Real-Event OCD: What is it and How To Treat it
Most OCD subtypes cause the sufferer to fixate on future-focused fears and outcomes. However, those with Real-event OCD – also known as ‘real-life’ OCD – is distinguished by obsessions and compulsions surrounding an event that has happened in the past.
In the case of real-event OCD, the sufferer finds themselves scrutinizing and ruminating over past events. Doubting the things they’ve said and done, leaving them with immense feelings of guilt and shame that they attempt to navigate through compulsive behaviors.
Someone with real-event OCD will exert a great deal of energy to try and find certainty around a past event which makes it very difficult to live and embrace the present moment.
Real-event OCD can feel as though it steals from the present moment as the sufferer remains in a rumination loop, trying to analyze and scrutinize past events that often leave them feeling like they are a bad person.
Here we will explore the ins and outs of real-event OCD.
But first, a quick recap of the OCD basics…
Content
An Overview of OCD
There are two core components that characterize OCD and all of the OCD subtypes.
These are obsessions and compulsions.
OCD is a common mental health condition whereby the sufferer experiences obsessions in the form of thoughts, images, urges, feelings, or sensations, which trigger extreme levels of uncertainty and anxiety.
As OCD is egodystonic – meaning it goes against our values and morals – those obsessions are disturbing in nature and leave the sufferer questioning their sense of self.
This is why intrusive thoughts are often described as ‘sticky’.
Because the very nature of these thoughts has us challenging who we are, they are perceived as a cause for concern and we believe they require our attention.
In a bid to manage the uncertainty and anxiety following these obsessions, the sufferer engages in compulsive behaviors that offer temporary relief.
These behaviors can present as physical or mental compulsions.
Common mental compulsions can include:
- Rumination
- Counting
- Prayer
- Self reassurance-seeking
- Mental Review
Click here to join our newsletter and receive instant access to our 6-part mental compulsions series, teaching you how to resist the urge to do mental compulsions (with PDF worksheets)
Common physical compulsions can include:
- Physically checking
- Reassurance-seeking
- Tapping
- Organizing
- Avoiding
- Excessive cleaning
These compulsions offer short-term relief but contribute to long-term struggle as they leave the sufferer trapped in the OCD cycle.
The good news is that this OCD cycle can be broken!
Effective treatment is available so you can begin managing the anxiety and uncertainty without needing to engage in compulsive behaviors.
The ins and outs of Real-Event OCD
We can all find ourselves reflecting on past events from time to time, wondering whether we should have done things a little differently.
We might berate ourselves for a moment about the things we have said or done that could have been handled more effectively.
We may even experience momentary guilt over the potential consequences of our past behaviors.
But for those without OCD, these reflections and feelings tend to fade over time. For those with real-event OCD, they find themselves over-analyzing, fixating, and ruminating on past events in a desperate plea to gain a sense of certainty.
They may be searching for definitive answers to suggest that they didn’t do anything wrong and that they aren’t a bad person.
A common compulsion within real-event OCD is mental review.
The sufferer will replay the moment over and over again.
Guilt and shame are overwhelming feelings that occur for those with real-event OCD. And these feelings brought about by such reflections are intense and painful to manage as they leave the sufferer questioning their morality and identity.
OCD takes hold of the past event and warps the sufferer’s perception, positioning them as the ‘bad guy’ or ‘villain’ of the piece, for which they can often call on self-punishment as the compulsion believing they deserve to be punished.
Examples of Real-Event OCD
Someone with real-event OCD can experience obsessions about a wide variety of past events. Anything from cheating in an exam, an argument with a partner, a job interview, or even an interaction with a stranger at the local shop.
The common thread is that obsessions are almost always driven by the fear of being a bad person.
Common Real-Event Obsessions
- Did I inadvertently cause that person to feel X,Y, or Z
- What would have happened if I hadn’t said or done X,Y, or Z
- Was that wrong? Did I commit a crime? Am I morally corrupt?
- Am I bad person for doing/saying X,Y, or Z?
- It’s because I did (X) that this bad outcome occurred
- I’m the reason that person I care for is suffering, because I did/said (X) when I shouldn’t have
- This negative circumstance is a direct result of this thing I did/said years ago
An example of how real-event obsessions may occur could look like this…
“A friend of mine told me she kept having heart palpitations and feeling faint but I simply joked and told her she was probably just unfit. She has now been diagnosed with heart disease which they would have caught sooner if I had taken it more seriously and told her to get herself checked. If she get’s seriously ill, this will all be my fault.”
Common Real-Event Compulsions
- Mental Review – repetitively playing the event over and over again in their mind to find proof that what they believe about themselves or the event is true.
- Self-punishment – criticizing and berating themselves because they believe they deserve to be punished for their past behaviors.
