Obsessive compulsive disorder - OCD treatment and therapy from NOCD
OCD subtypes
Real Events OCD

Real Event OCD: What It Is and How to Get Help

9 min read
Nicholas Farrell, Ph.D
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

There’s no one single snapshot of obsessive-compulsive disorder (OCD), a disorder that afflicts around 1 in 40 people worldwide. That’s because OCD can take many forms, and the ones that you don’t see reflected in movies or on TV are even more misunderstood. 

The most common types of obsessions in OCD often involve a fear that something “bad” may happen in the future. In these cases, the OCD mind tells you that if you perform a certain action or compulsion, you will prevent this bad thing from happening. But that’s now how all OCD works.

There’s something called “Real Event OCD” and it stems from memories of events which have already happened. Maybe you feel uncertain about what you did or you feel riddled with guilt and self-doubt.

In the words of my colleague Dr. Patrick McGrath, “Memory is a tricky thing. No one remembers every detail of what transpires in their lives.” But for people with Real Event OCD, this inability to remember everything results in assuming the worst. “Because of how their brain fills in the blanks for what they can’t remember, they walk around feeling like some awful person with a secret they need to hide.”

Most people probably don’t associate symptoms like these with OCD, but that doesn’t mean that they’re not common, or that they’re not just as treatable as any other form of the condition. As an OCD specialist with extensive experience treating real event OCD, I can assure you: if you’re experiencing these symptoms, you’re not alone—and you can have hope for recovery.

Real Event OCD vs. “Justified” Guilt Over Past Mistakes

One example that Dr. McGrath gives: Say that you were driving home one night after having a drink and you were a little tipsy. When you arrive home, your mind starts to run through the what-ifs: “What if I hit another car and I didn’t realize it? Am I a horrible person and have I done something terribly wrong?”

The real event is that this person got in the car after having an alcoholic beverage. But the guilt is not over having the drink—it’s about the imagined event (a car accident) that didn’t actually transpire. 

Many people with Real Event OCD are convinced that their severe guilt is a normal or necessary response to their past behavior, but this is a mistake. Getting to the root of your issue and determining if it could, in fact, be Real Event OCD is crucial for getting the appropriate treatment and gaining freedom from debilitating doubts and rumination. 

Let’s dive into the signs and symptoms of Real Event OCD, as well as what you can do to fight back.

What are the symptoms of Real Event OCD? 

Real Event OCD is a subtype of OCD characterized by ongoing intrusive thoughts and compulsive behaviors around someone’s past actions. Someone with Real Event OCD spends extensive energy attempting to gain certainty about a past event and whether they’ve done something potentially immoral or wrong.

While all subtypes of OCD involve two parts—obsessions and compulsions—you can think of Real Event OCD as having three components, in a sense: 

  1. The event: what really happened
  2. The obsessions: the thoughts, fears, images, or doubts you have about what happened, which are often irrational 
  3. The compulsions: the behaviors you engage in to try to ease distress over the obsession or gain temporary reassurance

Practically everyone experiences regret or doubt about the past. However, people with Real Event OCD often experience all-or-nothing thinking about these events. This is one of the main symptoms of this subtype. A person without OCD may think, “I probably shouldn’t have made fun of that boy in middle school,” reflect on their feelings, and move on. For someone with Real Event OCD, guilt over this memory can feel overwhelming, equivalent to committing a murder. Their OCD will take hold of past events and warp them until they are a villain who can never be excused.

Real Event OCD will latch onto even the slightest doubt and cause fear that is not proportional to the action one is worried about. It often focuses on your teenage years, when there was more ambiguity and higher potential for regret. People with Real Event OCD will generally spend at least one hour per day or more on these obsessions and compulsions.

