Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Is Responsibility OCD, Symptoms, and How To Treat It?

8 min read
NOCD Staff
Reviewed by Patrick McGrath, PhD
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.

What Is Responsibility OCD?

Responsibility OCD is a subtype of obsessive-compulsive disorder. It’s characterized by ongoing intrusive thoughts, images or urges, and compulsive physical and/or mental behaviors around a person’s sense of responsibility for other people and animals around them. 

People with this subtype of OCD experience frequent, intrusive, unwanted thoughts that they could be responsible for something awful happening because they did not perform specific actions or because of something they did or didn’t do in the past. Though it’s called responsibility OCD, it’s caused by thoughts about having been irresponsible in some way. 

Responsibility OCD Symptoms 

People with responsibility OCD focus exclusively on the impact their actions or thoughts could have on others.” For example, they may be excessively worried about the possibility of running someone over. They might feel it is their job to be 100% responsible for making sure their loved ones are always safe. They may be overly concerned with saying something or doing something that could hurt someone physically or emotionally. They might even feel an excessive amount of responsibility for protecting our planet. The responsibility and feared outcomes are unique to each person with OCD because OCD always goes after what each person values the most.

These intrusive thoughts can take over a person’s ability to think about anything else and lead to intense fears about the severity of their condition. In an attempt to stop these intrusive thoughts, people with responsibility OCD engage in compulsions. These compulsions are aimed at making them go away and aimed at achieving an unrealistic perfect sense of responsibility.

People with responsibility OCD experience high levels of guilt, too. Their guilt could lead them to go out of their way to help others and prevent these imagined scenarios from becoming a reality. As a result, their actions are driven by a sense of guilt and fear of doing something wrong because they fear they are secretly a bad person and that others could be greatly harmed because they failed to prevent such a thing. 

Examples of Responsibility OCD Obsessions

People with responsibility OCD experience obsessive thoughts, images, and urges focused around their sense of responsibility for others. Here are some examples of responsibility OCD obsessive thoughts:

  • If I rush to catch the train, what if someone tries to hold the door for me and their arm breaks and it’s my fault?
  • What if I cough in public and it spreads germs, and I get someone else sick and end up being responsible for their death?
  • If I think of something negative while looking at someone else, something terrible could happen to them. 
  • I have to make sure my cats never interact with the poisonous flowers outside. They depend on me.
  • Did I lock the doors? Did I turn off the stove? I need to recheck because it would be awful if there was a burglary or fire and my family got hurt. It’s my responsibility to keep them safe at home.
  • Did I accidentally run someone over without knowing? Was that really a speed bump? How can I be sure? Should I go back and check?
  • What happens if I take out this book from the library and someone else wants to read it? What if that person is suffering, and this was the book that would change their life, and because I checked it out of the library, I’d be responsible for their suffering?

Examples of Responsibility OCD Compulsions

In response to their obsessive thoughts, a person with responsibility OCD will engage in compulsive actions to alleviate their anxiety or prevent a feared outcome from happening. Here are some examples of what that might look like:

  • Seeking reassurance: A person with responsibility OCD may constantly ask their friends and family to reassure them that they are not responsible for anything bad happening. This validation is intended to relieve the anxiety their intrusive thoughts are causing. They may also look to trusted people in their lives to discredit their fears. For example, they might ask, “Do you think it’s OK for me to buy the last carton of milk? Do you think someone else might need it more than I do?” Even though they may experience temporary relief from reassurance, it’s only a matter of time before their responsibility OCD starts up again with new intrusive thoughts about how their actions could lead to more potential negative circumstances. Reassurance-seeking leads to more reassurance-seeking, and for OCD, there’s no such thing as enough reassurance.
  • Performing rituals: Some people may perform rituals during certain times of the day or under specific circumstances. For example, a person may pick up and put down an item in a particular way in order to prevent their fear from becoming a reality. They may have a ritual to think seven positive thoughts each time a negative thought about a friend comes into their head to ensure their negative thought won’t lead to something bad happening to their friend. 
  • Mental review and Mental Checking: Some people may engage in mental review and mental checking to reassure themselves that they are not responsible for their feared outcomes. For example, a person might spend hours recalling a conversation with a friend to be sure they didn’t say anything hurtful or offensive. They might replay every moment they can remember from the conversation a dozen times and attempt to arrive at a definitive conclusion about whether or not they said something offensive and need to apologize, which they may significantly overdo.
  • Excessive Research: A person may engage in compulsive  research about the fears they are experiencing. For example, someone may fear they could run over a pedestrian or an animal while driving. They may spend hours researching this possibility online or looking for new reports of hit & runs they fear they could be responsible for
  • Avoidance: Someone may avoid certain scenarios, places, products, or people where they think they could be responsible for a negative outcome. For example, they might stop driving because the perceived possibility of hurting someone is too high. They may avoid interacting with particular people for fear of saying the wrong comment and hurting their feelings. They may even become homebound as a way to avoid being in any scenario that challenges their sense of hyper-responsibility. 

