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Real Event OCD, also known as Real Life OCD, is a unique subtype of obsessive-compulsive disorder (OCD). People who suffer from Real Event OCD will experience unwanted, obsessive thoughts and fears around an actual event that occurred in the past.
Individuals with Real Life OCD become fixated on actual events or past experiences that make them question their character or morality or made them believe that they are not good or ethical people.
They might replay the event(s) over and over again in their heads, scrutinizing every detail, reciting every word they said, and analyzing any harm they may have caused through their actions.
“For the past 3 years my life has been hell ruminating over things I did/thought as a teenager, and I feel as though I’m putting up a facade whenever I interact with people. Like I’m some awful criminal with terrible secrets I need to hide. I hate myself. Logically, I know that what I did wasn’t that bad, but I just can’t convince myself.”
People who suffer from this type of OCD often overestimate the importance of their actions, and if they can’t clearly remember every detail of what happened, they are likely to assume the worst. These obsessions cause significant anxiety and distress, thus creating an urgent need to seek answers or reassurance.
As a result, people with Real Life OCD will engage in ritualistic and repetitive behaviors known as compulsions to repress these thoughts and reduce the anxiety caused by their intrusive thinking.
Like every other type of OCD, the more you seek certainty, the less certain you will become. While the compulsive actions will provide a temporary sense of relief, this feeling is short-lived because new doubts or questions tend to re-arise soon thereafter.
Real Event OCD Obsessions
Obsessions often take the form of repetitive, persistent ideas, unwanted or intrusive thoughts, images, or impulses that are experienced as distressing.
Common examples of Real Event OCD obsessions include:
- Worrying that you said or did something bigoted or offensive
- Fearing that you acted inappropriately
- Fearing consequences from your actions, such as being punished, canceled, or caught
- Worrying that your actions have caused others harm
- Feeling that you may have been critical, inauthentic, or unfair
- Worrying that your thoughts or actions make you a bad person
- Having intense, overwhelming feelings of shame, guilt, fear, or embarrassment
- Believing you are a terrible person because of your past actions
- Experiencing intrusive thoughts, images, memories, or flashbacks about what happened
- Believing that you deserve to be punished for your actions
What Events Can Trigger a Real-Event Obsession?
There are an endless number of events that could trigger a real-event obsession.
The event could be something minor such as making a rude remark to a customer service representative or cheating on a test, or something more major like driving drunk or making a racist comment.
Essentially, any event that makes someone fear they are a bad person can trigger these obsessive thoughts.
Other examples include: breaking up with a significant other, cheating in a relationship, having sex with someone who seemed reluctant, plagiarizing on an assignment, or stealing.
They can be focused on a recent event or something from far in the past, such as stealing from a store as a child many years ago.
Real Event OCD Compulsions
Compulsions are repeated patterns of ritualistic behaviors, used to reduce anxiety and prevent an outcome, following a strong obsessive urge to do so.
Common examples of Real Event OCD compulsions include:
- Seeking punishment for your actions
- Repeatedly analyzing your past behaviors and actions, looking for wrongdoings or evaluating the terribleness of the actions
- Confessing or unnecessarily apologizing for your perceived wrongdoings in the hope of gaining forgiveness
- Excessively seeking reassurance from friends and family that you did not do anything wrong and / or that you are not a bad person
- Looking for ways to prove to yourself that you are a good person
- Calling authority figures, such as police officers or lawyers, to inquire about the potential consequences from your past actions
- Reimagining the event the way you would have liked it to go
- Criticizing and berating yourself because you believe you deserve to be punished for your past behaviors
- Trying to repent by doing “good deeds”
Example
Real Event OCD is made up of three components:
- The Event: What really happened
E.g., I took LSD with my college roommate. He became paranoid. A few years later, he was diagnosed with schizophrenia. - The Obsession(s): The intrusive thoughts about what happened. These are usually irrational or exaggerated.
The individual may exaggerate the significance of the event, believing that it defines their entire character or that it will have long-lasting consequences on their future.
The person might feel intense guilt and shame for taking drugs with their roommate, even if they have faced the consequences and learned from their mistake.
It is my fault he is schizophrenic. I am a bad person. I caused this to happen. - The Compulsions(s): The actions taken to try and gain temporary relief or reassurance.
The individual may ruminate on the event, constantly thinking about it and seeking reassurance from others about their actions.
E.g., Researching schizophrenia and its causes; asking others who were there if they thought the person seemed reluctant to try the drug; replaying the details of the event in your mind to see if you had peer pressured him; trying to remember if you noticed any previous signs of mental health illness in the friend.
Do I Have Real Event OCD?
It is common for everyone to reflect on past events occasionally and wonder whether we should have done or said things differently.
We might even berate ourselves about something we said or did that we wish we had handled more effectively, or experience momentary guilt over the consequences of our past behaviors. But, these reflections and feelings often fade over time without much rumination or distress.
Someone with Real Event OCD, on the other hand, will spend hours over-analyzing, fixating, and ruminating on past events.
They will replay events repeatedly in their head and excessively seek reassurance from others to gain a sense of certainty that they did not do anything wrong and are not a bad person. This process of engaging with the thoughts indicates that it may be OCD.
These individuals often find themselves trapped in the past, unable to engage in the present moment. They suffer from excessive feelings of guilt, shame, and doubt about their actions and an overwhelming sense that they are immoral or shameful.
They will find themselves in a never-ending quest to find certainty and relief, but this relief is always short-lived as additional doubts and fears seem to be constantly regenerated in their minds.
Real-Life Personal Experiences
It was bearable for a large part of those years, only coming up every once in a while. This summer and into December, it was the worst it had ever been. Constant feelings of I am a bad person, how can I live with the mistakes I have made, you know the deal if you have real event OCD.”
