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

What is Real Events OCD? Overview, Examples and Treatment

5 min read
April Kilduff, MA, LCPC
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.


Obsessive-compulsive disorder (OCD) usually takes feared scenarios that could take place in the future, then torments you with impending doom in order to get you to carry out compulsions to (allegedly) save the day. However, not all OCD is future-oriented. “Real Event OCD” takes something that actually happened in your past and twists it into an all-or-nothing game about how awful or harmful it was in OCD’s classic winner-take-all fashion.

As Dr. Lynne Gots notes in this article, “Even though the content and focus of the obsessions differ, the underlying thought processes driving them are identical; an extreme sense of responsibility, an overestimation of danger, and a poor tolerance for uncertainty.”

In the end, Real Event OCD is just OCD rearing its usual ugly head, just with a different type of trigger. What can make the trigger so powerful is that these real-life events are often ambiguous in nature — an ideal scenario for OCD to exploit.

Below, Dr. Lynne Gots shares several examples of Real Event OCD she’s encountered as an OCD therapist.

  • Event: I talked my college roommate into taking LSD with me. He became paranoid. A few years later, he was diagnosed with schizophrenia.

Obsession: It’s my fault he’s schizophrenic.

Compulsions: Researching the causes of schizophrenia, reviewing the event to remember if I pressured him, asking friends who were there if they thought he had been reluctant to try the drug, reviewing conversations had with him prior to the event for signs of mental illness.

  • Event: I caught the flu when I was pregnant because I didn’t get a flu shot. I had a high fever and took Tylenol for a week. My child has dyslexia.

Obsession: If I’d gotten the flu shot, I wouldn’t have had a fever and wouldn’t have taken Tylenol, and she wouldn’t have learning issues. She won’t do well in school; she won’t get a good job; her life will be ruined. I’m a bad mother.

Compulsions: Asking my husband if he thinks I’m a bad mother, researching the causes of dyslexia, asking other moms if they had fevers during their pregnancies, checking several times a day to see if my child can read simple words, self-punishment

  • Event: When I was in law school, I made extra money helping high school students write college admission essays.

Obsession: I didn’t think about it until recent news about college admission standards and now I think I committed a crime.

Compulsions: researching criminal statutes about fraud, reading the news and comparing myself to Felicity Huffman and Lori Loughlin, confessing to trusted friends, mentally reviewing the past to be sure no fraud was committed

As you can see from these examples, the integrity and responsibility of each person gets called into question by OCD. The ferocity with which these memories about real events shows up convinces you that something bad must have happened — or else you wouldn’t remember it with such uncertainty and guilt, right? (Wrong, that’s just a game OCD likes to play.)

Sure, we all have done some questionable things or things we wouldn’t do again — we’re human. Humans make mistakes. But those mistakes are meant to be learning opportunities for us, things to inform our future, not grounds for a life sentence of compulsions, self-punishment and unrelenting guilt about not being a “good person.”

Treatment For Real Events OCD

OCD expert Stacey Kuhl Wochner, LCSW, frames the issue with Real Event OCD quite well: “It is really not about the life event that is the problem. It is also not the thoughts or feelings about the life event that is the problem. The problem is your reaction to the thoughts and feelings about the life event.”

Because this is just OCD with a twist, exposure and response prevention (ERP) remains the gold standard treatment of choice based on numerous academic research studies. In ERP, you will likely be doing scripting where you take the real event as the basis for a worst-case scenario that you play out to the worst possible end. In this counterintuitive approach, you are being exposed to your fears and the intense reactions you have in order to eventually habituate to them so they become less triggering overall.

You may also practice hearing your worst fears confirmed on a loop tape as a way to desensitize yourself to them. At NOCD, we typically see a 40% to 45% reduction in OCD symptoms after successful completion of our nine-week “Get Better” program.

In addition to standard ERP, a healthy dose of self-compassion and acceptance also helps. You have to go back to that “Hey, I’m only human after all” mindset and accept that you may have made a mistake or engaged in some morally ambiguous behavior when younger, as pretty much everyone does. We deserve to have those experiences and learn from them, not to live under a life sentence of suffering. That does no one any good. You can make mistakes and still be a good person. (Watch out for that all-or-nothing thinking error that says one mistake makes me an entirely bad person.) In fact, thinking of yourself as a “good person” may actually be a bit of an exposure after buying into the fact that you “must be a bad person” for so long!

If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. You can also join our Real Events OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

April Kilduff, MA, LCPC

April Kilduff is a NOCD therapist who has exclusively treated OCD and anxiety disorders, as well as their intersection with the Autism spectrum, for over a decade. Her path to this career started with her own journey dealing with panic attacks, perfectionism and a couple phobias. When not working on exposures with members, you can find her at home reading books and hanging out with her two cats or out taking pictures and traveling the world.

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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.

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.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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