Obsessive compulsive disorder - OCD treatment and therapy from NOCD

I’m always afraid of being watched. Is there something wrong?

By Grant Stoddard

Sep 18, 20238 min read minute read

Reviewed byApril Kilduff, MA, LCPC

“What if someone is trying to steal my identity?”  

“What if people saw me googling those shameful things?”

“What if a camera was in that hotel bathroom and people watched me masturbate?” 

In the absence of any evidence to support this sort of surveillance, the first conclusion people might come to is that the person asking these “what ifs” was exhibiting signs of paranoia. 

True, paranoia, however, is not a stand-alone condition, but rather a symptom of several other disorders, including paranoid schizophrenia, bipolar disorder, delusional disorder, and paranoid personality disorder. That said, questions like those above can also be central to a fairly common but widely misunderstood condition called Obsessive-Compulsive Disorder (OCD)

Yes—the same OCD that most people think of as a relatively benign personality quirk associated with repetitive actions like washing one’s hands, checking locks, or rearranging items on one’s desk.  While it’s true that OCD sometimes focuses on themes of contamination, safety, and order for millions of people worldwide, it can take entirely different forms for millions of others. Several of these themes can lead to obsessions about being watched, followed, or monitored, as well as compulsions intended to cope with the extreme anxiety that comes as a result. 

In this article, we’ll investigate why these fears might occur, how you might be able to tell if they’re a sign of a mental health condition like OCD, and introduce you to a form of therapy that’s highly effective in helping people manage fears like these and get back to getting the most out of life. 

Do these experiences sound familiar? Learn how you can overcome them.

Here at NOCD, we know how overwhelming OCD symptoms can be—and how hard it is to open up about your experience. You’re not on your own, and you can talk to a specialist who has experience treating OCD.

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Why am I experiencing these fears?

Being around strangers can be scary. Other people always introduce variables that are out of your control: they have different thoughts and intentions from your own, you have no way of knowing exactly what people are up to, and there’s always at least the possibility that they could harm you. That much is undeniably true.

That being said, fear and worry can make us react to uncertainty in completely irrational ways, and can hold us back from living life on our own terms. The fact is that uncertainty is a universal part of life. Your health is uncertain, the weather is unpredictable, geopolitical events are out of your control, and every day is, in a sense, a roll of the dice. But uncertainty isn’t actually dangerous—it’s just that sometimes, our brains latch onto specific topics to worry about more than others, finding it difficult to let go. 

That’s exactly what lies at the core of a mental health condition like OCD. Your brain receives some trigger—perhaps it’s an intrusive thought about being surveilled, a suspicious glance that made you feel uncomfortable, seeing cameras in public or even as part of door bells, or a troubling TV episode about someone being kidnapped that you just can’t seem to shake off. Whatever triggers your fears, your brain might leap to the worst-case scenario. They’re going to follow me home. I’ll be reported to the police. What if I’m in danger? How can I be sure they’re not watching me for some reason?

The problem is that the more you give your attention to these unwanted fears, the more real and threatening they feel. In fact, the best way to loosen their grip is to simply acknowledge that they’re there, resist engaging with them, and allow your discomfort to go away on its own. This process can be really difficult, though—we’ll return to it later in more detail. First, you’ll need a better understanding of how OCD really works.

OCD explained

We’ll begin by discussing a phenomenon that everyone experiences: intrusive thoughts. Intrusive thoughts are random thoughts, urges, and images that pop into our heads from time to time. They’re unwanted, bizarre, and contrary to our true thoughts and feelings, but most people can dismiss a thought about plowing their car into oncoming traffic, or an unfounded worry about their partner cheating on them, without too much difficulty. For most people, they’re just glitches that come with having a brain.  

But if you have OCD—and an estimated 2.5% of the global population does—those thoughts feel impossible to let go of. You’ll engage with them, try desperately to answer their “what ifs?,” and try to fathom what they mean. Before long, the uncertainty can feel unbearable. In other words, these intrusive thoughts will become obsessions.  

Unfortunately, giving your attention to unwanted thoughts about things that scare you or oppose your values tends to result in a fair amount of distress. For people with OCD, this distress leads them to engage in repetitive behaviors and/or mental rituals in order to feel safe or reassured. These are known as compulsions—the “C” in OCD. 

