Pure-O OCD: Have you ever had a strange, intrusive thought that you couldn't let go of?

The real obsessive-compulsive disorder is not about orderliness or cleanliness, it’s about uncertainty

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Have you ever had an intrusive thought so shocking you’ve questioned your sanity? Have you ever felt the urge to say something so unspeakably inappropriate you’ve scared yourself? Telling your boss she’s a fugly bitch? Scalding your kid with your tea?

Though seldom aired in polite conversation, these kinds of thoughts are near-universal. Psychologist Stanley Rachman presented a questionnaire to a group of healthy college students and found that virtually all of them had such thoughts occasionally, including thoughts and mental images of sexual violence, harming old people, making impulsive or abusive outbursts, blasphemous acts and violence against animals or children.

‘Well, that was weird’, you’d think, having just imagined sneaking up behind the sofa and laying your penis down the bridge of your mate’s nose like a Corinthian helmet. All along your neurons a message would fizz – wrong, wrong, wrong – until your brain was certain that it’d just been a random anomaly. Then you’d slowly zone back into the soothing chatter of Time Team. And that would be that.

But what if your brain wasn’t wired up quite right? What if your neurons were a bit skew-whiff, and that message just kept fizzing and fizzing and fizzing, preventing you from reaching that sense of certainty? What if you started getting feverishly anxious? What if you started thinking that you actually wanted to do the willy trick? What if every time you told your brain ‘no’ it entrenched the mental image more deeply?

Preposterous it may sound, but for people like me with OCD, this mental process will feel very familiar. OCD affects up to 1.2 million people in the UK, and despite popular understanding, it’s not characterised by orderliness, cleanliness or germ-phobia. Sometimes called the ‘doubting disease’, it’s all about the fear induced by uncertainty. As OCD world authority Dr Jeffrey Schwartz explains: "Obsessions are bothersome thoughts that intrude into your conscious awareness totally against your will and make you feel afraid that something might happen. Because of that feeling of fear, you then start to do compulsions."

A person who compulsively cleans will do so until they reach a sense of certainty that the surface is no longer contaminated. But what most people don’t realise is that the same process applies itself to a dizzying variety of obsessive themes and compulsions, which are often extremely subtle. A mother with an obsessive fear of suffocating her baby might compulsively repeat mantras to neutralise her thoughts. A school teacher with an obsessive fear of accidentally flashing his students might wear four pairs of y-fronts. A child with an obsessive fear of going to hell might repeatedly pray for forgiveness.

These less overt manifestations of OCD are sometimes colloquially called pure-O OCD. Short for ‘purely obsessional’, the word is a misnomer, as the compulsions are very much present, they’re merely hidden. But the term has become has become popular for people like me, who feel the need to differentiate from the narrow definitions of OCD meted out in the media. Regardless of the form they take, though, compulsions always feed back into OCD’s viscous cycle and fuel obsessions. ‘The more you try and get rid of the feeling,’ Dr Schwartz explains, ‘the more that feeling grips you tighter and tighter and tighter.’

My OCD started when I was fifteen years old with intrusive sexual mental images. These prompted obsessive questions about my sexual identity, which I compulsively tried to answer by scouring my childhood memories for clues. Those times me and my brother folded up our knee-fat to look like fannies – what did that mean? What about egging the dog on every time she humped the rosemary bush? Sometimes one such compulsion would offer a fleeting moment of certainty. But it never lasted long.

The more I questioned, the more the doubt redoubled, and the loop spun 24 hours a day for decade, leading to searing anxiety, self-harm, medication, failed relationships and suicidal ideation. I’m frivolous about it now, but OCD is listed in the World Health Organisation’s top ten most debilitating illness for a reason. And in my quiet moments I still feel a hollow chill to think of how very, very ill I was.

Eventually, a year of exposure therapy taught me to tolerate my anxiety-inducing thoughts without acting out compulsions, breaking the loop through gradual conditioning. It heated up my plastic brain and remoulded it and made it forget its hurts. But I don’t want to forget – not fully. Because experiencing OCD has taught me the value of doubt in a compulsive world. It’s taught that reassurance-seeking is overrated, and that I cannot engineer certainty in the things I love by trying to control them. It’s taught me that doubt is my rocket fuel.

Rose Bretécher is a London-based writer who is currently crowd-funding her story of life with pure-O, with the publisher Unbound.