These obsessions often pop into the person’s mind seemingly out of nowhere. For example, during a workday, you might suddenly experience obsessive thoughts about that time you cheated on an exam in middle school. The thoughts will take over your mind, and you won’t be able to concentrate on anything else. The fear of potentially wrong past actions drives people with this OCD subtype to engage in various compulsions aimed at gaining certainty about what exactly they’ve done and what this means about who they are as a person. To continue our example, you might go to extreme lengths to track down your middle school teacher to confess and apologize for your behavior all those years ago.

There’s no limit to the specific obsessions that people with real event OCD might experience, so it’s important to consult a qualified professional—one who has experience and training in OCD—in order to make sense of your own experience and start a journey toward recovery.

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Specialized OCD treatment is more accessible than ever. NOCD accepts most major insurance plans to help you start getting better.

Examples of Real Event OCD obsessions

Given how difficult it is to know if you have Real Event OCD, it can be helpful to take a look at some examples of how this subtype of OCD manifests. Here are just a few examples:

I told my friend 10 years ago that I supported her choice of partner, and I didn’t tell her that I noticed a few potential red flags. Now they are getting a divorce. What if it’s my fault because I didn’t tell her what I really think? 

Last year, I gave a restaurant a bad review, and I just found out they’ve shut down. It was all my fault their business tanked.

When I was 12 I laughed at my classmate. What if they are still suffering because of what I did to them?

When I was a teenager, I stole chips from a deli. I haven’t done anything like this since, but what if this act is still somehow a part of me? What if part of me is still a thief, and I unknowingly transfer this characteristic to my kids? What if they become thieves and it’s my fault?

Examples of Real Event OCD compulsions

Mental review

This is the most common compulsion for people with Real Event OCD. They will replay the event they are concerned about in their mind over and over until they feel like they’ve gained clarity and experienced relief. It’s usually only a matter of time before these obsessive thoughts return and the cycle begins again.

Reassurance-seeking

Someone who is concerned that stealing potato chips as a teenager makes them a bad person may ask the people in their life questions like, “Have you ever stolen anything when you were younger?” and, “Do you think stealing one time makes someone a bad person?” These questions are aimed at giving this person relief from their fear of being guilty. They may also engage in compulsive research online, searching things like, “How to know if you’re a bad person?” “Why do people steal?” or “How to make sure your children won’t steal?” 

Confession

The guilt people with Real Event OCD experience can be very intense. This can drive people to confess to figures of authority, often sharing things that they never actually did “just in case.” A person with this subtype may consider this the only way they can experience relief from their guilt. 

Talk therapy doesn’t work for OCD. This does.

NOCD clinicians are trained to treat OCD with the only solutions proven to work for over 80% of people.

Effective, evidence-based treatment for Real Event OCD 

The best course of treatment for Real Event OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been supported by decades of rigorous scientific research.

The idea behind ERP is that repeated exposure to obsessive thoughts, without engaging in compulsions, is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety. 

Odd as it may seem, when you take one of the fears driving your obsessive thoughts and play it out to the worst possible end, the fear has less power over you. For example, you might play out the fear that you stole something as a teenager and are still somehow a thief. What if that’s true? What will happen if your children do turn out to be thieves and it’s because of something you unknowingly taught them? Then what? Will they get caught? What happens next?

The idea behind ERP is to habituate yourself to these fearful thoughts so that they will loosen their grip on you. In my experience treating real event OCD, this process can actually occur in a short period of time: before long, you’ll develop skills and get to a point where you are comfortable with the uncertainty of the past, and you’ll actually experience less worry and anxiety about them over time.

Where you can access help today

Real Event OCD can be a tricky diagnosis to spot, even for some mental health professionals, because it’s an unconventional and highly misunderstood type of OCD. An experienced therapist who specializes in OCD—like myself and my colleagues here at NOCD—will be able to make an accurate diagnosis and work with you to create a personalized treatment plan for your individual symptoms. Every therapist at NOCD receives intensive, specialized training in OCD and how to treat it with an individualized ERP plan. In fact, many of them have dealt with OCD themselves and understand from personal experience just how crucial effective treatment is.

NOCD Therapists specialize in treating Real Events OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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