Danny paced the room furiously. Back and forth weren’t even enough for him. He paced at random angles, left the room to pace the hallway a few times, and took a few breaks to look out the window – trying to slow down his breathing and clear his mind. It didn’t work. Neither did Danny. At least not the work he was supposed to be doing. 

Danny searched website after website, article after article, to find answers – to how he could know if he was adopted and his parents weren’t telling him – but nothing gave him certainty. He thought it through in his mind. He searched the internet. He wasn’t satisfied. 

It made no sense to him for his parents to have adopted him. After all, he had three older siblings. Each one of them looked just like one of his parents. That meant they weren’t adopted. So why would his parents adopt a fourth child? 

On the other hand, he looked nothing like any of his family members. It was odd. He was six inches taller than any of his siblings, or even first cousins. He had never seen anything like it. While some family members had blond hair like his mother, and others had darker coloring like his father, Danny had a tanned complexion that looked Middle Eastern. Was he really from there? His mother had insisted that her great uncle looked like that, but Danny had never met him. Uncle Marvin was no longer alive, and the family didn’t have pictures of him. Long sessions of scouring the internet for pictures were unsuccessful.

Perhaps he had been switched at birth. That would account for why his family insisted that he wasn’t adopted despite his strong reason to suspect that he was. It would also explain why his parents had him after three children. They did have a biological child. Just not him. Did that mean that there was a family somewhere that was his real family? Did it mean that the real child of his parents was with them? How could he find them? 

Danny wondered if it even mattered. He grew up in a loving family. He was close with them to this very day – in his late twenties. This thought calmed him briefly, but he still felt spent - both physically and emotionally. Experience had taught him that this respite from his thoughts wouldn’t last. He had also just missed out on a few hours of work. His online business would not do well if he spent half the day doing internet searches about his existential questions. He was pretty sure of that. 

Danny finally went for help. 

Danny’s new psychologist, Dr. Berg, diagnosed him with obsessive compulsive disorder. Danny was surprised. His older sister had OCD. Didn’t people with OCD wash their hands a lot? That’s what she did. Dr. Berg explained that OCD can come in many different forms. The common denominator is only that the mind struggles with unwanted intrusive thoughts, and one engages in activities or rituals to allay the anxiety caused by those thoughts. Those who wash their hands overly frequently, like Danny’s sister, have the fear that they, or others, are going to become sick from germs or dirt. Washing their hands allays those concerns – albeit only temporarily.    

The theme of Danny’s OCD-related fears was the possibility that he was not who he thought he was. He was really not the child of his parents. His compulsions involved seeking absolute certainty about his identity. These included thoughts to refute the arguments that he was adopted, asking his parents for reassurance, and searching on the internet for answers to his questions. 

The form of OCD in which compulsions are mental – attempting to refute thoughts without a physical compulsion – has its own, albeit informal, title: “Pure O.” This is not a clinical term, but it is commonly used to describe this unique phenomenon. It is called this because the obsession – the intrusive thought – is clearly identifiable, but the compulsion is harder to notice. It can be mistaken for a typical thought process, and is not visible to an onlooker.

“Pure O” - like standard OCD – can exist in many different forms. In Danny’s case, the thoughts were about being adopted. More common themes include questions about one’s religious beliefs, concerns about sexual orientation, or distress from thinking one has offended someone else. The experience mirrors that of Danny’s: vexing questions that challenge a person’s core values or identity, and pursuit of absolute certainty to answer them.  

“Pure O” can easily be overlooked for two reasons. One reason is that people don’t realize the wide range of themes that OCD can have. They are familiar with the compulsions of washing hands, or checking to see that the door is locked, but not many more than that. A second reason – more specific to “Pure O” - is the fact that there is no visible compulsion. It is therefore not immediately associated with OCD. 

Danny worked with Dr. Berg to understand the origins of these thoughts, and why it mattered so much to him to know that he was not adopted. He was relieved to know that his struggles had a name and that he could be helped. He also wanted to get better quickly. As an entrepreneur, the more time he wasted, the worse his business would do. 

Dr. Berg told Danny that there are practical methods that he could use to help him become more productive and less distracted sooner than later. These could be implemented simultaneously with the work they were doing to uncover and address the source of the thoughts. He recommended a life coach who had trained in this area who could help him with this. A life coach would be less costly, as well as particularly inclined toward the practical, tangible results of productivity. 

Danny followed Dr. Berg’s advice. The coach explained to Danny how his brain was reacting to his thoughts as though it was in danger. He was hoping the compulsions would relieve the danger. In reality, they wouldn’t. They could provide a brief respite, but that would be fool’s gold at best. In truth, it would reinforce the idea that compulsions help, even though they actually don’t. In other words, they would exacerbate the problem. 

Danny’s coach – named Jack - introduced Danny to a practice called Exposure and Response Prevention. In this practice, Danny would need to expose himself to triggers that would raise his questions. He would then need to deliberately refrain from performing his compulsions – researching for answers and asking family and friends for reassurance. This would train his body to realize that it is not actually in danger.

This sounded scary, of course. Jack explained to Danny that they would begin by only engaging in a small measure of exposure. It would need to be enough of a trigger that his brain would think it was in danger, but small enough that he was willing to try it. Danny really wanted to get better, and trusted Jack’s judgement – they had quickly developed a strong rapport, and Danny was impressed with his level of knowledge and understanding – so he was willing to give it a try.

Danny’s ERP treatment was quickly successful. He and Jack devised methods of mild exposure that would trigger him enough that he was a little bit uncomfortable, but weren’t too daunting to do. He progressively did things that were more and more unthinkable relative to where he had begun, until he reached a point at which his day-to-day activities were able to be highly productive. He was not completely free from the intrusive thoughts, but now had tools to combat them when they arose. He was able to achieve this in just a few months. 

Danny continued to work with Dr. Berg. There was much to discuss, uncover, and process. In the meantime, he was thrilled to be able to function. He was grateful to have learned that his struggles had a name, that OCD apparently could come in many forms, how his brain worked, and – most of all – skills to help him succeed.