Real Event OCD: What It Is, Symptoms, & Treatment

What Is Real Event OCD?

Real event OCD (also called real-life OCD) is a type of OCD characterized by a fixation on guilt associated with past events. A person with this disorder becomes fixated on their own actions during past events and how they may have played a role in any negative consequences. The event might be as small as a simple conversation or something on a grander scale. Those with real event OCD will continuously question how things could have been improved had they acted differently. Often, they will continue to ruminate until they find validation in their actions.

When experiencing real event OCD, a person moves through a cycle of validating their own feelings and being triggered by the memory of the event, thus perpetuating their guilt. A person might fear their actions being found out or getting in trouble with authorities.

Real event OCD is comprised of:

• The event: This is the actual occurrence that precedes a person’s guilt.
• The obsessions: These are the irrational and exaggerated thought patterns revolving around the event.
• The compulsions: These are a person’s steps taken to relieve guilt and validate emotions temporarily.

Real Event OCD & Guilt

Someone with real life OCD will typically endure excessive guilt and shame that is all-consuming and distressful enough to impact their capacity to function in their day-to-day life. A person who has real event OCD will likely experience tremendous challenges with managing such intense feelings, resolving them, and moving on since the self-doubt is ongoing.¹

For someone who doesn’t have OCD, regular guilty feelings often stem from remorse that’s provoked when they are aware that they have actually behaved inappropriately or done something wrong. Thus, it’s perfectly natural and even healthy to experience some degree of guilt, allowing the person to learn from their mistakes, make peace with themselves, and ultimately do better as they move forward.¹

Can Real Event OCD Distort Your Memories?

It is normal that with the passage of time we might forget certain events or some aspects of them. However, it’s believed that OCD symptoms can possibly impact how sufferers remember things, making them prone to having distorted memories. Furthermore, people with OCD usually struggle with recurrent self-doubt regarding whether something occurred or not and distrust their recollections, which in turn perpetuates deficits in memory and can trigger false recollections.^2,3,4

Symptoms of Real Event OCD

A person with real event OCD will experience typical symptoms of OCD along with intense feelings of guilt and self-doubt. This guilt stems from feelings that they were the source of any negative impacts of an event. For example, someone might blame themselves for having their car broken into if they left something of value inside, as it must have enticed someone to break in.⁵

Symptoms of real event OCD may include:

• Intense feelings of guilt
• Rumination on past actions
• Excessive shame about actions
• Intrusive thoughts about an event

Real Event OCD Examples

Obsessions and compulsions will both be present in those with real event OCD. The compulsions a person experiences are attempts to alleviate the anxiety that stems from their obsessions. They include the actions that one takes in order to ease their mind of intrusive thoughts about an event. This may look different for everyone, but the goal of these compulsions are the same–easing the feelings of guilt and shame.

Real Event OCD Obsessions

Common obsessions in real event OCD include:

• Worrying that their past actions have changed someone’s life in a negative way
• Feeling they are a bad person because of their past actions
• Thoughts of extreme punishment by authorities
• Fear of judgment
• False ideas that others have lied about or manipulated information about a past event

Real Event OCD Compulsions

Common compulsions in real event OCD include:

• Seeking ways to be punished for past actions
• Imagining different outcomes to an event
• Seeking validation and reassurance from others regarding actions
• Researching consequences of behavior and the extremes to which a person can be punished
• Evaluating the event and how it relates to other areas of one’s life
• An intense urge to confess actions to others

How Do I Know It’s OCD?

Real-life OCD can start gradually and vary in intensity over time. Nevertheless, when left untreated, like any form of OCD, real-life OCD can be so severe and time-consuming that it diminishes someone’s quality of life.

If you are wondering if you have real event OCD ask yourself the following:¹

• Am I feeling extreme and overwhelming guilt and doubt about something I did or said?
• Am I constantly replaying past actions in my mind to the point that it’s hindering my ability to focus on other aspects of my life?
• Do I feel like my past actions are inexcusable and make me a bad person?
• Does the thought pop up randomly and I can’t seem to shrug it off?
• Am I constantly seeking reassurance from others hoping to hear that what I did/said wasn’t wrong, offensive, or harmful?
• Do I try to counteract the recurring thought with a mental ritual or a particular action?

