Can you have OCD without the compulsions?
Lesser-known form of OCD that doesn't involve compulsive rituals
When we think about Obsessive-Compulsive Disorder (OCD), this image: someone endlessly washing their hands, checking locks, or fiddling with the same items in a specific order "over and over" just pops up those visible behaviours usually known as compulsions. They're so often linked with OCD that they're kind of synonymous with the condition in most people's minds.
However, there's a lesser-known form of OCD that doesn't involve these compulsive rituals. This type of OCD, sometimes referred to as "Pure O" or primarily obsessional OCD, is characterized by distressing, intrusive thoughts without visible compulsions.
But can you really have OCD without compulsions? Let's explore this complex and often misunderstood aspect of mental health.
Understanding Pure O: The Hidden Face of OCD
Imagine Sarah carrying on her life, being bright and sociable, but feeling like she is not really keeping it all together. She is a great worker and has many friends. Moreover, Sarah appears to care less about the world. Nevertheless, Sarah is actually tormented by endless invisible mental issues with herself.
Sarah is probably going on with persistent thoughts that sometimes frighten her. For example:
- What if she had pushed someone in front of a moving car?
- What if she had accidentally poisoned her coworkers' food?
- What if she's a terrible person and doesn't know it?
These are not her transient thoughts, but become the reason Sarah remains in intense anxiety and distress.
Moreover, instead of the common behaviors of OCD, Sarah does not involve herself in acts like hand-washing or checking. On the other hand, her compulsion rituals are just in her mind.
A mental rehearsal of her conversation. These mental processes are as real to her as her physical compulsions, but they are hidden from the world.
The Invisible Struggle
Pure O villains are usually related to the subjects that are really alarming for the individuals who are undergoing them. Some common themes are like this:
- Harm OCD: Intrusive thoughts about harming oneself or others, even loved ones.
- Relationship OCD: Constant doubts about one's feelings for a partner or the partner's feelings for them.
- Scrupulosity: Religious or moral obsessions, such as fears of sinning or being a bad person by nature.
- Sexual Orientation OCD (SO-OCD): Persistent doubts about one's sexual orientation.
- Pedophilia OCD: Fears of being a harm to children. Despite having no actual desire to hurt a child.
- Contamination OCD: Fears of getting or spreading diseases, but without any visible cleaning rituals.
Another example, a man named John, who has recently become a father, engaged in extreme activities of the intrusive thoughts circuit, i.e., the thoughts that force him to see a situation in which he hurts his baby. These thoughts are completely foreign to him, and he loves his child more than life itself. Moreover, he does not even acknowledge these thoughts or carry out the actual rituals. However, he could mentally review his communication with his child or whisper calming words to himself.
Why Pure O Often Goes Undiagnosed?
‘Pure O’ OCD condition is the most difficult to diagnose because its symptoms are not very apparent and recognizable. Furthermore, the fact that people with this condition are hesitant, often feel embarrassed or ashamed to share, or don’t prefer to discuss their personal thoughts, contributes to this situation. Furthermore, not all healthcare providers are familiar with this form of OCD.
People with ‘Pure O’ OCD may also experience symptoms of other conditions. A stress-free life is impossible for those with pure obsessive-compulsive disorder (OCD). This is due to the lack of physical symptoms, but many of the problems and stresses of everyday life are significant issues.
So, if you suffer from intrusive thoughts and mental rituals, but they aren't physical and you feel alone, you should know that mental health expert, such as a psychiatrist, can help you to address the root cause for long-term wellbeing.
The good news is that Pure O is treatable. Here are some ways a psychiatrist can help you:
- Screening and diagnosis thoroughly:
Here, your role is important. Be honest with yourself and your psychiatrist about your situation. Speak sincerely and candidly with a therapist about your OCD thoughts.
- Customized treatment plan:
Depending on the severity of your condition, the psychiatrist plans the treatment. The most common treatment plan for Pure OCD is:
- Medication: Prescribed medication helps dispel the symptoms. The fact is, medication allows you to actually do therapy because it reduces the volume of thoughts, so you can actually hear your therapist (aka increase the efficiency of talk therapy).
- Cognitive Behavioral Therapy (CBT): It helps patients change the distorted thought patterns and responses into positive ones.
- Exposure and Response Prevention (ERP): Step by step, patients are exposed to the list of fears, sidestepping them mentally
- Mindfulness techniques: This technique helps patients get to acknowledge thoughts without criticizing them. Being aware of thoughts without judgment is one of the methods to help achieve a peaceful mental state.
