What Is Real Event OCD? (2024)

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive thoughts (obsessions) and engages in specific actions (compulsions) to relieve anxiety caused by the obsessions. The compulsions are often unrelated to the nature of the obsession, and the adverse consequences are almost always imagined and irrational.

Unlike most manifestations of OCD, real event OCD centers around an actual event that occurred in the past, instead of imagined expectations of future events. While everyone experiences guilt or regret, people with real event OCD become fixated on an experience that makes them question their character or morals, engaging in thoughts and actions that seek to reassure themselves.

Read on to learn more about real event OCD and its treatments.

What Is Real Event OCD?

People with real event OCD (also called real-life OCD) become fixated on actual events or past experiences that caused them to question their morality, making them feel as though they aren't a good person. They may replay the event over and over in their minds, analyzing all the details, and scrutinizing their role in it and any harm they may have caused through their actions.

They may worry about potential consequences of the event, such as losing a relationship with a loved one. They are also likely to take actions to reassure themselves, though this reassurance is short-lived.

The event can be something minor such as a rude remark to a customer service representative, something major like drinking and driving, or anything that makes them fear they are a bad person.

They may be focused on a recent event or something well in the past, such as an item they stole from a store as a child decades ago.

Real event OCD is typically made up of the following three components:

• Event: What really happened
• Obsession: Intrusive thoughts about what happened, often irrational or exaggerated
• Compulsions: Actions taken to try to gain temporary reassurance

Common Obsessions in Real Event OCD

Real event OCD obsessions can arise from anything that causes the person concern about their moral character, such as whether they are a good person, or potential future fallout stemming from the event.

These obsessions may include:

• Worrying they said or did something bigoted or offensive that has harmed a person they care about
• Believing that it is because of what they said or did that something bad happened
• Fearing consequences, such as punishment or being "canceled," or worrying about getting caught
• Believing their actions have caused harm or suffering to strangers
• Feeling they may have been hypocritical, inauthentic, unfair, and/or deceitful
• Worrying their thoughts or actions make them a bad person
• Worrying they have committed a crime
• Having repeated thoughts about confessing to a wrongdoing
• Having intense, overwhelming feelings of shame, guilt, or embarrassment about something they said or did
• Having repeated thoughts that they made a big mistake and now life will never be the same
• Having intrusive thoughts, images, and/or memories about an event or what happened afterward
• Wondering what would have happened if they hadn't said or done "X"

People with real event OCD tend to overestimate the importance of their actions. For example, they may ruminate regularly on a hurtful thing they said to a classmate in elementary school, worrying it caused them lasting harm, when their classmate doesn't remember the incident.

If they can't clearly remember every detail of the event, they are likely to assume something bad happened.

These obsessions cause anxiety that creates an urgent need to seek answers or reassurance.

Common Compulsions in Real Event OCD

A person with real event OCD will try to relieve the anxiety caused by their obsessions through compulsive actions. These might include:

• Seeking punishment for their actions
  
• Repeatedly going over past behaviors, looking for wrongdoings, and evaluating their actions
• Confessing or unnecessarily apologizing for their perceived wrongdoings (often after a long time has passed)
• Engaging in self-punishment by criticizing themselves and/or denying themselves from having positive emotions or experiences
• Seeking reassurance from friends and family either that they didn't do anything bad or that they aren't a bad person, sometimes using progressive hypothetical situations
• Doing online research on how to obtain forgiveness and/or how to forgive themselves
• Observing the person whom they believed they harmed to determine if their actions did negatively impact that person
• Repeatedly asking the wronged person for forgiveness
• Repeatedly confessing the previous negative things that were said or done
• Looking for ways to prove to themselves that they are a good person
• Engaging in excessive behaviors with the goal of becoming a better person
• Engaging in excessive good deeds to make amends for their wrongdoing
  
• Calling authority figures to inquire about potential consequences of past actions
• Repeatedly thinking about what they would have done differently if they had it to do over
• Reimagining the event the way they would have liked it to go
• Avoiding reminders, such as places, images, and people, that are related to the event

The relief brought on by these compulsions is usually temporary. The intrusive thoughts seep back in, and the cycle begins again.

How Is Real Event OCD Different From Guilt or Shame?

Everyone thinks back on past experiences and feels guilt or shame to some extent. However, people experiencing real event OCD have difficulty moving past these events.

Under usual circ*mstances, experiencing guilt can help people learn from their mistakes and do better in the future, whereas shame is less productive because it centers on a person's inherent value rather than specific actions that might lead to positive change.

However, people with real event OCD experience feelings of guilt and shame that are more intense and affect their ability to function well. It is more difficult for people with real event OCD to work through these feelings, reconcile them, and move on.

People with real event OCD have cognitive distortions (ways in which the mind warps or distorts information), such as:

• All-or-nothing thinking: This way of thinking focuses on the extremes and nothing in between. An example of all-or-nothing thinking is: "Because of what I did, I am dishonest."
• Magnification: Also called catastrophizing, a person perceives a relatively minor event in an exaggerated way. An example of magnification is: "I made a terrible mistake and can never forgive myself."
• Emotional reasoning: The person believes that the way they feel is evidence of something factual. An example of emotional reasoning is: "I feel afraid, so there must be danger present."
• Personalization: The person assumes responsibility and the blame for events that are beyondtheir control. An example of personalization is: "If I took better care of my parent, their illness wouldn't have gotten worse."