Some people engage in avoidance compulsions—in our case, that might involve staying away from public spaces where others could be watching you. Other people seek reassurance as a compulsion. This could come in the form of asking others if they noticed anyone acting suspiciously around you. For some, their compulsion may involve repetitive checking, either mental or physical. They may become extremely wary of the people around them—constantly looking over their shoulder—or mentally review all the things they did while outside in order to ensure that nothing could be embarrassing or incriminating. 

Do these tactics work? Well, yes and no. Compulsions often make people feel better temporarily, but they end up reinforcing a vicious cycle of obsessions, anxiety, compulsions, and relief known as the OCD cycle. That’s because they teach your brain that uncertainty and anxiety are dangerous, and that they require compulsions in order to stay safe. But nothing could be further from the truth. These intrusive triggers don’t pose any threat to you, and uncertainty is a part of life that you can learn to tolerate—or even learn to embrace!

Which types of OCD are associated with fears of being watched?

While not an exhaustive list, the following OCD subtypes are among those that could lead sufferers to have obsessions about being watched and engage in compulsions to reduce the distress these obsessions provoke. 

Harm OCD

This theme of OCD involves disproportionate fear about harming others or, conversely, harm coming to oneself. Obsessions might be triggered by an intrusive thought about a stranger stealing your identity, a persistent worry that people are out to get you, or a random memory of the time someone was laughing as they passed you on the street: What if they were laughing at you? It may also come from an awareness of police cams set up around the neighborhood or city you live in.

Responsibility OCD

This OCD subtype involves excessive feelings of responsibility and guilt. People may have intrusive thoughts that they are responsible for preventing harm or bad outcomes to others, including being observed falling short of that responsibility. This may lead them to engage in compulsive behaviors aimed at ensuring safety and proper behavior.

Scrupulosity OCD

Scrupulosity OCD is characterized by excessive religious or ethical concerns. People with this subtype might have intrusive thoughts about sin, blasphemy, or ethical transgressions. They may fear that any perceived wrongdoing is being watched by others or by a higher power, leading to compulsive rituals such as excessive prayer or seeking reassurance from religious figures or others they see as leaders of ethical systems they subscribe to, such as veganism.

Relationship OCD

This subtype revolves around persistent doubts and fears about romantic relationships. People with relationship OCD might constantly question their feelings for their partner or obsess over being in the “perfect” relationship. They could have fears about their partner watching them use pornography, or worry that talking to an attractive person will somehow be taken out of context by their partner. 

The good news is that every one of these experiences can be treated effectively with the right approach. Exposure and response prevention therapy (ERP) is highly effective in treating all OCD subtypes—including those that cause people to fear that they are being watched. 

“If someone is afraid of being watched, we first want to rule out other forms of paranoia,” says Dr. Patrick McGrath, Chief Medical Officer at OCD. “Does this person truly believe they’re being watched? People with actual delusions truly believe that their fear is real, whereas someone with OCD usually knows that their fears don’t actually hold up to scrutiny; they have more insight into their condition. 

“Of course, that awareness doesn’t make their symptoms any less disruptive, and the sooner they begin ERP, the sooner they’ll be able to manage them and get back to living life.” 

Exposure and Response Prevention (ERP)

Over the last five decades, ERP has proven to be highly effective in treating OCD. Numerous studies have demonstrated that the large majority of people who commit to this approach experience significant improvement in their symptoms. 

As the name suggests, ERP involves exposing people with OCD to situations, objects, or thoughts that trigger their obsessions, while preventing them from engaging in their usual compulsive responses. By carefully, repeatedly exposing themselves to these anxiety-provoking triggers and resisting the urge to perform compulsions, people gradually learn that their fears are unfounded, that they can tolerate discomfort, and that their anxiety diminishes over time—no compulsions needed.

A trained ERP therapist will begin by helping you identify the specific obsessions and compulsions you experience, and developing a list of triggers for exposure exercises, ranked from least to most distressing. Sessions will involve gradually exposing you to these triggers, starting with the easiest ones, and you’ll be guided to resist your usual compulsive behaviors and learn to tolerate the resulting discomfort. Through repeated exercises, you can learn to break the cycle of obsessions and compulsions, and your worries about being watched will gradually become less distressing—and likely less frequent.

Start getting better today

All of our therapists specialize in OCD and receive ERP-specific training. If you think you might have OCD and want to learn more about treatment, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD Care team.

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