Erendira Mancias/FUSION

They first began at night when Aaron Harvey would pray before bed. He was a pre-teen, and the thoughts came on as graphic images of Jesus Christ in sexual situations. They were so repugnant he would be forced to restart his verses. The cycle of blasphemous thoughts, followed by fervent and repentant prayer, followed by blasphemous thoughts, would only end once he finally fell asleep.

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It took many years before Harvey realized that his dark mental acrobatics were what’s colloquially known as Pure O, an oft-misunderstood form of OCD that differs from the usual hand-washing-and-knob-checking compulsivity most people associate with the disorder. Instead, its manifestations exist solely in the minds of sufferers, creating a cycle of mental compulsions, avoidances, and reassurances that appear generally as three schools of thought: violent, sexual, or, as in the case of Harvey, “scrupulosity”—compulsive religious heresy. Under these umbrellas exists a Rolodex of terrible brain tics and mental flashes that range from homicide to incest and, in many, create a crisis of sexual identity.

The dark thoughts tend to surface between ages 8 to 13, and morph in frequency and intensity with time. As Harvey grew older, his sexual obsessions became more disturbing. “It really escalated when I was 12 or 13,” he told me by phone. “My parents were having a party and I’d just come in from playing basketball outside and there was a little kid in my room. I was trying not to wake him up when I had this graphic thought about being a pedophile. That’s really when my stomach sunk. I was just like ‘what is wrong with me?’” In his 20s, Harvey began having vivid hallucinations of violently stabbing his girlfriend with the knife on his counter, so he started avoiding kitchen cutlery and eating only take-out. For lack of an apparent cure, or even a cause, he contemplated suicide. Instead, he took to the internet to learn what was wrong with him, and stumbled down the rabbit hole of the Pure O online community.

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Today Harvey, 35, is a successful digital marketing entrepreneur with a splashy digital agency in New York City. He’s also the founder of intrusivethoughts.org, a just-launched self-funded web resource that helps Pure O sufferers find useful information, curated videos, and personal stories meant to showcase “different perspectives on healthy living, therapy and medication.”

While there’s no known cure for Pure O, people with the disorder can indeed benefit from therapy and, in some cases, going on medication. But due to the many of the misconceptions around OCD and compulsive thoughts, many sufferers must first self-diagnose their illness. Harvey’s website makes this preliminary assessment a little easier, and also creates a sense of camaraderie among sufferers, who share tips and advice for managing the daily tide of compulsive thoughts. These thoughts, in certain cases, can even lead to life-like flashes or graphic hallucinations—sort of like porn pop-ups, but IRL. The saddest part is that most Pure O sufferers go through their ordeal alone. As one therapist told me, “because of the nature of these unwanted thoughts and misconceptions about mental health, most sufferers internalize their condition for the majority of their lives.” The disorder is often misdiagnosed as antisocial personality disorder, schizophrenia, bipolar disorder, or ADHD, among other illnesses.

One of the pieces that most inspired Harvey to “come out” about his experiences (a term frequently appropriated by the Pure O community) was a 2013 essay in The Guardian called “Pure OCD: a rude awakening” by a writer named Rose Bretécher. The article detailed her excruciating lifetime struggle with intrusive sexual thoughts. This was the first time that Harvey had heard of Pure O. He began to feel less alone, and wanted to create an online resource that would help others like him.

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An attractive blue-eyed blonde from the United Kingdom, Bretécher spent much of her 20s traveling the country in a double decker bus, meeting famous bands, falling in love, and living something of a freewheeling bohemian existence. But on the inside she was fighting with a mind in revolt that once melted Jake Gyllenhaal’s face into “a chubby vagina” and, on her first day at a temp job at the BBC, transformed the newsroom into a parade of naked figures. Bretécher’s OCD, detailed in her memoir Pure (Simon & Schuster), caused her to doubt her sexual orientation, restraint, and most importantly, her sanity.

That’s why they call OCD the “doubting disease”—because it makes you question every facet of your personality. “I’d felt ashamed for many years,” Bretécher told me via email. “Of my thoughts, but also of being unhappy. When you’re young you feel like it’s your duty to be carefree, and that anything less is failure,” she said. For her, things got to the point, emotionally, where she felt that she needed people to understand the invisible pain of Pure O. “My mental health problems are a part of me, and I didn’t want to hide who I was any more,” she said. Bretécher’s story marked one of the first times many outside the mental health community had heard of Pure O, a term that originated on OCD online forums and in specialty treatment centers. "I’d never seen a single piece of press about ‘Pure O’,” she told me. “It felt like a big dark secret of mental health, and I just wanted to blow the roof off it.”

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Given the invisible nature of the disorder, sufferers face a conundrum: Do you stay silent and struggle? Or do you talk about your intrusive thoughts and risk being branded a pedophile, sociopath, or dangerous person? People with Pure O also face the lingering risk that a therapist, unfamiliar with the signs of extreme OCD, might see his or her patient as a threat and report them to the police or child protective services.

