American country music star Luke Combs recently shared his battle with obsessive-compulsive disorder (OCD) and anxiety in an honest interview with 60 Minutes Australia. The 35-year-old singer revealed that he experiences a lesser-known form of OCD, known as “purely obsessional” or “pure O.”
“Mine is a more obscure form of OCD,” Combs explained, noting that this type of OCD doesn’t display obvious outward symptoms. While some experts dispute the term “pure O” as slang, Combs described it as a condition that involves intrusive thoughts without any visible rituals.
“I can experience anything from violent thoughts to religious questions, or focus on unanswerable questions,” Combs said. “It’s about deep personal questions that you can never answer. That’s what fuels the anxiety.”
According to psychotherapist Sarah Innes from Shift Collab, pure O sufferers experience intense, unwanted thoughts that cause anxiety, but instead of performing physical rituals seen in other types of OCD, they often engage in mental rituals. These may include overanalyzing their thoughts, seeking reassurance, or avoiding triggers.
While pure O is not uncommon, Innes stressed that it is harder to diagnose since symptoms are internal and not as visible. This makes it no less severe than other forms of OCD.
Combs described how the disorder can take a toll on his daily life. During a flare-up, he may fixate on troubling thoughts for up to 45 seconds every minute, which can last for weeks. “It’s a vicious cycle,” he explained. “You have thoughts you don’t want, and they cause you stress. That stress only makes more thoughts appear. Trying to get rid of them just makes it worse.”
However, after years of struggling, Combs now knows how to manage his condition. “I’m lucky to have learned how to get out of it,” he said. “But I feel for people who don’t know how to cope.”
Combs’ rise to fame has been rapid, with his 2017 debut single “Hurricane” becoming a massive hit. He recently topped the charts again with his cover of Tracy Chapman’s “Fast Car,” which he performed with Chapman at the 2024 Grammys. The country music star has won numerous awards, including nine Country Music Association awards and three Academy of Country Music awards.
Despite his success, Combs shared that OCD flare-ups can still occur, even while performing on stage. “When it hits, it can be all-consuming,” he said, recalling how it has sometimes hindered his progress. “You feel like you’re on a roll, and then a flare-up can set you back for months.”
The Debate Over Pure O
The term “pure O” remains controversial within the mental health community. While some professionals argue that it is not an official diagnosis, others acknowledge that it is used by many to describe OCD without physical compulsions.
Psychology professor Martin Antony from Toronto Metropolitan University clarified that a diagnosis of OCD does not require both obsessions and compulsions, although most people with OCD experience both. He emphasized that while the term “pure O” may be misleading, it still refers to the mental struggles that people with this form of OCD face.
Innes agreed, noting that although mental compulsions are not visible, they can be just as distressing as physical ones. “Because they are internal, these mental struggles are often overlooked or invalidated,” she said.
Treatment and Coping
Innes explained that treatment for pure O typically involves cognitive behavioral therapy (CBT) and exposure and response prevention (ERP). Medication may also be used in some cases.
Combs, who has dealt with OCD for years, now feels more in control of his condition. “It’s possible to live a full life, be successful, and have a family, even while managing this condition,” he said. “I hope my story helps others struggling with the same challenges.”
Combs’ message is one of hope, showing that success and happiness are possible, even when facing the invisible struggles of OCD.
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