Covert Symptoms in OCD

Mental Compulsions

Although obsessions without overt rituals are now considered relatively common among people with OCD, this OCD symptoms has generally been understudied and until recently has been considered resistant treatment. Beliefs regarding the importance of thoughts and the need to control them are common in people with this type of OCD. The meanings associated with unwanted thoughts may be related to views of self, for example, the ideaa that "Having a bad thought means I am a bad person."

People with mental compulsions are usually coping with thoughts are that are unacceptable or taboo in nature (sexual, harming, religious thoughts), or worries about illness and health. Rather than perform an overt ritual, such people will engage in these covert rituals and mental neutralizing. This might include repeating silent prayers, replacing "bad" thoughts with "good" thoughts, or erasing unpleasant mental images. They might also engage in excessive silent prayer or confession, perform some form of mental checking (e.g., reviewing one's behaviors), or engage in excessive self-reassurance (e.g., "I have never done that bad thing before so I won't do it now.") These mental compulsions result in the same temporary relief from anxiety, and are thus are thus equivalent to more overt rituals.

People with OCD tend to be introspective and may spend a great deal of time and effort ruminating about the origins of their disorder. In fact, this sort of rumination can also be a mental compulsion.

Common mental rituals

• Special words, images, numbers, repeated mentally to neutralize anxiety
• Special prayers (short or long) repeated in a set manner
• Mental counting
• Mental list-making
• Mental reviewing (e.g. reviewing conversations or actions)
• Mental erasing of unwanted mental images
• Mental un-doing
• Self-reassurance

Pure-O

Sometimes people who have primarily mental compulsions are called "pure-o" or "pure OCD". This actually means "pure obsessional" — someone with only obsessions and no compulsions. But this person does have compulsions, they just go unseen.

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