It’s extremely important to mention that Pure O sufferers are in no way actually dangerous. They do not derive sexual stimulation from these thoughts, nor do they carry the desire to act on them. “I think that we all have had thoughts of causing harm,” said Dr. Tom Corboy, executive director at the OCD Center Los Angeles, or “sexual thoughts that we wouldn’t necessarily want to act on. The human brain is designed to do numerous things, one of which is think constantly. It goes 24/7 even when you’re sleeping.” Corboy believes that these thoughts are in many ways a “cycling out” of unconscious waste of the mind, much the same way dreams are.

As treatment, Corboy tries to help his patients through a type of cognitive behavioral therapy called “exposure and response prevention” treatment, which involves stripping the shame and stigma and terror from these thoughts, so they no longer “pop up” in your consciousness. “When we treat people, the first thing we do is psycho-education,” Corboy explained. “We try to help them get a better grasp on not just what OCD is, but the normalcy of their thoughts. People think that if they have a [specific] thought, that somehow is indicative of their true character. And it’s not even close to reality. We all have thoughts that could be described as less than ideal.”

But where do these sexual thoughts even come from? Dr. Fredric Neuman, director of the Anxiety and Phobia Center at White Plains Hospital in New York, thinks we may never have a satisfactory answer. “Had you asked that question about 50 years ago, most psychiatrists would have said they represent an underlying wish on an unconscious level,” he explained, but “having seen many patients over the years with this problem, I haven't seen anything consistent with any aspect of the behavior that's true.” What he has noticed is that patients tend to imagine the worst possible thing that they can conjure. “The most humiliating, the most upsetting, the most devastating” to their personal moral code—hence the prevalence of scrupulosity among practicing Christian patients.

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But solely blaming societal shame and taboos for these thoughts is an easy out, as even those who have few “conventional hang ups” are still plagued by abhorrent thoughts. Take Johanna, a 27-year old librarian from Vermont who has struggled with Pure O for most of her life. (She requested we change her name to protect her privacy.) Her intrusive thoughts are “never sexual in nature, nor are they religious,” she told me via email. “I think this is because I have a healthy and open relationship with both sex and religion. I'm a pansexual polyatheist, so there are not a lot of rules or norms I could be transgressing in those areas.” Her thoughts tend to come from a fear of loss and possible personal failings. “I have a good handle on my obsessions now, but when my wife and I were first dating, they definitely got in the way,” she said. “During a rough patch in our relationship I became fairly convinced that I was emotionally contaminated. Basically, I was in essence a bad person and people who came into contact with me would only be hurt, so I should keep myself as far from others as possible,” she explained. She began to withdraw from her family, friends and her then-girlfriend-now-wife.

With time, antidepressants, and organic remedies (mostly medical marijuana she takes for an unrelated chronic pain issue)—supplemented with therapy—she was able to stem some of these thoughts. “If I get an image of hurting a baby, I try to say to myself ‘that's just a picture, it's not reality, and you're very careful with babies.’ It sounds silly, but it helps. It proves to me that those thoughts are just thoughts.”

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Many who suffer from Pure O fear that if they admit their struggles, they’ll lose the trust of loved ones, have their children taken away, or be terminated from their jobs. One woman, Alison Dotson, who runs a site called alisondotson.com where she chronicles her experiences with Pure O, often worries about this. But ultimately, like Bretécher, she thinks openness about her experiences will better help others understand. “I think the label [Pure O as opposed to OCD] is really helpful because it helps us seek each other out,” she said. “We all hate it, we all suffer, but there’s another level of shame and secrecy that comes with having something so taboo that we can’t even talk about it.”

Because of the verboten nature of these thoughts, and a hesitancy for sufferers to come forward, we may never know the extent of who is currently experiencing this pain; hard numbers don’t currently exist. And there is no “cure” for Pure O, or OCD in general, which affects 1 out of every 100 people. But advances in cognitive behavioral therapy have helped many achieve control over their intrusive thoughts, and it’s the treatment of choice for Corboy. While anti-anxiety medication may “turn your anxiety off for the three or four hours that it’s effective in your body,” he said, but “it’s not a treatment. It’s barely even a band-aid.”

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As for Aaron Harvey, while he worries about sharing his darkest thoughts on the internet and the possible negative effects that doing so could have on his business or personal relationships, ultimately the rewards outweigh the drawbacks: “At the end of the day I just don’t want another 13-year-old to be wasting 20 years of their life, worrying about stuff that they don’t need to be worried about.”

Laura Feinstein is the Head of Social Stories at Fusion. Formerly, she held staff roles as the East Coast Editor of GOOD Magazine and the EIC of The Creators Project at VICE, and has contributed to The Guardian, T/The New York Times, Paper Magazine and many others. She specializes in the niche, the esoteric and the un-boring.