- Support groups: They offer a safe place for individuals with ‘Pure O’ OCD to talk about their experiences and coping strategies.
- Lifestyle changes: Unhealthy habits like alcohol and drug abuse worsen the condition. Therefore, adopting healthy habits, such as eating a balanced diet, staying physically active, getting sound sleep, and implementing stress management techniques like deep breathing, helps to live a relaxed life.
- Family therapy: Involving family members in therapy can help an individual with OCD better understand the condition and learn how to support their loved ones.
Living with Pure O
If you are someone who generally tends to think purely, think of the following:
- Your thoughts don't make you a bad person
- It's okay to ask for help
- With strong support, you will heal and feel better
If you experience very disturbing thoughts that have an extremely impair your basic day-to-day activities, academic or career life, and relationships, it is important to consult with a mental health professional. Keep in mind that you do not have to deal with it alone.
Moreover, it is crucial to remember that Pure O is one type of OCD that can be effectively treated. With the right approaches to therapy, you can be able to break the cycle of fears overwhelming the mind. So, take control of your mind and lead an enjoyable life.
If you are looking for a second opinion or OCD therapy in Columbia, visit https://gabapsychiatrist.com/location/psychiatrist-in-columbia/ or call us at +1(833)312–4222.
About the Creator
Neha
Writer & mental health advocate. I have overcome anxiety & embraced my introverted nature. As a person, I consider my mental health as important as my physical health.
Why Smiling Can Feel Like the Hardest Thing
The Unbearable Weight of a Smile: When Your Face Refuses to Lie Anymore "Just smile," they said, as if my face were a light switch I could simply flip. As if the muscles required to curve my lips upward hadn't become so heavy that lifting them felt like deadlifting my own despair. As if smiling—the simplest, most automatic human expression—hadn't become the most exhausting performance of my entire day. I'm standing in line at the coffee shop, and the barista is making small talk. "How's your day going?" she asks, cheerful, genuine, expecting the standard response. My jaw tenses. My face feels like stone. I know what I'm supposed to do—smile, say "great, how about you?", participate in this basic social ritual that I've performed thousands of times without thinking. But I can't. My face won't cooperate. The muscles required to form a smile feel paralyzed, or more accurately, weighted down by something too heavy to lift. I force it anyway. The corners of my mouth move upward mechanically, but it doesn't reach my eyes. It doesn't feel genuine. It feels like I'm wearing a mask that doesn't quite fit. "Fine, thanks," I manage, and the barista's smile falters slightly. She can tell. Something's off. My smile is wrong somehow—too tight, too forced, too obviously fake. I take my coffee and leave quickly, exhausted by the thirty-second interaction. My face hurts from the effort of that brief, failed smile. And I still have an entire day of this ahead of me. When Your Face Becomes a Traitor I used to smile easily, automatically. It was a reflex, an unconscious response to humor, kindness, joy, social situations. I never thought about it, never had to try. Now every smile is manual labor. Every upward curve of my lips requires conscious effort, deliberate muscle activation, sustained energy I don't have. My face has become resistant, like it knows I'm lying and refuses to participate in the deception. In meetings at work, I'd notice other people smiling, laughing, their faces animated and expressive. And I'd try to match them, to mirror their expressions, to look like I was engaged and present. But my face wouldn't cooperate. It would freeze in this neutral, flat expression that read as either bored or angry, even though I wasn't trying to look either way. I just... couldn't make my face do what faces are supposed to do. "You look upset," my boss said after one meeting. "Is everything okay?" "I'm fine," I said, and tried to smile to prove it. But even I could feel how wrong it looked—this grimace that pretended to be a smile, this contortion that fooled no one. "If something's bothering you, you can talk to me," he pressed. Nothing was bothering me. At least, nothing specific. I wasn't angry or upset about work. I was just... unable to smile. Unable to make my face perform the basic signals that tell others I'm okay, I'm engaged, I'm a functioning human being having a normal interaction. The Exhaustion of Performance Every day became a marathon of forced facial expressions. Wake up. Try to smile at my partner over breakfast. Fail. See his concern. Force a smile to reassure him. Feel my face muscles strain with the effort. Get to work. Try to look pleasant and approachable. Feel my face settle into that blank, heavy expression despite my best efforts. Force periodic smiles during conversations. Feel exhausted by 10 AM from the sheer effort of manipulating my own face. Lunch with colleagues. They're laughing about something. I hear the joke, understand it's funny, know I should be laughing too. Try to make my face do the laughing expression. Produce something that's almost a smile but not quite right. See them notice. Feel them pull back slightly, unsure how to read me. By the end of each day, my face would actually ache. Not from overuse, but