Responsibility OCD: Symptoms, Examples & Treatment

What Is Responsibility OCD?

Responsibility OCD is one of many subtypes of obsessive-compulsive disorder (OCD) that causes people to experience certain types of obsessive thoughts and compulsive urges. People with responsibility OCD have an inflated sense of responsibility for other people, animals, or situations. When responsibility OCD shows up, it causes people to feel afraid of being blamed or held responsible for a bad outcome.¹

Is Responsibility OCD a Subtype or Symptom of OCD?

Studies show that many people with OCD struggle with an excessive sense of personal responsibility for other people and situations that aren’t fully within their control. Therefore, some researchers suggest that hyper-responsibility is a symptom of most or all types of OCD.^3,4 According to this theory, hyper-responsibility causes people with OCD to develop anxiety about making mistakes, which leads to compulsive and OCD-induced perfectionistic behaviors. While it is true that hyper-responsibility is a common feature in OCD, some experts still believe responsibility OCD is a distinct subtype.^3,4

Symptoms of Responsibility OCD

All subtypes of OCD involve repeated, unwanted thoughts that the person finds distressing or personally unacceptable. To cope with these thoughts and the distress they cause, people with OCD engage in OCD compulsions.² Unlike other OCD subtypes, responsibility OCD can show up in a wide variety of situations and might cause different kinds of obsessions and compulsions.

Here are some examples of responsibility OCD obsessions:¹

• Worrying that a partner will develop type 2 diabetes because you do not enable them to eat healthily
• Fear of a family member getting into a car accident because you forget to tell the family member to avoid a certain freeway because of traffic
• Concern that an underperforming colleague will be fired because you do not do your part of the project properly
• Fear of accidentally infecting someone immunocompromised with a cold
• Feeling compelled to give to a charity to prevent hunger in your community
• Excessive concern about polluting the planet and accelerating global warming
• Fear that making a simple mistake at work could cause the company to go bankrupt

Here are some examples of responsibility OCD compulsions:¹

• Excessive meal planning, nutritional research, and tracking food intake
• Repeatedly calling family members to ensure they made it to work safely
• Dedicating too much time to training colleagues and neglecting your own tasks
• Excessive masking, hand washing, and precautions to avoid getting people sick
• Overextending yourself financially to make large charity donations
• Obsessive tracking of your carbon footprint and excessive steps to limit pollution
• Perfectionistic tendencies and needing to check and recheck your work multiple times

What Triggers Responsibility OCD Symptoms?

OCD symptoms can be triggered at work as well as in a person’s personal life and may show up a little differently for each person. Countless situations could trigger responsibility OCD symptoms, but almost all of them involve a fear of making a mistake.¹ The specific kinds of mistakes people with responsibility OCD worry about can vary, depending on the person’s past experiences, core fears, and the types of OCD obsessions they have.

Situations that may trigger responsibility OCD symptoms include:

• A meeting where the CEO threatened to write people up for careless errors
• News reports of break-ins in your neighborhood and wondering if your neighbors heard
• Replaying a past scenario where a colleague had a ‘silent heart attack’ at work
• Being told in a 1:1 with your boss that people see you as a leader and role model
• Attending a sermon that talked about the importance of community service and charity
• A friend telling you they’re counting on you to be an accountability buddy for them
• Being blamed as a child for your brother’s broken arm while you were babysitting him
• Feeling compared to a perfectionistic sibling who always seemed to excel at things
• Ruminating on past mistakes and attributing a lot of hardship and distress to them
• Being raised to believe that your salvation depends on strict adherence to certain rules

The common thread in all of the different responsibility OCD examples is the tendency to assume too much personal responsibility. This creates pressure for the person to do or say things without any mistakes that would cause a bad outcome. Usually, the underlying fear of responsibility OCD is a fear of the aftermath of a mistake, including concerns about being blamed, feeling guilty, or causing someone else harm.^1,3