“This cropped up for me the other day. I had a small verbal confrontation with someone while out with my daughter for March break (they failed to stop at pedestrian stop and then chose to honk and complain to me about it.) I kept replaying it throughout most of the day. Did I respond right, was I wrong, etc.”
“I am still scared of death and sometimes I am afraid that If I don’t do something, something bad will happen to someone I love or to me. I had some bad experiences with OCD. One of them was when one my friend’s dad died and the thoughts made me think that it was my fault because I didn’t do something that my brain wanted to.”
How to Manage Real-Event OCD
Someone with Real Event OCD will exert much energy and time to try and find certainty around a past event, making it very difficult to live and embrace the present moment.
OCD can be treated and managed effectively. You can learn to manage how your symptoms affect your daily life through medication, therapy, mindfulness, or a combination of treatments.
Self-Management Techniques
In addition to seeking professional help, people with OCD can practice several techniques in their daily lives to manage their obsessive thoughts.
One of the problems with OCD is people treating their intrusive thoughts as enemy, not accepting them:
- Challenge Your Assumptions and Feared Stories →
Try to use your most logical and rational mind to reconsider the importance placed on feelings, certainty, and the likelihood of a catastrophic outcome.
Ask yourself: “What are all the things that would need to happen or line up for my fear to be true? How likely is it that all those things would line up just like that?
Are there other areas of life where I am able to make decisions or move forward while accepting uncertainty and letting go of the need for perfect assurance?”
This exercise will hopefully help you gain the confidence that the feared outcome is highly unlikely and help you realize that continued rumination will not bring you any closer to certainty.
However, it is also common that people with OCD may still struggle with their compulsions despite their rational mind knowing their feared outcome is not proportionate to reality. - Make a Real-Event OCD Compulsion Inventory →
One of the first things to do in OCD treatment is to make a list of all your compulsions.
This list should include both external actions, like asking others for reassurance, and internal thinking patterns like mentally replaying the event over and over.
With your therapist, you will then progressively work to minimize and eliminate these from your life.
The hope is that as you stop the compulsions, you will be able to see that you can deal with the memory of the event and the presence of the guilt without performing compulsive actions. - Accept Imperfection of Character, Self-Compassion→
Most individuals who suffer from Real Event OCD struggle with questioning their morality and character.
They become stuck in a cycle of self-doubt and uncertainty and will sacrifice significant time, energy, and effort to regain a sense of assurance and worth.
There is no winning with OCD because no matter how good you try to be, your anxiety and mistrust will always tell you to do more.
We must practice self-compassion, telling ourselves that we are enough and allow ourselves to feel loved despite our mistakes and imperfections. - Turn Shame into Guilt →
A good place to start is to practice shifting any shame-based language into guilt-based language. Observe how you talk to and about yourself in relationship to the event(s) in question.
Shameful thinking will only cause you to experience more isolation, guilt, and self-criticism; but you can change and improve these intrinsic thoughts.
Guilt thinking instead focuses on the actions you took and the decisions you made. Practice acknowledging your actions for what they are and set them apart from your character.
For example, if you catch yourself saying things like “I am a terrible person” or “I deserve to be punished for what I did,” try to re-frame this to “I feel terrible for what I said” or “I should not have done that because I put someone else in danger.” - Turn Guilt into Self-Compassion →
Once you are able to turn your shame-based language into guilt-based language, you can then work on shifting this guilt into self-compassion.
This involves understanding that all humans make mistakes, and we all have something that we regret or wish we would have done differently.
We should take responsibility for our actions while also allowing for forgiveness.
We must resist the urge to continuously condemn ourselves for our past errors, and instead, offer ourselves compassion for being imperfect and making mistakes.
Exposure and Response Therapy
As with all OCD subtypes, Exposure and Response Therapy (ERP) is a type of CBT considered the first-line psychotherapy for OCD.
At least half of the people who seek treatment for OCD will show symptomatic remission over the long term and experience an increased quality of life and improved functioning.
The best outcomes occur in individuals who are diagnosed early and start an intense treatment program right away. Depending on the severity of OCD, some people may need longer-term or more intensive treatment.
In ERP, a person works with a therapist to identify both external and internal triggers that cause them stress and make them want to behave compulsively. ERP is designed to gradually reduce the anxiety that feeds the obsessions and compulsions through a process called habituation.
The goal of habituation is to purposely invoke anxiety in attempts to disrupt the neural circuit between the processing and action parts of the brain.
In the case of Real Event OCD, a common form of ERP therapy is to use an imaginal exposure script. Imaginal Exposure involves vividly imagining the feared object, situation, or activity. The goal is to create a first-person, present tense, detailed narrative of the worst-case scenario occurring.
By writing out the story as it happened, as specifically as possible, people can learn that catastrophes are less likely than they expect and that they can cope with the catastrophe if it ever does happen.
As part of this exercise, you can also draw a picture of the location, the event, or the person involved, or listen to music that makes you think of the time.
Sources
Pozza, A., & Dèttore, D. (2019). “Was it real or did I imagine it?” Perfectionistic beliefs are associated with dissociative absorption and imaginative involvement in obsessive-compulsive disorder. Psychology Research and Behavior Management, 603-607.
Rosso, G., Albert, U., Asinari, G. F., Bogetto, F., & Maina, G. (2012). Stressful life events and obsessive–compulsive disorder: clinical features and symptom dimensions. Psychiatry research, 197(3), 259-264.
Vidal-Ribas, P., Stringaris, A., Rück, C., Serlachius, E., Lichtenstein, P., & Mataix-Cols, D. (2015). Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study. European psychiatry, 30(2), 309-316.
