The Truth About Covert OCD: When Obsessions Are Invisible
When most people think of OCD, they picture someone meticulously washing their hands, checking locks repeatedly, or arranging objects symmetrically. But for many, OCD isn’t about visible rituals at all. Instead, it takes place almost entirely in the mind. This is often called Covert OCD (formerly known as "Pure O" or Purely Obsessional OCD), and it’s one of the most misunderstood forms of the condition. While the term "Pure O" suggested that compulsions were absent, research now recognises that covert mental compulsions are a significant part of the experience.
What Is Covert OCD?
Covert OCD is a term used to describe OCD that primarily involves intrusive, distressing thoughts without obvious physical compulsions. However, the idea that compulsions are absent is misleading—because even though they may not be external, they are very much present. Instead of physical rituals, individuals engage in mental compulsions, such as:
Repetitive mental reviewing (e.g., going over past interactions to check if they said something wrong)
Seeking certainty by analysing their thoughts excessively
Silent prayers or counting to ‘neutralise’ distressing thoughts
Avoiding triggers that bring up unwanted thoughts
Constant self-reassurance or asking others for reassurance
Research on Covert OCD
Recent studies indicate that while individuals with Covert OCD may not display visible compulsions, they do engage in covert mental rituals that sustain the obsessive-compulsive cycle (Williams et al., 2019; Abramowitz & Jacoby, 2015). Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) has been consistently identified as the most effective, research-backed treatment for OCD, including covert presentations (Koran & Simpson, 2013).
Common Themes, Obsessions, and Compulsions in Covert OCD
People with Covert OCD can experience intrusive thoughts about virtually anything, but some of the most common themes and obsessions include:
Harm OCD – Fear of accidentally harming others or oneself, often accompanied by distressing mental imagery or urges
Relationship OCD (ROCD) – Obsessive doubts about a partner or relationship, including questioning love, attraction, or compatibility
Sexual Orientation OCD (SO-OCD) – Distressing uncertainty about sexual identity despite prior certainty
Existential OCD – Over analyzing deep questions about life, death, or reality, leading to unrelenting doubt and anxiety
Religious or Moral OCD (Scrupulosity) – Extreme fear of being immoral, sinful, or offending a higher power
Fear of losing control – Worrying about acting on violent, aggressive, or inappropriate impulses
Intrusive sexual thoughts – Unwanted thoughts about taboo or inappropriate sexual scenarios, leading to shame and distress
Paedophilia OCD (POCD) – Distressing and unwanted intrusive thoughts about harming children, leading to intense shame and avoidance behaviours despite having no desire or intent to act on these thoughts
Fear of being a bad person – Persistent self-doubt about one’s morality or intentions
Health-related obsessions – Fixating on the possibility of having a serious, undiagnosed illness, often leading to excessive self-monitoring
Obsessions about memory or false memories – Constantly doubting whether past events happened the way they remember
Philosophical or existential fears – Obsessing over the nature of reality, the meaning of life, or whether they truly exist
Common compulsions that accompany these obsessions include:
Mental checking – Repeatedly analysing thoughts or past behaviours to ‘make sure’ they didn’t do something wrong
Self-reassurance – Silently telling oneself that they are not a bad person or that their fears are irrational
Replaying scenarios – Mentally reviewing past events to check for wrongdoing or to find ‘proof’ that they are safe
Thought neutralisation – Replacing ‘bad’ thoughts with ‘good’ thoughts or mentally repeating certain phrases to counteract distress
Compulsive researching – Spending hours online looking for reassurance about their fears
Avoidance behaviours – Steering clear of people, places, or situations that might trigger distressing thoughts
Confessing – Feeling compelled to admit ‘wrongdoings’ or seek reassurance from loved ones about their thoughts
These thoughts and compulsions are often disturbing and go against the person's values, leading to intense shame and fear, making them feel isolated or even question their own identity.
Why Reassurance Doesn’t Help
One of the biggest struggles with Covert OCD is the relentless search for certainty. People may seek reassurance from loved ones or mentally ‘check’ whether their thoughts mean something terrible about them. Unfortunately, reassurance only reinforces the OCD cycle. The more you try to ‘solve’ the thought, the more power it has over you (Rachman, 2002).
Therapy for Covert OCD
If you struggle with Covert OCD, you are not alone—and you are not your thoughts. The good news is that OCD is treatable. Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) is the gold standard for OCD treatment (Abramowitz, McKay, & Storch, 2017). It helps individuals learn to sit with uncertainty and resist compulsions, breaking the cycle of obsession and reassurance-seeking.
Narrative Therapy is also a valuable approach for individuals with Covert OCD. By externalising intrusive thoughts and recognising that they do not define one's identity, individuals can gain a sense of control and reduce distress. This therapeutic method helps clients reframe their experiences and separate themselves from OCD-driven narratives.
Eye Movement Desensitisation and Reprocessing (EMDR) is another therapeutic approach that has shown promise in treating OCD, particularly for individuals whose obsessions and compulsions are linked to past trauma or distressing experiences. EMDR helps process these past events and reduce the emotional intensity of intrusive thoughts, allowing individuals to engage more effectively in other forms of OCD treatment.
Ready to Take the First Step?
Living with OCD can be overwhelming, but you don’t have to face it alone. I offer a compassionate, supportive space where you can explore your experiences without fear of judgment. Together, we can work towards managing your intrusive thoughts and compulsions to reduce their power and helping you regain a sense of peace and autonomy over your life.
If you're ready to take that first step, reach out today – tracyjanefoster@gmail.com
References
Abramowitz, J. S., McKay, D., & Storch, E. A. (2017). The Wiley Handbook of Obsessive Compulsive Disorders. Wiley-Blackwell.
Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive disorder in the DSM-5. Clinical Psychology: Science and Practice, 22(3), 299–313.
Koran, L. M., & Simpson, H. B. (2013). Guidelines for the pharmacological treatment of patients with obsessive-compulsive disorder. Journal of Clinical Psychiatry, 74(2), 144-150.
Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 625-639.
Williams, M. T., Mugno, B. L., Franklin, M. E., & Faber, S. (2019). Symptom dimensions in OCD: A meta-analysis of factor analytic studies. Behavior Therapy, 50(2), 314-328.
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