Rose Cartwright was 15 when a series of disturbing thoughts suddenly began flashing through her head.
“I started getting intrusive thoughts that maybe I had abused a child, or that I could.”
They were accompanied by flashing mental images of it happening. “I was still a child myself, a virgin and extremely naive, and seeing things that were anathema. It was a nightmare.”
She had no idea these repetitive thoughts, doubts and mental images were a type of obsessive-compulsive disorder (OCD) referred to as ‘pure-O’ or ‘pure-OCD’.
The more she desperately tried to banish the thoughts from her mind, the more uncontrollable they became.
What is Pure OCD?
OCD is an anxiety disorder which has two main components: obsessions and compulsions, says Rachel Boyd, Information Manager at the mental health charity Mind.
“Pure O stands for ‘purely obsessional’. Unlike OCD, people can experience distressing intrusive thoughts but there are no external signs of compulsions, such as checking or hand-washing. If you have Pure O you will still experience mental compulsions, but you might not be aware of them. Because they are not as obvious as physical compulsions it can sometimes be difficult to define exactly what these compulsions are.”
‘I would delve around looking for clues as to whether or not what my thoughts were accusing me of were true’
Research suggests 1.3 per cent of the population have OCD, according to Mind. But a lack of awareness deterred Cartwright from telling anyone about what she was experiencing. “I thought I would go to prison if I told anybody.”
Cartwright, a writer and creative director based in London, became obsessed with trying to understand where the thoughts were coming from. “I’m not religious but I would repeatedly ask for forgiveness for my ‘sins’,” she recalls. “I would ruminate and delve around looking for clues as to whether or not what my thoughts were accusing me of were true.”
Am I gay?
The theme of her intrusive thoughts shifted as she grew older, taking the form of more general sexual thoughts. Now she began seeing mental images of people naked: friends sat across from her in the pub, uni lecturers in class, prospective bosses interviewing her for jobs.
She began to obsessively doubt herself and question her identity. “Maybe I’m gay? Maybe I’m bisexual? Maybe I don’t really want to be with the men I’m with?” The more she compulsively soul-searched for reasons behind these thoughts, the more overbearing they became, until her whole life was consumed by them.
“I became very severely depressed and highly anxious,” she says. “I started self-harming. I was bulimic. I desperately wanted to be loved by men, but I thought I can’t without knowing who I am.”
Cartwright struggled to articulate all of this to doctors, who prescribed talking therapies and antidepressants, treatments which were unsuccessful.
‘Repetitive intrusive thoughts were a hallmark of OCD, and actually, sexual scenes and violent scenes within that were extremely common’
But by 27, Cartwright had managed to tentatively tell a boyfriend what was happening to her. After conducting her own extensive research and a decade blighted by intrusive thoughts, she had what she calls her “eureka moment”.
“I discovered repetitive intrusive thoughts were a hallmark of OCD, and actually, sexual scenes and violent scenes within that were extremely common. This was exactly describing my life. From that point I was able to start telling doctors exactly what I thought was going on.”
Exposure prevention therapy
She eventually chose to undergo exposure and response prevention therapy [ERP], deciding to pay privately for treatment with an OCD specialist based in New York. “I was never offered that on the NHS. It is available, and I believe things are getting better all the time. But it’s a postcode lottery.”
ERP involves gradually exposing the person to their obsessive theme to get them to tolerate their presence instead of compulsively trying to escape them. According to Ms Boyd, ERP works by helping you confront your obsessions and resist the urge to carry out compulsions.“It is a recommended treatment for OCD, but it will work well for some people and not as well for others.”
‘I was taught to look at materials and just accept whatever emotions and anxiety that comes up when I do’
Exposure therapy tried to get her to embrace her self-doubts, says Cartwright. “When I had an intrusive thought about a woman, maybe when I was walking down a street and thinking about her breasts or thinking about having sex with her, instead of giving into the temptation to compulsively ruminate about what that meant, I would just have to go – ‘Maybe I’m attracted to her? Maybe I don’t want to be with my boyfriend?”
These ideas did not sit well with her – “I really did want to be with my boyfriend and would rather not be thinking about naked women. But resisting the temptation to run away from it took away some of its power.”
The therapy also saw her engaging with structured exposures to sexually explicit and pornographic content. “I was taught to look at materials and just accept whatever emotions and anxiety that comes up when I do.”
Bowled over by support
The publication of her story in a piece for The Guardian in 2013 under the pen name Rose Bretécher marked the first time her family had any idea of what she had been experiencing. Her piece was shocking, but she was bowled over by their support. The article, read more than 180,000 online in two days, caused “a bit of a stir”. People found her online almost immediately, telling her how they too were secretly experiencing what she had described. “I’ve been getting messages from people ever since, and that was five years ago.”
‘I don’t have these big identity questions that I once had. I just let them be there’
“Experiencing OCD can be very lonely and frightening,” says Ms Boyd. “Asking for help is one of the most important things to do. Speak to someone you know and trust – such as a friend or family member – or go to your GP, who can talk you through the support that’s available.”
Cartwright wrote a crowd-funded book on her experiences, Pure, which is now the subject of a six-part Channel 4 drama, due to air in autumn. She hopes this will create more awareness of this kind of OCD. “I still have intrusive thoughts, intrusive doubts, intrusive mental images, but they don’t ruffle my feathers like they used to because I don’t engage compulsively with them,” she says. “I don’t have these big identity questions that I once had. I just let them be there.”
Pure by Rose Bretécher is available for £8.99 here.