We often see OCD portrayed in the media as a series of quirks—hand-washing, light-flicking, and obsessive organizing. While these are real and valid compulsions, they represent only a fraction of what Obsessive-Compulsive Disorder can be. What happens when the compulsions aren’t visible? What if the exhausting, repetitive rituals are all happening silently, inside your own mind?
This is the reality for millions of people who live with a lesser-known presentation of OCD, often referred to as “Purely Obsessional” or “Pure O.” Recently, country music superstar Luke Combs opened up about his lifelong battle with this “wicked variant” of OCD, pulling back the curtain on a silent struggle that often leaves people feeling isolated and misunderstood. His courage to speak out gives us a valuable opportunity to shed light on this challenging condition and, most importantly, to talk about the hope and healing that is entirely possible.
The OCD No One Sees
So, what exactly is “Pure O”? The term itself is a bit of a misnomer. It isn’t that there are no compulsions, but rather that the compulsions are primarily mental. Instead of performing a physical ritual, a person with Pure O engages in internal neutralizing behaviors to find relief from distressing intrusive thoughts.
Luke Combs described his experience in a way that will resonate with many: an endless, looping cycle of unwanted thoughts that cause immense stress. He said, “It’s thoughts essentially that you don’t want to have that you’re having, and then they cause you stress, and then you’re stressed out, and then the stress causes you to have more of the thoughts.”
This is the core of OCD. It’s not the presence of a strange or disturbing thought that’s the problem—neuroscience tells us that virtually everyone has bizarre, unwanted thoughts. The difference is that for someone with OCD, the brain’s “threat detector” (the amygdala) misfires, flagging these thoughts as dangerous and critically important. The individual feels an urgent need to figure them out, neutralize them, or make them go away.
This leads to the compulsions. In Pure O, these can look like:
- Mental Review and Rumination: Endlessly replaying a memory or a conversation to check for mistakes or hidden meanings.
- Reassurance Seeking (Internal): Constantly telling yourself, “I’m a good person,” or “I would never do that,” in an attempt to feel certain and safe.
- Mental Checking: Scanning your body for feelings or sensations that might “prove” or “disprove” a fear (e.g., checking for arousal in response to a disturbing sexual thought).
- Thought Suppression: Trying to forcibly push thoughts out of your mind, which, paradoxically, only makes them stronger and more persistent.
- Silent Praying or Counting: Engaging in specific mental phrases or number sequences to counteract a “bad” thought.
Luke Combs’ experience with intrusive thoughts about his health or his relationships is a classic example. He explained that his OCD often poses a question “about who you are as a person that you really can’t ever get an answer to.” This quest for an unanswerable question is what keeps the OCD cycle spinning. The disorder feeds on uncertainty and promises that if you just think about it one more time, you’ll finally find the certainty you crave. But it’s a false promise.
You Are Not Your Thoughts
One of the most painful aspects of Pure O is the content of the obsessions. Because the compulsions are hidden, the distress is deeply internal and often shameful. The intrusive thoughts frequently attack a person’s most cherished values.
Common themes include:
- Responsibility/Harm: Unwanted thoughts of harming a loved one, a child, or even a stranger.
- Sexual Obsessions: Intrusive and unwanted sexual thoughts that may be violent, incestuous, or involve children (pedophilic obsessions, or POCD). These are especially distressing because they are so contrary to the person’s actual values.
- Religious/Moral Scrupulosity: An obsessive fear of having sinned, being unworthy in the eyes of God, or having violated a deep moral principle.
- Relationship OCD (ROCD): Persistent doubts about whether you truly love your partner, whether they are the “right” one, or whether you are truly attracted to them.
- Existential OCD: Obsessive, looping questions about the nature of reality, the self, or the universe that provide no resolution.
It is absolutely crucial to understand this: Having an intrusive thought does not mean you are a bad person, and it does not mean you want to act on it. In fact, the very reason these thoughts cause so much distress is because they are “ego-dystonic”—meaning they are the complete opposite of what you truly believe and value. As Combs put it, OCD “preys on everything you’re not, and it makes you feel like you are that.”
Finding a Way Forward: Evidence-Based Hope
Luke Combs mentioned that after years of struggling, he now has the “tools” to manage his OCD and is no longer as afraid of the flare-ups. This is the message of hope that anyone struggling needs to hear. OCD is highly treatable, but it requires a specific, evidence-based approach.
The gold standard for treating all forms of OCD, including Pure O, is Exposure and Response Prevention (ERP).
ERP sounds intimidating, but it’s a logical and incredibly effective process. Here’s how it works for mental compulsions:
- Exposure: Instead of pushing the unwanted thought away, you purposefully and gradually allow yourself to be exposed to it. This can be done through “imaginal exposures,” where you write or record a short script about your fear coming true. The goal isn’t to enjoy the thought, but to learn to sit with the discomfort it brings without performing a compulsion.
- Response Prevention: This is the most important part. You make a conscious choice to not engage in the mental rituals. You don’t ruminate, you don’t seek reassurance, you don’t argue with the thought. You simply let it be there, like a cloud passing in the sky.
Luke Combs described his own version of this process: “It’s learning to just go, ‘it doesn’t even matter what the thoughts are. I just have to accept that they’re happening and then just go, whatever dude, it’s happening.’”
This is the essence of response prevention. By not giving the thoughts special attention, you are retraining your brain. You are teaching your amygdala that this thought is not a genuine threat. It’s just a misfire, a bit of junk mail from your brain. Over time, as you resist the compulsions, the anxiety associated with the thought begins to fade. The thoughts may still pop up from time to time, but they no longer have the power to derail your life.
Other therapeutic approaches like Acceptance and Commitment Therapy (ACT) are also incredibly valuable, often used alongside ERP. ACT helps you change your relationship with your thoughts, learning to see them for what they are—just words and images—while you commit to living a life guided by your values, not by your anxiety.
Your First Steps Toward Freedom
If you are reading this and recognizing your own silent struggle, please know this: You are not alone, and you are not broken. What you are experiencing is a treatable medical condition. The path to recovery begins with understanding and taking that first brave step toward seeking the right kind of help.
Finding a therapist who specializes in OCD and ERP is key. This is a specialized treatment, and working with someone who truly understands the nuances of the disorder can make all the difference. When you are ready to take that step, we are here to help guide you.
The freedom Luke Combs describes—the freedom of not needing an answer to the “what if” questions—is available to you, too. It takes work, courage, and the right support, but a life where you are in control, not your thoughts, is within your reach.
Resources for Further Study:
- The International OCD Foundation (IOCDF): An invaluable resource for information, finding qualified therapists, and connecting with the OCD community. https://iocdf.org/
- NOCD: Provides online ERP therapy with licensed specialists and offers a wealth of free information and community support. https://www.treatmyocd.com/
- “Freedom from Obsessive Compulsive Disorder” by Dr. Jonathan Grayson: A comprehensive guide to understanding and using ERP for recovery.
- “The Mindfulness Workbook for OCD” by Jon Hershfield, MFT, and Tom Corboy, MFT: An excellent resource for integrating mindfulness and ACT skills into your recovery.
Original Source Credit: This post was inspired by the reporting in Rolling Stone’s article, “Luke Combs Opens Up About His Struggle With an Obscure Form of OCD.”
Stay hopeful,
West Breedlove, LPC-MHSP
This video provides a concise explanation of Luke Combs speaking out about his personal struggles with OCD since childhood, which is relevant to the blog post.
Country star Luke Combs discusses his OCD diagnosis