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.

What Events Can Trigger a Real Event OCD Obsession?

Real event OCD can be triggered by actual events, past experiences, or anything a person thinks they did wrong that may have resulted in a negative outcome. Regardless of how trivial it may have been, someone with real event OCD will often overestimate the significance of their actions.

People with real event OCD will likely obsess over things like:

• Causing lasting harm to a childhood friend, classmate, or relative due to something insensitive or offensive they might have done or said, such as bullying someone or saying something racist.
• Fearing that a negative thought they had could have caused a tragic event, like thinking about a plane crash and then seeing the news that a crash actually occurred (a sign of magical thinking OCD).
• Ruminating and feeling extreme concern about having done something wrong, deceitful, immoral, sexually inappropriate, or unlawful, like cheating on a test, driving under the influence, etc.
• Having persistent thoughts, images, and/or recollections about a particular incidence and what occurred afterward.
• Blaming themselves for an unfortunate event in their own or someone else’s life.
• Having ongoing thoughts of regret or feeling like they have made irreparable errors that changed their future in an unfavorable way, like obsession over issues with work and being convinced that’s why they haven’t received a promotion.
• Experiencing overwhelming and excessive feelings of shame, guilt, or remorse about something, like having intercourse with a person they didn’t have feelings for.

Real Event OCD & Guilt

Someone with real life OCD will typically endure excessive OCD guilt and shame that is all-consuming and distressing 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

Real-event OCD Vs. False Memory OCD

Real-event and false memory OCD are both characterized by distressing, unwelcome thoughts and compulsive behavior. However, real life OCD involves an intense fixation about concerns stemming from an event that already occurred in the distant past (years ago) or recent past (the past couple of months). Often, people exert a great deal of effort trying to figure out if they’ve caused something awful to happen. In turn, they question their integrity and self-regard as “bad” which brings extreme guilt and shame in ways that are illogical and prevent them from moving on.^2,3,4,5

People with false memory OCD, on the other hand, constantly struggle with obsessing thoughts about events that didn’t actually happen, but the person fears it did, or that they had an impact on an incident that indeed occurred, but the details remain ambiguous. Someone with false memory OCD often struggles with tremendous doubts about their memories, questions the veracity of their recollections, and becomes fixated with the fear about possibly engaging in something harmful, even if there isn’t real evidence to support these concerns. Moreover, their feelings of guilt and responsibility are stronger than real life OCD.

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.⁶

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

Real Event OCD Vs. Guilt & Shame

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

Signs of real event OCD include:^7,8

• All-or-nothing thinking: Viewing things in extremes or as black or white while discarding anything that challenges the distorted belief.
• Inability to move on: This cognitive distortion may surface when the person believes that letting go of the obsessive thoughts or not having them proves that something may or not be true.
• Magnification: Involves exaggerating the importance of a negative incident and viewing it as catastrophic while downplaying the significance of its positive aspects.
• Personalization: This is when someone takes responsibility for situations that are beyond their control or attributing external events to themselves without having any evidence.
• Emotional reasoning: This thinking error involves jumping to conclusions based on emotions. People with OCD often think that something must be true just because they feel strongly about it, even if there’s evidence of the opposite.
• Cognitive distortions: As with other forms of OCD, a person with real event OCD is often afflicted by a variety of faulty cognitions. These usually twist and distort information in ways that are irrational and/or magnified and not congruent with reality.⁹

Do I Have Real Event OCD?

If you are wondering if you have real event OCD, ask yourself the following questions: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 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, usually in the form of exposure and response prevention (ERP), 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 (ERP) for Real Event OCD

ERP for OCD works to reframe someone’s thought patterns. It is generally one of the most common forms of therapy for those with real event OCD.¹⁰ 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.

Examples of ERP Exposures for Real Event OCD

Generally, the exposures used during ERP are tailored to the specific fears and triggers of the person being treated. The goal is to help them gradually confront and tolerate the anxiety-producing stimuli without resorting to compulsive behaviors.

Some possible exposures to treat real event OCD could include:^7,9

• Narrating or writing in detail about the event as it really occurred
• Drawing a picture (or several) of the event
• Visualizing a variety of ways someone else was unfavorably affected due to the sufferer’s words or behaviors
• Describing or writing about the most dreadful thing another person may have experienced and the possible long-term effects it had on them
• Composing a written confession about what the sufferer fears transpired because of something they said or did
• Going to a location where the event occurred and discussing what the sufferer thinks took place and the uncomfortable feelings as they arise

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.
• Mindfulness training: This approach is about developing a mindset that involves paying attention to the present moment with non-judgmental awareness. It can help people with OCD to observe their thoughts and feelings without getting overwhelmed by them, and is often part of a holistic treatment approach.⁹

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)

How to Get Help for Real Event OCD

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. You can also use an online OCD resource, like an OCD-specific therapy platform such as NOCD, to start receiving help from home.

6 Tips for Coping With Real Event OCD

Outside of treatment, it’s important for those with real event OCD to adopt healthy OCD 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.¹¹

Here are six tips for coping with real event OCD:

1. Try grounding techniques: Using grounding techniques can help 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 to incorporate a variety of nourishing foods 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.