How Is Real Event OCD Diagnosed?

Like any mental health disorder, receiving a correct diagnosis is critical in ensuring a person is provided with the best treatment. A diagnosis of real event OCD may be provided using a screening tool, which is a set of questions designed to identify the components of the disorder–the obsessions, compulsions, and triggers. A licensed therapist, medical doctor, or psychiatrist may provide this test.

Real Event OCD Treatment 

Therapy is generally the first and most effective option for treating OCD, as it provides someone with the tools they need to change thought and behavior patterns. Because of the intensity of symptoms in real event OCD, it is crucial to find proper treatment so that one’s obsessions do not spill into other areas of their life.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a form of cognitive behavioral therapy (CBT) that works to reframe someone’s thought patterns. It is generally one of the most common forms of therapy for those with real event OCD.⁶ Through ERP for OCD, a person is taught to reprocess events through exposure scripts. These allow a person to relive an event without being physically present in it, and offer them the opportunity to understand why their actions were not as impactful as they believed them to be.

It’s important to find the right therapist who has experience treating OCD and will utilize approaches that work best for you. Using an online therapist directory is a great way to do so.

Other Therapeutic Options

While exposure and response prevention is believed to be the most effective form of therapy for real event OCD, there are many other options available. Several other therapy options may be used in conjunction with ERP.

Other therapy methods that may be used when treating real event OCD include:

• Group therapy: Group therapy allows an individual to connect with others experiencing similar struggles. This sense of community helps a person feel less alone in their diagnosis.
• Acceptance and commitment therapy (ACT):  ACT is a form of therapy that teaches specific mindfulness techniques and can help an individual tap into their present self, rather than focus on reliving an event.
• Family therapy: A helpful part of any treatment plan is making sure that a person has a good support system. Family therapy offers a place for everyone in a family dynamic to discuss and share their feelings, and learn how to assist the person who is diagnosed.

Medications

Medication for OCD may be a beneficial addition to a person’s treatment plan, because they can help with decreasing one’s anxiety. SSRIs and SNRIs may be prescribed to those with real event OCD. The main difference between SSRIs and SNRIs is that while SSRIs inhibit serotonin reuptake and destruction, therefore increasing levels of serotonin, SNRIs also increase levels of norepinephrine, as well as serotonin.

Common medications that may be prescribed to treat symptoms of real event OCD include:

• Prozac (fluoxetine)*
• Zoloft (sertraline)*
• Lexapro (escitalopram)*
• Paxil (paroxetine)*
• Celexa (citalopram)*

*These medication have a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting any of these medications.

6 Tips for Coping With Real Event OCD

Outside of treatment, it’s important for those with real event OCD to adopt healthy coping mechanisms in order to better navigate day-to-day life. These may include practices such as mindfulness, grounding techniques, and journaling. Engaging in these practices can help increase one’s self-worth, thus decreasing overwhelming feelings of guilt.⁷

Here are six tips for coping with real event OCD:

1. Try grounding techniques: Using grounding techniques helps a person remain centered in the present moment, not past events.
2. Practice mindfulness: Similar to grounding techniques, mindfulness brings awareness to a person’s body and mind, keeping them focused on the here-and-now.
3. Spend time with loved ones: Spending time with the people we value most can help decrease negative self-talk, as it provides validation that we are loved and appreciated by others.
4. Change your diet: The saying goes that you are what you eat. Changing your diet will help you feel better both physically and mentally.
5. Create a better sleeping schedule: Adopting a healthier sleeping schedule will help you feel less on edge as a result of sleep deprivation.
6. Journal: When we keep negative thoughts combined to our minds, they can develop further into obsessions and actions (compulsions). By journaling, we can rid ourselves of these thoughts and focus on healing.

Final Thoughts

While real event OCD can impact a person in numerous ways, there are treatment options available. It is important to seek one or a combination of these options, as they will help get you on your way to feeling your best.