An elucidating animation by the insightful School of Life defines the concept of primarily cognitive obsessive-compulsive disorder, which is also called pure OCD and explains how it is different from more common forms of the disorder which express outwardly with such actions as hand washing or switch flipping. Instead, pure OCD is more inward facing, torturing the person with uncharacteristic, unwanted and intrusive thoughts of causing harm towards others. Although this particular strain of the disorder is very difficult to treat, many psychotherapists are looking at low self-esteem caused by psychological trauma, rather than the thoughts themselves.
…psychotherapists …do not target the thoughts themselves or argue with them directly. They don’t try to reassure people logically that they are not about to murder a loved one or harm a child – because they don’t believe that this is what is actually at stake and judge that offering reassurance on these points only legitimates a pattern of thinking that has no basis in reality. …the sufferer of pure OCD has, first and foremost, a problem with self-esteem and shame. …Somewhere in their past, normally as a result of very traumatic and degrading childhood relationships, they will have derived an impression that they did not deserve to exist.