Checking OCD: Symptoms, Causes, and Treatment

Checking OCD is a common form of Obsessive-Compulsive Disorder (OCD), characterized by checking-based compulsive behavior.

People with Checking OCD fear that they will somehow cause something bad to happen to themselves or others, intentionally or not. This obsessive concern causes anxiety, which they respond to with checking rituals in an attempt to gain certainty that something terrible has not or will not happen.

Examples of Checking OCD

Example 1: A woman gets stuck trying to leave the apartment, checking for safety hazards.

For the third time this week, Jennifer is at risk of being embarrassingly late to work. Even though she got up early, got ready in time, and could have easily made it to the right bus – she was once again stuck in her apartment and bombarded with intrusive thoughts like: 

● “Did I remember to turn off the stove?” 

● “Did I really lock the windows and unplug the toaster?” 

● “What if a fire starts? What if someone gets hurt?” 

● “I couldn’t live with myself if it was my fault.” 

Example 2: A man turns his short commute into a long drive, checking for accidents. 

While driving to work, Tom feels his anxiety rise to uncomfortable levels as the familiar unwanted thoughts start: 

• “Did I look both ways before I made that last turn?” 

• “What was that bump I felt? Did I just hit someone?

• “There were a lot of pedestrians in that crosswalk. Did I see them all?” 

Tom worries that his carelessness will result in tragedy for someone else – a thought that feels unbearable. He feels the need to be 100% certain that nothing bad happened, so he starts his checking rituals. 

He ends up driving in circles, trying to retrace his route (sometimes several times). He excessively checks his rearview mirror to survey the stretch of road that he just traveled. At times he stops his truck, gets out, and walks all the way around it, checking for signs of a recent accident. What should be a short commute can take hours. 

As can be seen from these examples, Jennifer and Tom are both struggling with something far beyond the “double-checking” that most people experience. Instead, they get stuck in a downward spiral of anxiety, doubt, and repetitive checking. The more they perform their compulsions, the more entrenched the cycle becomes.

Signs and Symptoms of Checking OCD

Obsessive thoughts in Checking OCD tend to center on the possibility of something bad happening to ourselves or others. When it comes to others getting hurt, the fear is that it would be our fault. Common obsessive concerns in Checking OCD include: 

• Safety Concerns – fears about being responsible for a fire, flood, burglary, or any other threat to life or property.

• Health Concerns – fears of developing a serious illness.

• Mistake Concerns – fears of making errors of any sort.

• Inappropriate Behavior Concerns – fears of bad behavior (e.g., saying something hurtful in a conversation or accidentally writing racial slurs in a paper for school). 

These obsessive concerns lead to distress (usually in the form of anxiety), and for this subtype of OCD, checking is the compulsive behavior utilized to reduce that anxiety. The purpose of the checking is to try to be certain that these feared outcomes have not, or will not happen. Common checking behaviors include: 

• Physical Inspection: Looking closely at things (sometimes taking photos for more lasting “proof”), or physically examining them.

• Avoidance: Avoiding responsibility can mean escaping the anxiety around uncertainty. Getting someone else to be the last to leave the house or a room takes the responsibility for checking locks, stoves, faucets, etc. off of the person with OCD. If the concern is about making mistakes, then avoiding the opportunities to make mistakes, (e.g., not sending emails or having interactions with others), can reduce anxiety.

• Reassurance: People with Checking OCD often seek reassurance. This reassurance can be from within, reminding oneself that they have done things correctly. It is also common to seek reassurance from others with questions such as “You saw me lock the door, right?” or “Does this mole look normal to you?”

• Mental Rituals: A lot of checking goes on inside the head. This can take the form of replaying events in one’s mind. For example, a person with Checking OCD can spend hours in bed going over and over conversations they had that day in order to be certain that they did not do anything hurtful or inappropriate. Safety concerns can result in “replaying the video” (in one’s head) of all of your actions before you left the house, in order to be certain that everything was done correctly.

What Causes Checking OCD?

We can’t say conclusively what causes OCD, although it seems to be a combination of neurobiological, genetic, cognitive, behavioral, and environmental factors. We can be more confident in identifying what maintains the OCD. 

Compulsive behavior, like checking, is often temporarily effective because it reduces anxiety. Because of this, people with OCD are much more likely to do that checking behavior again the next time they find themselves feeling anxious about not being certain of something. This becomes a closed loop in which the person with OCD gets trapped, never learning that there is another way out.

Is Checking OCD Treatable?

The good news about Checking OCD, and every other form of OCD, is that it is treatable. Exposure and Response Prevention (ERP) therapy is considered the “gold standard” of treatment for OCD and is highly effective when done correctly. 

It encourages people to face their fears about possibly causing harm or destruction by purposefully triggering these thoughts (exposure) and then learning that they do not have to give in to their urges (response prevention) in order for everything to be okay. Let’s look at an example of how this might work: 

Example of ERP Therapy: 

Remember Jennifer, the woman from the first example, who was always late for work because she was repetitively checking her apartment for safety hazards? 

An ERP assignment might have Jennifer leave her apartment without doing the checking routine that she normally does.  

By avoiding her checking routine, Jennifer would learn that her compulsions are not necessary and that her anxiety will subside on its own. ERP would also teach Jennifer that she can handle uncertainty. 

How to Find Treatment

There is hope for people struggling with Checking OCD. An important first step is finding the right help by seeking out an OCD provider trained in ERP. 

ERP (Exposure and Response Prevention therapy) is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. Make that call and speak with the NOCD clinical team to learn more about how a licensed therapist can help. schedule a free call today for more information on how NOCD can help.