Understanding Pure O: You Are Not Having Intrusive Thoughts All Day, You Are Ruminating

Most people with intrusive thoughts (often referred to as Pure O) and most people who treat intrusive thoughts, think that these thoughts are involuntary and uncontrollable.  

The truth is that the vast majority of what people call intrusive thoughts — almost all of them — are actually being thought or imagined on purpose, in an effort to prevent something bad from happening.

Here’s an example of how this typically plays out in someone with OCD:

A person sees a knife near someone they love, and it occurs to them that they could stab that person with the knife.  This terrifies the person: What if they really did stab them?

So what does this person do?  They try to figure out if they would actually do it.  In order to figure this out, they purposely imagine stabbing their loved one in order to gauge their emotional response.  And when they aren’t 100% sure what their response was, they imagine it again. Then they might imagine doing it another way, or start thinking about other violent ideas to gauge their response to those.

At this point they are repeatedly imagining stabbing someone, not even realizing that they’re doing it on purpose.  This person will say that they are experiencing intrusive thoughts all day. They don’t realize that the majority of these intrusive thoughts are actually thought experiments that they are constantly running in their mind.  In other words, this isn’t automatic thinking that they can’t control; it’s analytical thinking that they are directing towards figuring out if they might actually stab someone.

(To understand why this thought process never reaches a conclusion, see Why Rumination is a Continuous Loop.)

The initial moment when it occurs to the person that they could stab their loved one is the actual intrusive thought, or ‘obsession.’  How long does it last?  A millisecond.  It’s instantaneous. Everything that follows that flash of fear is compulsive mental checking, also known as compulsive rumination.

I prefer not to use the term ‘intrusive thoughts’ at all, because it fails to differentiate between the thought that occurs to the person and the analytical thinking that follows it. For the same reason, the popular advice to ‘let thoughts be there’ can be extremely harmful and misleading.  As explained in Rumination is a Compulsion, Not an Obsession, and That Means You Have to Stop, the fact that rumination is a compulsion means that it will not go away on its own as a result of treatment; rather, the patient must eliminate it as part of treatment.

We need to teach people with OCD, and other people who ruminate, that they actually do have control over this thought process, and that even though it’s scary to stop, doing so is an essential step toward getting better.

To learn more about how to stop ruminating, please check out How to Stop Ruminating.

Please note that this article is for your information only and does not constitute clinical advice or establish a patient-psychologist relationship.