Pure-O OCD (Pure Obsessional OCD) is a subtype of OCD (Obsessive-Compulsive Disorder) characterized by recurrent, unwanted thoughts, impulses, or images (obsessions) that cause anxiety or distress. Individuals with Pure-O do not engage in visible compulsive behaviors such as counting, checking, or cleaning. But the term “pure-O” is somewhat misleading as individuals still compulse. They may mentally neutralize or counteract their obsessions through mental rituals such as mental praying, counting, or repeating words.