Obsessive compulsive disorder - OCD treatment and therapy from NOCD

The Psychology of Reassurance Seeking — And Why It Can Be Toxic for People With OCD

By Leeron Hoory

May 17, 20217 minute read

Reviewed byDr. Keara Valentine

Anna knew Taylor would find her text annoying, but she sent it anyway. “Does this sound right?” she wrote, pasting her drafted email response to a speaking panel she’d been asked to attend. It was a straightforward confirmation, but Anna, 28, still struggled with it. Should she add an exclamation mark after the first sentence? Was it too formal? Anna was convinced her email needed to be worded perfectly — or else her speaking opportunity might fall through. The only way she could make sure was to ask her friend for a second (and third) opinion. 

Taylor, 29, knew Anna needed her, but she couldn’t understand why she felt this much anxiety about something so inconsequential. “Can’t she just figure it out herself?” she thought. She had tried encouragement (“Don’t worry too much; it’s just an email!”) and a harsh-but-loving approach (“You really don’t need my help with this”). She’d also tried avoiding Anna’s requests, but she felt too guilty to give her friend the cold shoulder. Sometimes, it seemed to Taylor that no matter how many times she reassured her, Anna wouldn’t be able to send an email on her own.

What she didn’t know was that this behavior is indicative of just right obsessive-compulsive disorder (OCD), an OCD subtype that causes people to feel an incredible amount of distress if something feels “off.” According to OCD expert and licensed professional counselor Davida Vaughn, M.S., Ed.S., an ongoing need for reassurance can be a sign that a person is resorting to reassurance seeking as a compulsion. Continual texts like Anna’s may be part of an OCD cycle.

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Reassurance seeking, anxiety and OCD

OCD is a prevalent chronic mental health condition that affects millions of adults in the United States alone. It’s been ranked by the World Health Organization as a top 10 most disabling condition. There are many different subtypes of OCD, but the OCD cycle is generally the same: an intrusive thought leads to anxiety or distress, leading to a compulsive behavior. The symptoms of OCD can range from minor disturbances to a person’s daily tasks, to obsessive rituals that completely take over a person’s life. 

It’s normal to want to make sure a professional email is worded properly, especially when stakes are high. But for Anna, the stress could feel insurmountable. Without a second opinion, she’d often leave an email in her draft folder for weeks. The consequences of sending an email that wasn’t “just right” were so terrifying, Anna would rather not send any messages at all. 

Without a second opinion, Anna would often leave an email in her draft folder for weeks. The consequences of sending an email that wasn’t “just right” were terrifying.

Reassurance seeking is one of the more common OCD compulsions. When someone is not yet diagnosed, the constant need to hear others’ opinions can feel disorienting. “Especially before I knew I had OCD, I couldn’t understand why I couldn’t make a decision without getting someone else’s reassurance. I needed someone else to tell me it was right,” Casie David, a peer advocate at NOCD, tells me. “It got very bad to the point where I needed someone there to make a decision.”

To Anna, Taylor’s reassurance felt urgent. In the moment, it seemed like the only thing that would calm her down. Taylor, meanwhile, was strengthening Anna’s dependence on her response. “The hard thing about reassurance is that for most people, [reassurance] would help, but it feeds into the OCD,” David says. “You have an intrusive thought, you ask someone for reassurance, and you might feel better for some time, but then the OCD keeps cycling through. It comes back.” 

Examples of reassurance seeking in relationships 

Photo via Brooke Cagle/Unsplash

OCD is often nicknamed the “doubting disease.” It latches on to any ounce of uncertainty and starts spinning endless what-if scenarios. When people with OCD become overwhelmed with the stress of obsessive thoughts, it often feels like reassurance from a loved one is the only thing that can calm them down. They might ask questions like: 

  • “Are you sure you washed your hands?” 
  • “Is this food fresh? When did you buy it?” 
  • “Do you think I would ever harm someone?” 
  • “Do you think I’m a bad person for getting upset with my friend?” 

For the person on the receiving end, it’s natural to want to help by answering. (“Of course you would never harm someone.” “Yes, I washed my hands.” “I just bought the food yesterday; don’t worry, it’s fresh.”) But this reinforces the idea that the OCD compulsions were helpful and necessary. (“See, I knew I needed to ask. I would have been in danger otherwise.”) 

Providing support to someone with OCD can be a difficult balance. You want to make someone feel better, but you don’t want to make their condition worse. “I think it can be very taxing on other people because it probably feels like you can’t give someone the right answer enough times,” David says. 

Providing support to someone with OCD can be a difficult balance. You want to make someone feel better, but you don’t want to make their condition worse.

Seeking reassurance doesn’t always provide short-term relief. Sometimes it simply isn’t reassuring. “It’s hard when you ask someone for reassurance and they don’t give you the answer you’re expecting — it sends you down a whole other spiral,” David says. For people with OCD, reassurance-seeking can turn into a never-ending cycle. They might start doubting the responses they get, wondering, “What if Taylor is wrong?” or “What if she was busy when she responded and didn’t look over my email properly?” They might then seek reassurance from more people — and feel even more anxious if their answers don’t line up. 

Underneath the need for reassurance is discomfort with uncertainty. Anna wants to know with 100% confidence that her emails are perfectly worded, but of course she’ll never know with absolute confidence. That can leave someone with OCD in a perpetual cycle of anxiety as they seek an unattainable level of perfection.

How to respond to reassurance seeking

Loved ones may find it difficult to know how to help someone with OCD, but when it comes to reassurance, mental health professionals say there’s a better way to respond. “The best and most helpful thing for families to do is not provide reassurance,” says Vaughn. Instead, she advises friends and family to respond with phrases such as “I’m here for you, but I can’t answer that for you,” or “I can’t tell you whether things will turn out OK,” or “Is this part of reassurance seeking?” 

In OCD therapy, patients learn how to prevent themselves from engaging in the compulsions they’ve been dependent on. “Once you get to the point where you’re in recovery, I think it’s a lot easier to tell people, ‘I might ask for reassurance, but don’t give it to me. I need to figure this out on my own,’” David says. “It’s frustrating, but at the end of the day it’s better, because it’s forcing you to deal with it on your own and accept that you might not have the right answer.”

Reassurance seeking vs. information seeking

It can also be difficult for friends and family to spot the difference between OCD-driven reassurance and a well-meaning question. David says to consider how reassurance seeking falls under specific OCD subtypes: “If someone has harm OCD and they’re asking for reassurance, like, ‘Do you think I hurt this person?’ ‘Do you think I would ever hurt this person?,’ that reassurance is different from ‘Do you think I parked here OK?’”

During recovery, people with OCD often find that when they stop themselves from asking for reassurance, their intrusive thoughts become less intense. As part of Anna’s treatment process, she began sending an email without asking Taylor for reassurance. It was scary at first, but eventually she discovered she was capable of writing without her fears becoming a reality. “It’s dealing with uncertainty,” David describes: “‘I don’t know if I did this right. I don’t know if this is correct, but I need to be able to live with that.’”  

It wasn’t that Anna’s emails were “perfect.” It was that she became OK with the fact that they wouldn’t be. And she discovered an exclamation mark didn’t make or break her speaking opportunity. 

If you or someone you know is struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment 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.

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