- Reassurance-seeking – Excessive reassurance-seeking from friends or family to clarify that they behaved ‘correctly’ or to confirm that they did or didn’t do anything wrong or inappropriate.
- Apologizing – Someone with real-event OCD may excessively apologize to the person they believe to have wronged in the hope of gaining forgiveness.
We can use the obsession above to show an example of how the compulsion may then present.
This sufferer may replay the experience repeatedly in their mind noting what they believe they should have said or done differently. They may punish themselves by thinking, “You should have told her to see a doctor. You shouldn’t have joked about it. This is all your fault”
They may ask others whether or not they think this could have been prevented if they had told their friend to see a specialist sooner.
They may go out of their way to make up for their ‘wrong behavior’ by apologizing excessively to their friend. They may also go out of their way to do good deeds in service of the community to be forgiven for their ‘perceived error’ or ‘mistake’.
How to know if you’re experiencing Real-Event OCD?
It’s common for everyone to find themselves dwelling on past events from time to time. But here is a breakdown of symptoms to consider if you think you may have real event OCD:
- Repeatedly replaying events in your mind
- Over-analyzing the outcomes of your actions
- Feeling excessive guilt, shame, or doubt about your actions
- Apologizing excessively to those involved
- Excessive reassurance-seeking to validate your experience
- An intense and overwhelming feeling that you are a bad person
Someone with real event OCD can lose hours of their day ruminating and fixating on these past events.
It’s almost always impossible to gain 100% certainty, but even more so when it comes to analyzing past events that have come and gone. Because of this, those obsessions always tend to crop back up.
You can find yourself trapped in the past and unable to engage and enjoy the present moment and struggle to shake this overwhelming sense that you’re not a good person.
However, if you are able to change your relationship to those obsessions and resist the urge to do compulsions, you can find long-term relief from real-event OCD.
Treatment for Real-Event OCD
As with all OCD subtypes, the best course of treatment for real-event OCD is ERP therapy (exposure and response prevention).
ERP is deemed the gold standard treatment for OCD and has been shown to be highly effective. This means that it is highly possible for you to fully recover from OCD using this treatment.
In ERP, you work with your therapist to place yourself in scenarios that gradually and intentionally trigger your obsessions. You will work together to navigate the uncertainty and anxiety and resist the urge to do compulsions.
Your brain learns that you are capable of managing anxiety and uncertainty without the use of compulsions. Each time you engage in compulsive behaviors you strengthen OCD’s hold. When you resist the urge to engage in compulsions, you can learn new ways to respond to your obsessions that will – over time – reduce the anxiety.
ERP for Real-Event OCD
Most highly trained ERP therapists will first provide thorough psychoeducation on real-event OCD and train you to engage in effective response prevention.
Response prevention is a component of ERP where we practice reducing any compulsions that the person with real-even OCD is engaging in.
Research has shown that ACT (acceptance and commitment therapy) is a highly effective modality supplement to ERP, where the person with real-event OCD practices working with value-based behaviors rather than fear-based behaviors and learns how to manage their intrusive thoughts using tools like diffusion and mindfulness skills.
In the case of real-event OCD, a common form of ERP therapy is to use an imaginal exposure script.
An imaginal script for real-event could be writing out the story as it happened, as specifically as possible, so that you can use their mindfulness, ACT, and ERP tools to resist the urge to do compulsions.
In addition, other exposures that may be helpful and beneficial are engaging back in any behaviors that you have been avoiding. You and your therapist will work together to make sure the exposures you do are exposures that you feel will be helpful and worth engaging in.
Finding a qualified therapist
Real-event OCD can sometimes be tricky to diagnose and treat. The nature of most OCD types means they are driven by the fear of what might happen in the future whereas real-event OCD is driven by the fear of what’s happened in the past.
We highly recommend you want to do your due diligence and be sure to work with an OCD specialist who is ERP trained as this is the most effective treatment for OCD and yields incredible results. It is important to work with a qualified mental health professional who can offer an accurate diagnosis and support you with the best treatment plan.
If you are based in California, our friendly team of elite OCD specialists can help you navigate your OCD and support you on your recovery journey.
Please reach out to us by submitting an initial intake form here to see how we can best support you.
If you do not live in California, you can use the IOCDF directory to find support from a qualified clinician in your area.
ERP SCHOOL – Online Program
For an affordable and accessible alternative to private therapy, top OCD specialist Kimberley Quinlan, LMFT, has created ERP SCHOOL.
Learn to identify your specific real-event obsessions and compulsions and use science-backed ERP practices to manage your OCD symptoms.
This online program will help you change your relationship with those haunting thoughts and resist the urge to engage in compulsions.
You can no longer feel limited by fears of the past and live life fully in the present!