Treatment for Real Event OCD

First-line treatment for OCD is behavioral psychotherapy (talk therapy). Medication can be helpful for some people in combination with therapy.

Exposure and Response Prevention (ERP)

This evidence-based treatment involves exposing the person to their fears to help them learn to be less reactive to their triggers. ERP provides a safe place for challenging worries and working to increase the person's ability to tolerate uncertainty, discomfort, and doubt.

The goals of treatment are to reduce distress associated with triggering stimuli or situations and to decrease functional impairments in daily living.

Examples of exposures during treatment may include:

• Listening to music or seeing images that remind them of the event
• Visiting the location where the event took place
• Writing out a narrative of the event
• Imagining all the ways that their words and/or actions negatively impacted the other person(s)
• Writing a worst-case-scenario story of the event and the negative consequences it created for the other person(s)
• Writing an uncertainty story describing how they will never know for sure how the other person(s) was impacted
• Creating a written confession of what happened or what they feared occurred
• Writing a story of how their behavior will have negative consequences, such as never being able to stop obsessing about the event; getting away with committing a crime; being rejected by others; or believing life will never be the same

In conjunction with exposure experiences, the treatment includes Response Prevention, which is designed to eliminate compulsions and deconstruct rituals. Examples include:

• Refraining from seeking reassurance or doing research on the internet, social media, etc.
• Actively seeking out enjoyment and positive experiences and not withholding pleasurable experiences
• Refraining from making apologies
• Refraining from repeatedly confessing the things that were said or done
• Refraining from avoiding reminders (places, images, people, etc.) that have to do with the event and allowing themselves to naturally come across these reminders.
• Interrupting mental reviewing compulsions by redirecting the mind to a more neutral topic or mental exercise
• Refraining from engaging in any other compulsive behaviors to attempt to gain more certainty about the event and its aftermath

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) involves identifying problematic thought and behavior patterns and gradually changing them into healthy ones.

The main form of CBT used for OCD is exposure and response prevention (ERP).

Under the guidance of a mental health professional, people with OCD are exposed to their fears at gradually increasing intensities. For a person with real event OCD, this might mean:

• Allowing intrusive thoughts to arise
• Exposing themselves to things, such as music or images, that make them think of the event or experience
• Writing stories or songs, or creating artwork about the event or the feared consequences of it
• Visiting the location of the event
• Engaging in actions that trigger the obsessive thoughts
  

During this exposure, the person is urged to resist doing any compulsions or actions to try to reduce the anxiety.

Over time and repeated exposures, the person builds an increased capacity to resist the compulsions and, ideally, the obsessions reduce.

Medication

Medication like antidepressants may be used to help manage symptoms, particularly along with therapy to strengthen the effectiveness of both treatments. Sometimes, other types of medications are used to increase the benefit of antidepressants.

Antidepressant medications that may be prescribed include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Prozac (fluoxetine)
• Paxil (paroxetine)
• Celexa (citalopram)
• Luvox (fluvoxamine)
• Zoloft (sertraline)
• Lexapro (Escitalopram)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Pristiq (desvenlafaxine)
• Effexor (venlafaxine)
• Cymbalta (duloxetine)

Tricyclic Antidepressant

• Anafranil (clomipramine)

Mindfulness

Mindfulness involves allowing thoughts to come and go without assigning them judgment.

Acceptance and commitment therapy (ACT) is a type of psychotherapy that integrates aspects of mindfulness that can be used to teach people with OCD to accept their intrusive thoughts, rather than reacting or responding to them.

One of the goals of ACT is to separate the intrusive thoughts from the thinker, allowing them to be seen as separate entities and taking actions based on a person's values, not their obsessions. This way, they can acknowledge the thought as an "OCD thought," not as a fact.

Thoughts can also be reframed. For example, instead of thinking, "I am a horrible person," they might think, "I feel bad that I did that." Labeling the action—not the person—allows room for positive change.

From there, the person can take actionable steps to make the situation better now and/or avoid repeating the behavior in the future. This helps to move past the situation in a healthy, productive way, instead of being caught in an obsessive-compulsive cycle.

OCD Support Groups

Support groups are not a substitute for professional treatments like therapy, but they can be very valuable. Talking to others who understand your experiences firsthand is a great way to foster community, share resources, and offer and receive support.

The International OCD Foundation offers useful information on how to find (or start) support groups.

Diet and Lifestyle Changes

OCD cannot be treated with lifestyle changes alone, but developing healthy habits is important for overall health and can be a great support for traditional treatments.

Healthy habits worth adopting include:

• Eating nutritious foods
• Moving your body regularly
• Getting enough quality sleep
• Practicing relaxation exercises, such as yoga, mindfulness, or meditation
• Avoiding/limiting tobacco, caffeine, and alcohol
• Following your treatment plan
• Engaging in activities you enjoy
• Fostering and maintaining positive relationships

Summary

Real event OCD is a form of OCD in which a person becomes consumed by thoughts and feelings of guilt about a real event that happened sometime in the past. These thoughts cause them to question their morality. Compulsive actions follow in an effort to manage the anxiety triggered by the obsessions.

Real event OCD is typically treated with medication and/or behavioral therapy. Healthy lifestyle habits and mindfulness may also be beneficial.