from the constant tension of trying to force expressions that wouldn't come naturally, of fighting against muscles that wanted to remain flat and unresponsive. I started avoiding situations that required me to smile. Stopped going to social gatherings where I'd have to perform happiness I didn't feel. Turned down invitations to celebrations, parties, events where smiling would be expected and my inability to do so would be conspicuous. My world shrank to environments where I didn't have to pretend—mostly my apartment, alone, where my face could rest in its natural state of heavy neutrality without judgment or concern. Understanding the Impossibility "Why can't I smile?" I asked my therapist, genuinely baffled by this loss of what seemed like the most basic human function. "I'm not trying to look miserable. I just... can't make my face do it anymore." She explained it in a way that finally made sense. "Depression doesn't just affect your mood—it affects your motor functions, including the facial muscles. The neurotransmitters that allow for spontaneous emotional expression are depleted. Your face isn't refusing to smile. Your brain isn't sending the signals that create smiling." She showed me research about something called "facial feedback"—the way our facial expressions both reflect and influence our emotional state. When you smile, your brain registers that feedback and generates corresponding positive emotions. It's a two-way street. But in depression, that street is blocked. Your brain can't generate the positive emotions that produce genuine smiles, and forcing smiles doesn't trick your brain into feeling better—it just exhausts you with the effort of manually operating machinery that's supposed to be automatic. "It's not laziness," she emphasized. "It's not attitude. It's a literal neurological impairment. Your brain has lost the ability to generate spontaneous positive facial expressions." Knowing this didn't make it easier, but it helped me understand why something so simple had become so impossibly hard. The Social Cost The inability to smile carries a staggering social cost that people who've never experienced it can't understand. Humans are wired to read faces. We make split-second judgments about people based on their expressions. A lack of smiling reads as unfriendly, unapproachable, angry, or unstable—even when that's not what you're feeling at all. My relationships deteriorated. Friends stopped reaching out because interactions with me felt flat, heavy, unrewarding. I wasn't fun to be around anymore. Not because I was actively negative, but because I couldn't reflect back the warmth and positive energy that social bonds require. My partner grew increasingly frustrated. "You never seem happy to see me," he said one night. "I come home and you just... look at me. No smile, no warmth, nothing." "I am happy to see you," I insisted. "I just can't make my face show it." "That doesn't make sense," he said, hurt and confused. "If you're happy, why can't you smile?" How could I explain that happiness and smiling had become disconnected? That I could feel some small sense of gladness that he was home, but that feeling couldn't translate into facial expression? That the pathway between emotion and face had been severed? I couldn't explain it in a way that made sense to him. And eventually, he stopped believing I was happy to see him at all. The Judgment and Misunderstanding The worst part was the constant judgment from people who didn't understand. "You should smile more!" Random strangers, usually men, felt entitled to offer this advice, as if my face existed for their viewing pleasure. "Cheer up, it might never happen!" People would joke, assuming my expression meant something bad had occurred, when really it just meant my face was resting in its default depressed state. "Why are you so angry?" I wasn't angry. I was just unable to smile. "You need to work on your attitude." My attitude was fine. My face just couldn't show it. People assumed my lack of smiling meant I was rude, unfriendly, hostile, or miserable. They couldn't see that I was simply exhausted from trying to operate machinery that had stopped working. Even well-meaning people hurt me with their attempts to help. "Just fake it till you make it!" they'd say. "Force yourself to smile and you'll feel better!" But forcing smiles didn't make me feel better. It made me feel like a fraud. It highlighted the gap between what my face was doing and what I was actually feeling. It made the depression more obvious, not less, because the smile never reached my eyes, never looked genuine, never fooled anyone including me. The Breaking Point The crisis came during my niece's birthday party. She was turning five, excited, adorable, having the time of her life. She ran up to me with a drawing she'd made, her face lit up with pure childhood joy. "Look what I made for you, Auntie!" I looked at the drawing—a colorful, enthusiastic rendering of the two of us holding hands. She'd drawn me with a big smile. And I couldn't smile back at her. I tried. God, I tried. This innocent child showing me something she'd made with love, and I couldn't produce even a small smile of acknowledgment. My face remained flat. Heavy. Unresponsive. Her face fell. "Don't you like it?" "I love it, sweetheart," I said, my voice breaking slightly. "It's beautiful." But she'd already seen my expression—or lack of it. She walked away, confused and a little hurt, and I stood there holding her drawing, hating myself for not being