"Pure" Evil
A dark and unfamiliar form of a dark and unfamiliar illness
An Overview of OCD
In many conversations we have, people use nouns to describe themselves and other people, which don’t truly reflect what they are trying to convey, but which people understand.
Phrases like “I have PTSD from X” when referring to a bad memory or difficult period, and, although less common now, cruel insults such as “moron”, for someone who makes a mistake, or “gay”, for someone who has different interests to their peers, are just some examples of this.
Generally, however, people know the true meaning of what they are saying to someone. They know they don’t actually have PTSD, nor are speculating about the sexuality of a peer, merely using the terms they do to exaggerate what they are trying to convey to someone.
But although people vaguely understand this when referring to themselves being “OCD” about something, they perhaps do not know the seriousness of the mental illness they are referring to.
To many, OCD seems like an eccentric quirk, something that ensures someone keeps everything in check and perhaps in that way, it is even desirable.
The reality, though, is very different, and if people knew how brutal OCD can be as a mental illness, they would think twice before labelling, for example, their desire for mind maps to be colour-coordinated, alongside one of the most difficult and debilitating mental illnesses out there.
Instances of OCD appear to be growing, with a record number of US children - 500,000 - currently diagnosed, as the effects of social media and the pandemic on self-esteem has caused even more cases of this genetically predisposed illness to emerge.
Naturally, therefore, the illness particularly affects young people (as can be seen below), and though statistics suggest lower cases amongst older people, this is likely to change as the latest generation ages.
The Professional View
Karen Buckingham MBACP is a Devon-based therapist who started training for a career in that profession after suffering with the illness herself. She has helped hundreds with their recovery from OCD since she became a qualified therapist in 2006.
So what is Pure O?
Within a little-known illness there is an even more little-known form of it, the subject of this article, known as Pure-O (Obsessional) OCD, a form of OCD that exists entirely inside the mind without any visible compulsions.
Pure-O in itself is a misleading term, as compulsions do take place (and it is most certainly a disorder), but for clarity and simplicity – something which OCD sufferers like myself have a dearth of – the term is used to differentiate them from those without outwardly compulsive behaviours.
In many ways, Pure-O works exactly the same as all forms of OCD, and all forms of Pure-O work the same.
It all originates from an initial spike. This can come from any intrusive thought or worry, and is often more likely to strike when an individual is anxious, fearful or even excited.
This sends "distress signals" to the brain, which then make it believe that there is a threat to the individual that has to be dealt with.
As the intensity of the fear and worry build it becomes of immediate concern to deal with the problem, in the case of Pure-O, work out exactly how one feels about something or themselves.
So the ritual compulsion is performed, and in the case of Pure-O this is where an attempt is made to rationalise an issue, use evidence against it and disprove it.
And though this moment of clarity provides fleeting relief, like any compulsion, it doesn't work for long.
The obsessive thought returns like a malicious, abusive dictator figure, pushing its will onto the sufferer who cannot seek relief.
Examples of Mental Compulsions
Who has it?
According to National Institute for Health and Care Excellence (NICE) guidelines, approximately only 10% of OCD sufferers have what is known as Pure-O, although this estimate only includes those who are plagued with sexual intrusive thoughts or those related to harm.
The likelihood though, is that the vast majority of sufferers have to perform Pure-O compulsions at some point, perhaps when they are not in a situation where they can perform outward compulsions for example.
Equally, those who are predominantly Pure-O sufferers will perform some outward compulsions too. According to the Charity OCD UK these include:
- Checking phone for reassurance
- Seeking reassurance from loved ones or friends
- Physically avoiding people, places or objects that trigger obsessions
This indicates a relationship between Pure-O and other forms of OCD, as Karen explains below.
The Wasps' Nest analogy
Perhaps the best way to describe OCD, and in particular Pure-O, is that it is like being sat in a small room possessing only a stick with a wasps nest, filled with an endless number of wasps, nearby.
