief from it.

Among the remaining 70%, some symptoms are still present. This may even be the experience of people who believe they have “pure O.” They may, with treatment, have only obsessions but not compulsions.

People with OCD do not benefit from judgment or shaming and will need support and concern from loved ones. Support groups may help people with OCD learn to advocate for themselves and access effective treatment.

The International OCD Foundation offers in-person and online support groups and a wide range of educational materials.

Compulsions are a core feature of life with OCD. With treatment, they may diminish in severity or disappear altogether. Without treatment, they may vary in severity or presentation. Some people have compulsions that are not externally visible or that are inconsistent with stereotypical OCD behavior.

Regardless of how OCD manifests, it is a treatable condition that can get better with the right care. People who experience obsessions with or without compulsions should seek medical care.