able to give this child the one simple thing she wanted: a smile. That night, I called my psychiatrist. "Something's really wrong," I said. "I can't even smile at a five-year-old. What's happening to me?" The Medical Reality My psychiatrist adjusted my medication and explained what was happening. "What you're experiencing is called 'psychomotor retardation'—a slowing down of physical and emotional responses. It's a core symptom of major depression. Your facial muscles aren't responding normally because the neural pathways that control spontaneous expression aren't functioning properly." She also mentioned something called "anhedonia"—the inability to feel pleasure—which often comes with an inability to express pleasure, even when you're trying. "The medication we're adjusting should help," she said. "But it takes time. Six to eight weeks, possibly longer, before you notice a difference." She also recommended something unexpected: facial exercises. "Research shows that deliberately practicing facial movements—even without the corresponding emotion—can help retrain the neural pathways. It won't cure the depression, but it might make the physical expressions easier." So I started doing these bizarre exercises. Standing in front of the mirror, manually moving my face through expressions. Lifting the corners of my mouth with my fingers to simulate a smile. Holding it. Releasing. Repeating. It felt ridiculous. I felt ridiculous. But I was desperate enough to try anything. The Slow Return The medication took seven weeks to start working. Seven weeks of forced smiles, exhausted facial muscles, and social situations I couldn't navigate properly. Then one morning, my partner said something funny at breakfast and I felt it—a real smile, spontaneous and genuine, breaking across my face without effort. It lasted maybe three seconds before fading. But it was real. It was mine. It happened without me having to manually operate my face. I started crying, which alarmed my partner until I explained: "I just smiled. A real smile. I didn't have to force it." He looked at me with such relief and sadness. "I didn't realize how hard it's been for you," he said quietly. After that, smiles came more frequently. Not all the time—I still had days where my face felt weighted and unresponsive. But the genuine smiles started outnumbering the forced ones. The effort required diminished. My face started cooperating again. Living With the Memory A year later, I can smile relatively easily again. Not effortlessly like I used to, and not constantly. But the heavy impossibility has lifted. My face has mostly remembered how to express what I'm feeling without requiring manual operation. But I haven't forgotten what it was like. That period when smiling felt harder than anything else, when my face betrayed me every day, when the simplest human expression became impossible. I'm gentler with people now. When I see someone with a flat expression, with a face that doesn't smile easily, I don't assume they're unfriendly or angry or rude. I wonder if maybe they're fighting this same battle. If maybe their face is as heavy as mine once was. I also don't take smiling for granted anymore. Every genuine smile feels like a gift, like evidence that my brain is working properly again, that the neural pathways are transmitting signals the way they should. The Truth That Needs Telling If you can't smile right now—if your face feels like dead weight, if forcing expressions exhausts you, if people keep telling you to cheer up and you want to scream that you're trying but your face won't cooperate—please know this: You're not broken. Your face isn't defective. This is a symptom of depression as real and valid as any other symptom. Your brain's ability to generate spontaneous positive expressions has been impaired by depleted neurotransmitters and disrupted neural pathways. This isn't attitude. This isn't choice. This is neurology. And it's treatable. With the right medication, therapy, and time, your face can remember how to smile again. The heaviness can lift. The effort can diminish. The genuine smiles can return. Don't let people shame you for something you literally cannot control. Don't let them tell you to "just smile" as if you haven't been trying. Don't let them mistake your depression for rudeness or hostility. Your face will cooperate again. The pathways will reconnect. The expressions will come naturally once more. Until then, be patient with yourself. You're not failing at something easy. You're managing something impossibly hard. And you're doing better than you think. When smiling becomes the hardest thing, it's not because you're ungrateful or negative or refusing to see the bright side—it's because depression has literally disconnected the neural pathways between emotion and facial expression. Your face isn't betraying you out of spite. It's malfunctioning because your brain chemistry is disrupted. The effort it takes you to produce a smile is the same effort it would take someone else to deadlift a car. You're not being difficult. You're being incredibly strong, showing up to social situations and manually operating facial machinery that's supposed to be automatic. The heaviness will lift. Your face will remember. Until then, please stop judging yourself for not being able to do something your broken neurology has made nearly impossible. --------------------------------------------- Thanks for Reading!
By Ameer Moavia6 days ago in Psyche
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