Causes of Responsibility OCD

Like almost all mental health disorders, the causes of responsibility OCD are believed to be both genetic and environmental in nature. Having a family member with OCD is believed to be a risk factor that predisposes a person to responsibility OCD, and some studies have even pinpointed specific genes linked to OCD. Still, most experts believe that being genetically predisposed to OCD doesn’t translate into a 100% guarantee that a person will develop the disorder.^5,6

While genetics and family history can increase the likelihood of developing OCD, a person’s environment and choices may also play a determining role in who develops the disorder. It’s possible that high levels of stress caused by trauma in childhood or later life may ‘activate’ a person’s predisposition for OCD. When people develop rigid, ritualistic behaviors and routines in an effort to cope with their anxiety, this may also play a role in ‘activating’ OCD symptoms.⁵

Risk factors that can play a role in causing responsibility OCD include:^5,6

• Genetics or having a first-degree relative with OCD or a related disorder (i.e., hoarding, trichotillomania)
• Pregnancy complications like edema, excessive weight gain, or pre-term labor
• Recently being pregnant or giving birth (new moms are at higher risk for OCD)
• Certain childhood illnesses or infections (i.e., strep, PANDAS)
• Having certain personality traits like high conscientiousness and neuroticism
• High levels of perfectionism or perfectionist tendencies
• Experiencing overwhelming stress or trauma in childhood
• Early experimentation or abuse of drugs like alcohol, marijuana, or cocaine
• High levels of toxic stress, chronic stress, or many big life changes at once
• Being raised by caregivers with an overprotective parenting style
• Experiencing high levels of separation anxiety in childhood
• Having another mental illness diagnosis (i.e., eating disorder, anxiety disorder)

Impact of Responsibility OCD

Someone with responsibility OCD may spend hours obsessing and engaging in compulsions to avoid making mistakes. As symptoms worsen, responsibility OCD symptoms can demand even more time, limiting their ability to work, have a social life, and follow a healthy routine.² It’s common for people’s sense of responsibility to broaden to areas of life that they are unable to control, which creates extreme distress.⁷

Possible impacts of untreated responsibility OCD are:⁷

• Time-consuming compulsive routines that limit time for leisure or social activities
• High levels of stress and anxiety related to making simple mistakes at work or home
• Increased risk for professional burnout because of perfectionism and anxiety
• Lowered overall quality of life and life satisfaction or the onset of depression
• Social isolation and weakened relationships with friends, family, and supports
• Worsening of anxiety, intrusive thoughts, compulsive routines, and avoidance coping
• Feelings of guilt and worthlessness, especially after making a mistake or letting someone down

How Is Responsibility OCD Diagnosed?

Most of the time, responsibility OCD is diagnosed by a licensed medical or mental health professional. This normally happens during the first intake appointment. Unlike many medical diagnoses, an OCD diagnosis doesn’t usually require labs, tests, or invasive diagnostic procedures. Instead, a licensed and trained clinician assigns the diagnosis after asking a series of questions about the symptoms the person is experiencing.

If you are trying to determine whether you or a loved one has a diagnosis of OCD, it’s important to seek out a professional with specialized experience in OCD. OCD is one of the most commonly misdiagnosed mental health conditions, and many therapists and doctors mistake OCD for other disorders.

Treatment for Responsibility OCD

Responsibility OCD is treatable with psychotherapy, which may be combined with medications or used as a standalone treatment. According to the research, seeking help for OCD symptoms early on provides a person with the best chance of achieving remission.^7,8

Treatment for responsibility OCD may involve:

Therapy for Responsibility OCD

Certain types of therapy have been proven to be more effective for treating responsibility OCD. In therapy, people with OCD can learn new and more effective methods of coping with their OCD thoughts and compulsive urges. Finding a therapist who specializes in OCD is recommended in order to ensure they can best address OCD symptoms.

Effective treatment options for OCD include:^7,8,9

• Exposure and response prevention (ERP): Exposure and response prevention (ERP) is a specialized type of exposure therapy that helps people with OCD face their fears, learn healthy coping skills, and break the cycle of compulsive behaviors.
• Cognitive behavioral therapy (CBT): CBT for OCD can help people identify, track, and change unhelpful obsessive thoughts that contribute to their symptoms while also using behaviorism and habit-reversal training to break compulsive habits.
• Acceptance and commitment therapy (ACT): ACT for OCD can help people learn how to use mindfulness and emotional acceptance skills to cope in healthier ways while also encouraging people to identify and align their actions with their core values.

