Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Checking OCD: Symptoms, Causes, and Treatment

Sep 21, 20237 minute read

We’ve all left the house worried that we left the iron on or forgotten to turn off the lights. We might go back in to make sure everything is okay before heading off for work. But for some people, checking and re-checking something isn’t the occasional occurrence—it takes over their life.

Sometimes checking does not merely involve going back into the house seconds after you left—it requires a significant investment of time and energy. For instance, some people might have parked their car at a faraway lot but then, in the middle of a concert or a dinner out with friends, become preoccupied with the thought that they didn’t lock their car doors. They excuse themselves to go and check. Or they pack and re-pack their backpack several times before leaving home to “make sure” that they have that item they’ll need.

What’s going on here? In many cases, this behavior can be explained by a subtype of obsessive-compulsive disorder (OCD) called Checking OCD. Let’s delve into what it is, and how to get help if you think you might be suffering from this condition. 

What is Checking OCD?

Checking OCD is a common form of OCD characterized by checking compulsions.

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—aka “checking compulsions”—in an attempt to gain certainty that something terrible has not or will not happen.

The lengths people go to in order to check vary from person to person, notes Dr. Patrick McGrath, Chief Clinical Officer for NOCD and author of The OCD Answer Book. There are some people whose “checking” is satisfied by the reassurance from someone else—for instance, your husband telling you that you turned off all the lights before you left home—while others need visual confirmation (e.g. driving home from the office in the middle of the workday to check for yourself). 

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: 

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.

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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 the sufferer’s fault. 

Checking obsessions 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. 

Checking compulsions 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-seeking: 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.

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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, which will help her confront any intrusive worries or doubts that creep up from time to time. 

How to access treatment today

As an OCD specialist with decades of experience treating the condition, I want to emphasize that recovering from checking OCD is possible—you don’t have to let your worries, doubts, and relentless compulsions rule your life forever.

If you think you may be struggling with OCD, I strongly encourage you to learn about NOCD’s evidence-based, accessible approach to OCD treatment. I’m confident that we can help you regain control of your life.

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