ERP Therapy for Responsibility OCD

The best course of treatment for responsibility OCD, like all subtypes of OCD, is exposure and response prevention therapy. ERP is considered the gold standard for OCD treatment; 80% of people with OCD experience positive results from treatment. The majority of patients see results within 12 to 20 sessions

As part of ERP therapy, you’ll track your obsessions and compulsions and make a list of possible ways to face your fears. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions and the accompanying anxiety or discomfort while also working with you to prevent giving into compulsions. ERP exercises will be mindfully created so that you’re gradually building toward your goal rather than moving too quickly and getting overwhelmed. 

The idea behind ERP therapy is that exposure to these thoughts and the discomfort while resisting compulsions is the most effective way to treat OCD. This is because while we can’t totally control our thoughts, we can control our behaviors. When you continually submit to the urge to do compulsions, it only strengthens your perceived need to engage in them.

On the other hand, when you prevent yourself from engaging in compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety as you provide yourself with opportunities to change your learning and practice living with uncertainty and discomfort, just as people without OCD do every day..

Examples of Responsibility OCD Exposures

If you’ve ever tried not worrying about something, you know how difficult it is to control thoughts of concern. ERP therapy takes the opposite approach: Instead of trying to make yourself stop your obsessive thoughts, you practice welcoming and accepting them.  

Let’s say that every night, you can’t stop seeing mental images of you and your family’s home going up in flames or being invaded by armed robbers. These scenes are vivid and horrific. As a way of coping, you start checking all the locks on doors and windows and making sure the stove/oven isn’t on. Then you recheck. And you recheck. Suddenly you’re spending an hour in this nighttime ritual.

An ERP therapist may ask you to welcome the intrusive images without trying to make them go away or do any compulsions in response to them. You might think, “Welcome them? No way! That’s terrible. I just want these images to stop and for my family to be safe.” But instead of trying to suppress them, your therapist may ask you to put your full attention on them, again, without resorting to compulsions. 

This teaches your brain a new response to your obsessions and the anxiety they bring. And it shows you that OCD doesn’t have to control your life and keep you from living the way you would like. Eventually, you will begin to distinguish yourself from your OCD, and it will be easier to let intrusive thoughts and images come and go without engaging in compulsions.

As part of ERP treatment, you will be asked to gradually give up your checking routines at a gradual pace. For example, you might be asked to do just one less check per night to start challenging the OCD. As time passes, you’ll take on fewer and fewer checks until you are able to get through the evening with no checks at all. 

Once you become more familiar with intrusive thoughts and images and allow them to exist without responding via compulsions, they typically begin to feel less alarming. By confronting these thoughts without compulsions, you start to learn that your feared outcomes won’t occur, that you can manage the outcome if it does occur, and that you can tolerate the anxiety or distress that arises when you have intrusive thoughts. In some cases, people find that their anxiety subsides to the point where they no longer experience intense fears related to their thoughts.

How To Get Help for Responsibility OCD

The symptoms of responsibility OCD can often be considered generous or altruistic (even by mental health professionals) because the people experiencing them are constantly going out of their way for others. 

While someone with this OCD subtype may appear excessively kind—and while they are genuinely trying to do good in the world—they are motivated by a sense of guilt and fear of being responsible for harming another person. That fear contributes to anxiety and suffering.

People with responsibility OCD don’t actually experience the pride and relief they should feel after doing something good, mostly because the only acceptable level of responsibility is to keep others 100% safe. It’s an impossible task for anyone but a typical demand from OCD. 

A therapist who specializes in OCD will be able to make an accurate diagnosis and treatment plan for the OCD symptoms.

If you’re struggling with responsibility OCD, help is available. To learn more about this OCD subtype and how it’s treated with ERP, you can schedule a free call with the NOCD care team and 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 experienced OCD themselves and understand how crucial ERP therapy is to OCD recovery. 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.

Patrick McGrath, PhD

Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."

Responsibility OCD

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

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

Licensed Therapist, LCMHC

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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