Medication for Responsibility OCD

There are no FDA-approved medications for OCD, but certain prescription drugs are commonly used off-label to help people with OCD symptoms. Medication isn’t always recommended in an OCD treatment plan, but it can be helpful to people with very severe symptoms. Medication may also be recommended for people with OCD who have other co-occurring mental health conditions like depression or anxiety.⁸

Medications used to treat OCD symptoms include:^7,8

• SRI or SSRI medications: SRI and SSRI antidepressant medications work on serotonin receptors in the brain and are commonly prescribed to people with OCD, especially when they have a co-occurring mood or anxiety disorder.
• Antipsychotic medications: Antipsychotic medications block dopamine receptors in the brain, which can help reduce intrusive thoughts related to OCD

How to Cope With Responsibility OCD

Healthy habits and flexible routines can provide a template for a successful recovery from OCD, and incorporating regular self-care, mindfulness, leisure, and social activities can also help. Utilizing your support system and learning to ask for help is also an important step towards recovery. Finally, facing your fears and triggers can provide opportunities to practice new, healthier ways of coping with your OCD symptoms.

Here are eight tips on how to cope with OCD symptoms:

1. Start a Mindfulness or Meditation Routine

Mindfulness and meditation practices for OCD are a proven way to reduce stress and anxiety and improve your mood and concentration. Even making time for 15-20 minutes of guided meditation or mindfulness for OCD each day can help keep OCD-related anxiety and distress in check. Plus, mindfulness and meditation are excellent ways to train and condition your mind to focus on what you want or need to focus on rather than spinning on OCD thoughts.

Here are some simple ways to practice meditation or mindfulness techniques for OCD:

• Download a meditation app and sign up for notifications to remind you to practice
• Look on YouTube for free guided meditation channels until you find one you like
• Spend 15-20 minutes outside noticing the sights, smells, and sounds around you
• Each time your mind wanders to a random OCD thought or worry, gently bring it back
• Try doing a body scan or using progressive muscle relaxation to tune into your body

2. Refocus Your Attention Away From OCD Thoughts

The next tip for coping with responsibility OCD is to practice the skill of refocusing. Refocusing just means pulling your attention away from one target and fixing it on another target. The target can be anything you want, including a task or assignment you’re working on, a movie you’re watching, or even just focusing on your surroundings.

Practice this skill when you’re not experiencing symptoms to get the hang of it, and then try it again when you’re having OCD thoughts. Eventually, practicing refocusing will make it possible to redirect your attention away from the obsessive thoughts and urges related to your OCD. Because OCD symptoms feed on your attention, this practice can help you feel more in control of how much these symptoms interfere with your daily life and routine.

3. Avoid Giving Into Compulsive Urges

Each time you give in to a compulsive OCD urge (i.e., to spellcheck an email or seek reassurance), the urge becomes stronger and more powerful. That’s why it’s so important to stay strong and resist urges to engage in compulsive OCD behaviors. This is really hard to do, but it’s also one of the best and fastest ways to relieve OCD symptoms.

One of the best ways to resist compulsive OCD urges is to use a skill called urge surfing. Urge surfing is the practice of learning how to observe and experience an urge without acting on it, which involves these simple steps:

1. Visualize the urge (to do a compulsion) as a wave that’s rising up inside of you
2. Use this mental image to track the urge as it rises, crests, and subsides, staying focused on the sensations in your body (vs the thoughts in your mind)
3. Avoid doing or saying anything until the urge has passed and you are feeling more stable, centered, and calm

4. Desensitize Yourself to OCD Triggers

The next self-help tip for OCD is to identify the things, people, places, and situations that trigger your OCD and gradually expose yourself to them. Many people with OCD go to great lengths to avoid their triggers, but this tends to make their symptoms worse in the long run. You can counteract this by facing your fears and triggers, which also helps you develop the skills and confidence to manage your symptoms.

