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What is OCDOCD SubtypesReal Event OCD: Symptoms, Obsessions, Compulsions and Treatment.

Real Event OCD: Symptoms, Obsessions, Compulsions and Treatment.

7 min read
Nicholas Farrell, Ph.D

By Nicholas Farrell, Ph.D

Apr 14, 2021

What Is Real Event OCD?

Real events obsessive-compulsive disorder (OCD) is a subtype of OCD characterized by ongoing intrusive thoughts and compulsive behaviors around someone’s past actions. While most types of OCD cause a person to fixate on feared future-oriented events, someone with real events OCD experiences intense anxiety over what they did or potentially could have done in the past. Someone with this OCD subtype will spend extensive energy attempting to gain certainty about a past event and whether they’ve done something potentially immoral or wrong.

Real Event OCD symptoms

Practically everyone experiences regret or doubt about the past. However, people with real events 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 events OCD, guilt over this reflection 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. Even if the person dismisses these thoughts in their mind with rational explanations of their innocence (e.g. everyone makes mistakes when they are growing up), the OCD will morph to find even more reasons they are guilty.

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 events OCD will generally spend at least one hour per day and often greater on these obsessions and compulsions.

These obsessions often pop into the person’s mind seemingly out of nowhere and can occur with or without any apparent connection to the present. For example, during a workday, you might suddenly experience obsessive thoughts about cheating 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 harmful 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 (e.g., searching for the person they bullied in middle school). 

Real events OCD can be incredibly time-consuming, drain someone of energy, and send them on a downward spiral of guilt as their OCD warps minor regrets into inexcusable crimes. These thoughts will go on and on, often for hours or days, and won’t leave until the person has engaged in a compulsion or found reassurance either internally or externally to dismiss these concerns. Often the person will replay the event in their mind and experience doubting thoughts about whether they remember the event correctly (e.g., “What if I didn’t accidentally cause my sister to trip when we were 5? What if I did it on purpose?”)

Examples of Real Event OCD obsessions

  • 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?
  • A month ago, I told my friend she should get the haircut she wanted even though I didn’t think it would look good. Now she is miserable and hasn’t left the house in weeks. I could have prevented this.
  • As a teenager, I drove after drinking a glass of wine. Nothing happened, thankfully, but what if something had? I can’t believe I risked that. 
  • 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 Events OCD compulsions

  • Mental reviewing: This is the most common compulsion for people with real events 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 experience relief. Because it’s impossible to know exactly what happened in the past, 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 confess to a friend, “Hey, when I was 12, I stole chips from a deli. Does this make me a bad person?” 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 events OCD experience can be very intense. This can drive people to confess to figures of authority. A person with this subtype may consider this the only way they can experience relief from their guilt. 

Real event OCD ERP therapy

The best course of treatment for real events OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. 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. 

ERP is considered the gold standard for OCD treatment and has been found to be 80% effective. The majority of patients experience results within 12-20 sessions. As part of ERP therapy, you will track your obsessions and compulsions, and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

Examples of Real Events OCD exposures

Using an imaginal exposure script is a common form of ERP therapy for real events OCD. This is where you take one of the fears driving your obsessive thoughts and play it out to the worst possible end. 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?

As you can imagine, using imaginal exposure scripts can be uncomfortable because it requires unfolding hypothetical scenarios your mind has labeled the worst possible thing that can happen. However, the idea behind ERP is to habituate yourself to these fearful thoughts so that they will loosen their grip on you. Eventually you’ll get to a point where you are relatively comfortable with the uncertainty of these past actions, and the obsessive thoughts will reside.

How to get help

Real events OCD can be a tricky diagnosis to spot because it’s an unconventional type of OCD. Instead of being driven by fears of things that may happen in the future, this subtype is driven by what’s already happened. A mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you’re interested in learning about real events OCD and how it’s treated with ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment. You can also join our Real Event OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

Learn More About Real Event OCD

Learn more about ERP
Nicholas Farrell, Ph.D

Nicholas R. Farrell, Ph.D. is a psychologist and the Regional Clinical Director at NOCD where he provides clinical leadership and direction for our teletherapy services. In this role, he works closely with our clinical leadership team to provide a high-quality training and developmental experience for all of our therapists with the aim of maximizing treatment effectiveness and improving our members’ experience. Dr. Farrell received his master's and doctoral degrees in Clinical Psychology from the University of Wyoming (Laramie, WY, USA). He served as a graduate research assistant in the Anxiety Disorders Research Laboratory at the University of Wyoming from 2010 to 2015 and completed his predoctoral internship training as a psychology resident at St. Joseph’s Healthcare Hamilton (Ontario, Canada).