Conceptualizations of Pure-O in Obsessive–Compulsive Disorder: A scoping review protocol

This project contains the protocol for a scoping review examining the phenomenon commonly referred to as “pure obsessional obsessive–compulsive disorder” (Pure-O). Although the term Pure-O is widely used in clinical, academic, and popular contexts, its conceptual status remains unclear and debated. Early dimensional models of obsessive–compulsive disorder (OCD) proposed a subtype characterized by predominantly intrusive obsessions in the apparent absence of compulsions. However, subsequent research has questioned the validity of a truly compulsion-free presentation, highlighting the presence of covert compulsive behaviors such as mental rituals, reassurance seeking, and avoidance. Despite ongoing debate, no comprehensive scoping review has systematically mapped how the Pure-O construct has been defined, described, and operationalized across the scientific and clinical literature. This project aims to address that gap. The objectives of the review are to: 1. identify and describe the body of research examining Pure-O; 2. examine the types of evidence and methodological approaches used to study this construct; 3. map the phenomenological and cognitive-behavioral characteristics attributed to Pure-O presentations and their integration within OCD classification models; 4. describe reported clinical and therapeutic implications; and 5. identify conceptual and empirical gaps in the literature. The review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported in accordance with PRISMA-ScR guidelines. The protocol is registered here prior to conducting the final search and data extraction in order to ensure methodological transparency and reproducibility.