Here are some tips on how to gradually desensitize yourself to responsibility OCD triggers:

• Identify triggers by making a list of situations where your OCD symptoms arise
• Rank these triggers from 1-10 based on how scary or upsetting they are
• Start intentionally exposing yourself to lower-ranked triggers on a daily basis
• Track your level of anxiety or distress before, during, and after each exposure
• Repeat exposures until your anxiety scores improve, and your avoidance decreases

5. Keep Your Routine as Flexible as Possible

Another tip for coping with responsibility OCD is to keep your schedule and routine as flexible as possible. As OCD symptoms progress, most people become more rigid and strict with their routines so they can fit more compulsive rituals into the day. This tends to backfire and make the symptoms of OCD more severe over time, but adding more flexibility can help to counteract this.

Here are some simple tips on how to keep your routine flexible:

• Avoid doing tasks the same way every time
• Mix up the timing of your normal daily routine
• Trying new places or new activities on a weekly basis
• Looking for new recipes or foods to try
• Taking an unplanned, unscheduled break during the day

6. Talk & Treat Yourself More Kindly

A lot of people who struggle with OCD and perfectionism are overly hard on themselves, especially when they feel insecure or make a mistake. Being overly self-critical might not seem like a big deal, but it’s a bad habit that can discourage you, make you anxious, and even derail your recovery. Being kinder in the way you talk to yourself and treat yourself is much more likely to help your OCD symptoms than being overly critical or hard on yourself.

Here are some ways to improve your self-care and self-compassion:

• Take better care of your body with nutritious food, adequate sleep, and healthy routines that keep you feeling healthy and energized
• Make time regularly for hobbies and enjoyable leisure activities or time with friends, and protect this time from being bumped off your schedule by other priorities
• Practice self-compassion and positive self-talk by making a daily list of three things you are proud of yourself for
• Interrupt negative self-talk and self-criticism by imagining a big stop sign in your mind and refocusing your attention on something more positive

7. Practice Making Small Mistakes

People with responsibility OCD spend a lot of time and effort trying to avoid mistakes, and this perfectionism is the main driver of their symptoms. One method of challenging perfectionism related to OCD is to practice making small mistakes. While this might seem like strange advice, making small mistakes on purpose is an exposure therapy tactic that triggers desensitization.

When you become desensitized to making small mistakes, the fear of making them can no longer exert the same degree over you, your life, and your choices.

Here are some ways to practice desensitizing yourself to small mistakes:

• Include a typo or spelling error in a casual email or message to a friend
• Intentionally enter the wrong item or amount into your daily food diary or tracker
• Raise your hand to ask a ‘stupid question’ you know the answer to in a meeting

8. Reality-Check Your Responsibilities With Trusted Supports

People with responsibility OCD have a habit of taking on too many responsibilities, including some that don’t belong to them. Assuming responsibilities for duties and tasks that should be done by others can add a lot of stress and pressure to people with OCD, and can also blur the boundaries with those they live and work with.

Sometimes, this means it’s necessary for someone to re-evaluate their roles, tasks, and responsibilities and delegate some of the ones that aren’t theirs. If you are overwhelmed by the amount of tasks and responsibilities on your plate, consider initiating a conversation with family members, colleagues, and others you trust to help you figure out how these can be redistributed.

When to Seek Professional Support

According to studies on people with OCD, many people struggle with symptoms for several years before reaching out for professional help.⁷ Waiting to get help until your symptoms become completely debilitating is a mistake since research shows early treatment for OCD tends to be the most successful.⁸ If you have concerns about your mental health or suspect you’re struggling with OCD, the best thing to do is seek professional help.

Many people begin their search for OCD treatment by using an online therapist directory that allows them to narrow their search by location, insurance type, and area of specialization. Many directories also allow you to conduct a search for a psychiatrist or other psychiatric medication provider as well if this is an option you want to explore. In your first appointment, your provider can confirm your diagnosis and discuss treatment options with you.