By Eliza Buzacott-Speer
Rose Bretécher was 15 when she first started experiencing intrusive, repetitive thoughts that she might be a paedophile.
“I tried to rid the thoughts from my mind by rationalising them or ruminating about them or repeating mantras to try to drown them out,” she says.
But the more Ms Bretécher tried to rationalise, analyse and defy the thoughts, the worse they became.
The cycle continued for several years, and by her late teens Ms Bretécher was experiencing “incredibly graphic” intrusive thoughts surrounding sex, and compulsively questioning her sexuality.
It was not until she was 26 and started therapy that she was freed from the cycle.
Paedophilia and other obscene sexual thoughts are one of several common themes associated with pure obsessional (Pure O), a little-known type of obsessive compulsive disorder (OCD).
Individuals with Pure O experience intrusive, upsetting obsessions, accompanied by vivid, seemingly incontrollable, imagery and feelings of great shame and distress — but no obvious compulsions or rituals.
Associate Professor in the School of Psychology at the University of New South Wales, Jessica Grisham, says there are a number of different themes of obsession.
“They tend to be topics like religion or sexual — but sexual in an obscene, unpleasant, unwanted type of sexual — or thoughts about harm to loved ones,” she explains.
“The very nature of these obsessions is that they are exactly the things the person would find most repugnant, most repulsive and most different from who they are.”
Principal psychologist at Anxiety House and The OCD Clinic, Ea Stewart, says everyone has intrusive thoughts, but people with Pure O give these thoughts weight and “feel responsible for having [them]”.
She says the term “Pure O” is also somewhat of a misnomer.
“Although it may appear as if there is only the obsessional thinking, there is actually often some sort of compulsion,” she says.
“There’s another thought process, whether that is overanalysing the thought, or trying to compulsively go through the thought [or] trying to defy the thought compulsively.
“Even if it’s a thought, it’s a process that is trying to relieve the anxiety.”
‘You’re a monster. How can you be a good father?’
For Adam Walker Cleaveland, these intrusive thoughts took the form of “obsessional thoughts and concerns and really ruminating on those thoughts that I was going to do something to harm my son”.
“The way I describe it is that I had a soundtrack going on in my head of all these really horrible, self-shaming, degrading thoughts about myself,” he says now.
“‘You’re a monster. How can you be a good father? You’re a horrible father’ … That was just my waking reality.”
Mr Walker Cleaveland began to find it difficult to complete daily tasks.
“Something as benign as going to the grocery store, each person I saw I would think they were looking at me a little funnier, like they knew what was going on in my mind,” he recalls.
“Many people tend to avoid situations which bring up those thoughts and those obsessions and so that act of avoidance in and of itself begins to kind of be a compulsion.”
Pure O is ‘a taboo upon a taboo’
Dr Stewart says there is strong evidence the treatments used to treat Pure O — cognitive behaviour therapy (CBT) and exposure and response prevention — are effective.
“It helps the client learn to directly face their fears by challenging the compulsive, avoidant behaviour or even the other thoughts that act as compulsions,” she says.
But Dr Stewart says many people with Pure O are too ashamed by their thoughts to seek help.
“It’s very confronting for them even to acknowledge the thoughts themselves, but then of course to try to discuss that with another person can be even more difficult,” she says.
Dr Stewart says the stigma attached to mental illness — that it is “crazy” or “weak” — also discourages people from seeking help.
“They either don’t talk about it and don’t get help and therefore don’t get better, or they do mention it and get criticised for it and harassed for it, and of course discriminated against,” she says.
Aron Bennett, author of The Walking Worried: A Young Man’s Journey With OCD, describes the sexual and harm thoughts associated with Pure O as “the last taboo, ‘a taboo upon a taboo'”.
“It’s one thing admitting to being ‘a bit OCD’ … But it is quite another to come clean to worrying about one day harming someone or questioning whether or not you are aroused by children,” he says.
Mr Walker Cleaveland puts it this way: “I was afraid to go to therapy because in my mind I thought, if I tell somebody the thoughts I’m having, they’re going to have to call the police or call Child Protection Services”.
‘It doesn’t need to be the thing that controls me or defines me’
Being diagnosed was coincidental for Mr Walker Cleaveland, when the opportunity arose to do some vocational work involving speaking to a psychologist.
“It was something I had to get off my chest and that therapist just happened to be someone who knew exactly what I was talking about.
“There was a real, initial, significant ‘Oh my gosh, this is what it is, I can name it’.
“‘I can know it is part of my mind and it’s there, but it doesn’t need to be the thing that controls me or defines me’.”
It was the months of unrelenting distress and lack of awareness that led Mr Walker Cleaveland to share his very personal story publicly.
“That was a pretty coincidental and lucky set of circumstances for me, and I know it isn’t that way for everybody,” he says now.
Mr Bennett says he was driven to write about his experiences in the hope of conveying that people with Pure O are not mad or evil.
“They have a condition, an illness, like heart disease or diabetes. It is not a moral choice … It is simply just an unfortunate fact of life.
“I cannot help but think society needs to catch up, get on board, challenge their own prejudices, and the only way for them to truly ‘get it’ is for us to keep on talking.”
‘Thoughts are just thoughts and do not mean anything’
Ms Bretécher, also a writer, has just released Pure, a memoir about living with Pure O.
“It seemed preposterous and unjust that these thoughts were being experienced by so many millions of people and so few of them felt able to talk about it,” she says.
She believes that governments also have a responsibility to take practical action.
“Mental illness can’t always be talked better,” she says.
“Our governments and health services have a responsibility to make sure that if people do pluck up the courage to talk, the right kind of professional care is available.”
Like Ms Bretécher, Emily (not her real name) was in her teens when she first experienced intrusive thoughts questioning if she was a paedophile.
She is still careful about who she discloses the nature of her obsessions to, for fear of judgement and lack of understanding. But after many years of distress, CBT put her on the path towards managing Pure O.
“It helped me realise that thoughts are just thoughts and do not mean anything about my character,” Emily says.
“It took me 14 long years to even realise this is OCD and if I can prevent one person from going through that and seeking treatment in a timely manner then this will be worthwhile.”
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This post originally appeared on ABC News.