The temptation is to prod it, to try and get rid of it completely, and with every wasp you kill you feel like you are getting closer, and the time spent prodding is meaningful, but the reality is that every prod brings as many wasps to the surface as it takes out, and the more it brings surface the more you will get stung.
If you ignore it you will get some stings, no question, and this is not a mental illness that can be cured outright. But by prodding the nest, you will simply only make it worse.
The Science of Pure-O
In blue are the areas of the brain that are excessively active in people with OCD.
Orbitofrontal cortex (represented by the area in the top left part of the diagram) - In a normal brain this investigates sensory information, makes decisions and anticipates rewards or punishment, but in an OCD brain it detects an error where there isn't one and sends "distress signals".
Basal Ganglia (represented by the area on the left front underside of the brain) - Inside the brain, this usually controls movements, judgement and thinking, but in an OCD brain causes compulsions, and in one with Pure-O sets its mind to putting to rest whatever mental challenge or concern it has been set.
Cingulate Gyrus (represented by the area running vertically in the centre of the brain) - In a normal brain this adds emotional responses to thought, which with Pure-O intrusive thoughts are paired with disgust, guilt and anxiety.
Caudate Nucleus (represented by the lower, more central area) - In a normal brain this processes and stores information, removing unwanted and irrelevant thoughts. This process fails in an OCD brain, influencing the Basal Ganglia to perform compulsions.
What is the impact?
Like any mental illness, Pure O can have a huge impact on the day-to-day life on the sufferer.
Distraction caused by intrusive thoughts can not just spoil social events or the "good" times, but can also majorly impact someone's motivation to perform basic day-to-day tasks and impact their commitment to work or education.
"Keeping busy", perhaps more than any mental illness, can be an antidote for high-functioning in itself, but when motivation is affected the individual is less likely to be able to keep busy and may spiral into crisis.
Fighting back by letting go
Whatever method of therapy someone uses, they are always met with a variation on the same answer to stop suffering from this problem.
Once someone is able to identify that their Pure-O is a form of OCD, the processes are similar to how to relieve other forms of the illness.
The sufferer has to ignore the urge to perform compulsions, which in the case of Pure-O means not reacting to the intrusive thought that continually pester you.
Acceptance is also a critical part of the process, as the uncomfortable feeling that comes with OCD can make it incredibly difficult not to be tempted into short term relief.
Referring back to the aforementioned wasps, you have to be prepared to be stung a little.
And then finally, it is key to focus the mind onto something else once the thought passes through, which is why keeping busy is so critical.
Karen outlines her L.I.A.R. treats the illness below.
Future Hopes
Raising awareness from activists will be key to allowing OCD to be taken more seriously, and groups like OCD Action and OCD UK are already making the move towards the illness, and indeed Pure-O being taken more seriously.
Celebrities like British singer/songwriter George Ezra, American country star Luke Combs and journalist Bryony Gordon - who has even written a book about it - are just some famous sufferers of Pure-O who have begun to draw attention to the issue.
As mentioned previously it is likely that more will suffer; although the illness has genetic roots, it can be caused by a lack of self-esteem through adolescence (although this is not always the case), which has been worsened amongst the current generation of young people.
But even reading an article such as this one contributes to the solution, as it is vital sufferers who are previously unaware of their problem know exactly where to go and are given a helping hand.
Because suffering with Pure-O and not knowing what it is a truly terrifying experience that no one should have to go through.
Special thanks to Karen Buckingham for all her help with this piece.
Photo by Alka Rautela on Unsplash
Photo Credits
Page 1 Photo - Lê Tân via Unsplash
Page 7 - Man and woman talking - charlesdeluvio via Unsplash
Page 8 - Wasps on Nest - Ally Lou Lou via Unsplash
Page 9 - OCD Brain - Scientific Animations via Wikimedia Commons
Page 12 - Alka Rautela via Unsplash
Photographs not credited do not require attribution
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