Hi CS:
I've been "in the mental health system" [insert eye roll here] since I was a child.
When I was finally diagnosed with OCD [Pure Obsessive/Pure O type] at 28/29, things finally began to make a hell of a lot more sense in terms of a clinical picture.

Some of my obsessive and intrusive thoughts resemble what might be seen as paranoia [which is not an uncommon tendency to have with treatment resistant bipolar in particular, but bipolar generally as well].

I had.. a LOT of issues with what had previously been termed paranoia, social anxiety, perseveration associated with autism, probably a couple other things.

As I got older, into my mid and late twenties, it was clear that no treatments addressing these issues were actually all that helpful. Gaining stability for longer than a couple months was considered a pipe dream- the effects of untreated Pure O can include depression, overwhelming and ultimately disabling anxiety, tendency toward agoraphobia, inability to maintain solid relationships or conduct life in general in a functional and normal way.

A lot of people are not dx'd with Pure O until many years after they first begin experiencing symptoms.

Part of this is that it's difficult to know that your internal monologue is a bit dysfunctional if you don't talk about specifics... and very few people, especially before any kind of treatment, will talk about the Pure O inner monologue.

Because frankly, it can make you feel like you are a monster [which has been my experience at times as well as others' that I have spoken with].

Pure O can get worse because even though it is referred to as "purely obsessional", there are actually routines and compulsions done to alleviate the distress that these thoughts bring.

You actually mentioned things that fall under common compulsions:
Because the compulsions and rituals happen mentally and the embarrassment or outright fear that some of our thoughts can induce- it can sometimes be very difficult for a clinician to understand what is going on.

Many clinicians who are not experienced with OCD specifically are likely to simply brush aside concerns that one might have OCD when they are symptoms resembling Pure O. Also, it is very difficult to "root out" that someone is experiencing this- the first therapist to even acknowledge that I had "obsessive tendencies" didn't actually do so until I had been seeing her well over two years. It took a couple more doctors and out patient hospitalization for any of the pieces to be put together... which means that at this point the most difficult part of my mental illnesses- the OCD [not the autism or the bipolar], is finally being addressed.

I think there is actually a lack of education regarding specifics of OCD. Social workers and counselors tend to be less informed, though certainly there are some very knowledgeable and competent individuals in those positions who understand the picture of OCD. I've found PhD's, PsyD's and MDs [psychiatrists] have a greater tendency to understand more about OCD.

I can't say "Yes, you have Pure O" and it is great that you don't want to self-diagnose or not involve a professional.

It has been my experience, as well, that some providers tend to jump on the PTSD train for everything. I don't actually have PTSD, but several have tried to slap that label on me as an explanation for what seemed to be intense social anxiety and paranoia.

You describe some complicated details and if the therapist you have been seeing isn't a PhD or PsyD, I would encourage you to see one, simply because OCD specifically can be very complex and people with those qualifications tend to understand more about it. [Not as a general disparagement toward those who are in the helping professions but don't have that degree.]

I have used this before to try to explain Pure O:
What is Pure O?|OCD-UK

I have found it to be one of the better explanations and introductions to the experience of Pure O.

All I can really say is that much of what you describe is VERY familiar, and i have found that the root of my issues was for the most part OCD.

I do encourage you to find another opinion and explore all possibilities, though. Particularly if what you are doing right now isn't helping as you need.

ETA: as far as SSRIs go, I've found most of them do nothing at all, and the ones that do something tended to make me sick.

The exception has bee Luvox [fluvoxamine], which has helped greatly with the OCD symptoms I experience.