American country music sensation Luke Combs got real about his struggle with obsessive-compulsive disorder and anxiety, as well as the challenges of being on the road, in a recent interview with 60 Minutes Australia.
“Mine is more of an obscure form of OCD,” the 35-year-old singer said, describing the disorder sometimes referred to as “purely obsessional” or “pure O.” However, there is some scientific disagreement over the use of the term and subtype, with some calling it slang.
Combs described the condition as “particularly wicked because there is no outward manifestation of it.” He said he can experience everything from intrusively violent thoughts to thoughts about religion, and focus on questions that don’t have an answer.
“It’s really questions about who you are as a person that you really can’t ever get an answer to … and that’s what fuels the anxiety,” he said.
Pure O is one of those subtypes of OCD in which people experience disturbing, unwanted thoughts that will cause anxiety, said Sarah Innes, a psychotherapist at the Canadian online therapy practice Shift Collab.
“But instead of performing those obvious physical rituals that we see with other subtypes, such as checking or symmetry, they’ll be engaging in mental rituals — so over-analyzing their thoughts, seeking reassurance or avoiding mental triggers,” she said.
Innes said the pure O form of OCD is not uncommon and isn’t less severe than other types, but it is harder to diagnose as the symptoms are more internal and the compulsions may not be as obvious.
Combs described the debilitating way the disorder functions, explaining that a really bad flare-up could have him fixating on thoughts for 45 seconds of every minute for weeks.
“It’s thoughts that you essentially don’t want to have that you’re having, and then they cause you stress,” he said, explaining the vicious cycle. “And then you’re stressed up and the stress causes you to have more thoughts. You don’t understand why you’re having them and you’re trying to get rid of them, but trying to get rid of them makes you have more of them.
“It’s very tedious to pull yourself out of it…. I’m lucky to be an expert in how to get out of it now, but I feel for people that struggle with this.”
Rise to fame
The eight-time Grammy nominee — who shot to fame in 2017 with his debut single Hurricane, which sold 10,000 copies in just the first week — described his sprint to the top of country music as “a crazy 10 years.”
His viral cover of the 1988 Tracy Chapman song Fast Car topped charts in 2023, and he went on to perform the song with Chapman during the 2024 Grammys. Among his several wins are nine Country Music Association awards and three Academy of Country Music awards.
WATCH | Song that shot Combs to fame:
Combs, a native of North Carolina, said his light-bulb moment came the summer after he turned 21, when he moved on from being in the choir to picking up his guitar and singing.
A flare-up could hit while on stage, and “when it hits, it can be all consuming,” said Combs, who is currently on tour.
He described how it held him back so many times when he was trying to accomplish something and doing really well, “but then you have a flare-up and it just ruins your whole life for six months, and then you’re back to where you started.”
Is pure O legit?
When it comes to this particular type of OCD, there seems to be a lack of clarity and some dissension in the professional community, with some saying pure O is not an actual term but slang.
“Pure O is not something that a lot of people have an understanding of,” Innes, with online therapy practice Shift Collab, said.
“When it comes to OCD, it is generally misunderstood, and a lot of people don’t even realize that there’s multiple subtypes that go along with that diagnosis.”
Pure O is also not a term used by many mental health organizations or the Diagnostic and Statistical Manual of Mental Disorders (DSM).
“It’s not an official diagnostic term that OCD experts use, but it is a term that’s being used colloquially,” Martin Antony, a psychology professor at Toronto Metropolitan University, said.
“To get a diagnosis of OCD, one needs to have obsessions or compulsions. So you don’t need both, although most people with OCD have both obsessions and compulsions,” he said.
Pure O could sometimes be misleading, as it’s just a form of OCD without physical compulsions, Innes said. But people with the subtype still experience mental compulsions.
WATCH | Combs talks about stardom and the struggles:
“This mental struggle is just as distressing for the clients as a physical compulsion. But because it’s not necessarily visible, it’s easily overlooked or can be invalidated,” she said.
“Treatment for pure O typically involves cognitive behavioural therapy, which is referred to as CBT, and something called exposure and response prevention, which we refer to as ERP,” Innes said, adding that people sometimes take medication when needed.
Having struggled with the condition for years, Combs said he now knows how to handle it and not be afraid.
“The message is if there’s someone out there that’s struggling with it, it’s possible to continue to live your life and be really successful and have a great family and achieve your dreams, while also dealing with things that you don’t want to be dealing with.”
