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Luke Combs Opens Up About His Struggle with OCD: Shedding Light on Taboo Obsessions
Written by Dr. Paulina Syracuse, Psy.D.
Recently, country music star Luke Combs opened up about his experience with, as he said, his “particularly wicked” obsessive-compulsive disorder (OCD), shedding light on a particularly misunderstood aspect of the condition. He shared that he has struggled with a form of OCD known as “Pure O,” which involves intrusive, unwanted thoughts and images that are often taboo in nature. Although “Pure O” isn’t a formal diagnosis in the DSM-5-TR (the standard manual for mental health diagnoses), it is a very real presentation of OCD that affects many people.
What Are Taboo Obsessions?
Taboo obsessions can include thoughts or images that are violent or sexual in nature—topics that many of us would consider uncomfortable or inappropriate. Everyone experiences strange, intrusive thoughts from time to time. These thoughts may be bizarre, unsettling, or even embarrassing. People without OCD are typically able to brush them off and move on. For someone with OCD, however, these intrusive thoughts don’t just go away. They get “stuck” in one’s mind and cause intense distress and uncertainty. This constant worry leads them to believe that these fleeting thoughts might have some deeper meaning, like that they are a “bad,” “dangerous,” or “deviant” person for just having these thoughts.
The Distress of OCD and the “Egodystonic” Nature of Obsessions
While people with OCD often believe that they are ‘bad’ or that perhaps the intrusive thoughts they experience reflect a desire to act on them, in reality, it’s the opposite. In OCD, these obsessive thoughts are considered “egodystonic,” meaning they are unwanted and clash with the person’s core morals, values, and character. For example, individuals with OCD might experience intrusive sexual thoughts or images about family members, children, strangers, or even religious figures. They might fear being attracted to someone they shouldn’t be, or question their own sexual identity—despite knowing that these fears aren’t grounded in reality. Similarly, the thoughts might involve violent or harmful urges, such as imagining causing harm to a loved one or pushing someone into traffic.
Luke Combs described these obsessions as “particularly wicked” because of how deeply distressing they are. The sheer repetition of these unwanted thoughts can lead someone to believe they’re a bad person or that there is something wrong with them simply because they’re experiencing these thoughts. They want them to stop, but they don’t, and this can be incredibly distressing. The thoughts can cause feelings of shame, guilt, and fear of being judged as deviant, even when they know these thoughts aren’t true.
How OCD Leads to Compulsions
To cope with distress brought on by obsessions, individuals with OCD engage in compulsions—acts or rituals they believe will reduce anxiety or prevent the feared event from happening. These compulsions can be physical, like tapping a specific number of times, avoiding certain objects (like sharp knives), or refusing to engage in certain activities, such as bathing a child for fear of accidentally being inappropriate.
However, as Luke Combs pointed out, many of the compulsions associated with taboo obsessions are invisible to others. These are known as mental compulsions. They can involve reviewing past situations repeatedly to make sure no harm was done, or mentally checking whether you are still a “good” person. For sexual obsessions, someone might review how they felt in past romantic relationships to confirm that the feared attraction is not true. They may even mentally scan their body to ensure they’re not aroused. In some cases, people with OCD might silently repeat reassuring statements or prayers in their mind, such as “It’s okay,” or “I’m not going to do that.”
Though it may feel like these mental compulsions help reduce the anxiety, they actually have the opposite effect. Engaging in mental compulsions only reinforces the obsession, increasing doubt, uncertainty, and distress. As Luke Combs described, trying to get rid of these obsessive thoughts only results in more of them.
How Exposure and Response Prevention (ExRP) Can Help
One of the most effective treatments for OCD, including the kind with taboo obsessions, is Exposure and Response Prevention (ExRP). This therapeutic approach encourages individuals to confront the situations that trigger their obsessive thoughts, instead of avoiding them. A key part of ExRP is response prevention, essentially, choosing to not engage in compulsions, whether they’re mental or physical. Now, this is hard work! It’s not easy to choose to tolerate the distress and anxiety that comes from breaking the OCD cycle. Over time, however, the outcomes are really powerful.
Mental compulsions can be particularly tricky to identify, so it’s important to differentiate between an obsession (an intrusive, unwanted, and distressing thought) and a compulsion (an act, whether physical or mental, to reduce anxiety or prevent a feared outcome). The goals of ExRP for taboo obsessions includes learning to tolerate uncertainty and anxiety and that the feared outcomes, like being a “bad” person or acting inappropriately, simply don’t happen. It’s important to note that this work should be done with a trained, OCD specialist.
Breaking the Silence Around Taboo Obsessions
By speaking up about his own struggles with OCD, Luke Combs is helping to break the stigma surrounding the disorder and its more taboo forms. These types of obsessions are often shrouded in shame and secrecy, making it difficult for individuals with OCD to reach out for help. The more we normalize discussions about these experiences, the more people will feel comfortable sharing their struggles and seeking life-changing treatment.
So, the next time someone shares their experience with OCD—especially if it involves taboo obsessions—remember that their thoughts don’t reflect who they are. They’re simply symptoms of a condition that can be treated with compassion, understanding, and the right therapeutic tools. And as Luke Combs’ bravery demonstrates, it’s okay to talk about it.
