Dr. Aliza Goldstein writes about what it means to suffer from Responsibility OCD.
At times, we may not know if something we did led to someone being hurt or upset.
This uncertainty about what they may be experiencing may trigger uncomfortable feelings. Now amplify this feeling one hundred-fold and you may understand what it is like to live with a subtype of obsessive-compulsive disorder (OCD) called Responsibility OCD.
OCD is an impairing psychological disorder. It is characterized by the experience of repetitive intrusive thoughts or images that feel threatening (obsessions) and rituals aimed at reducing the distress caused by those obsessions (compulsions). These compulsions can be mental or physical behaviors.
What Is Responsibility OCD?
People with Responsibility OCD have an overinflated sense of responsibility for the safety of others and often engage in rituals to protect others from perceived harm. A person experiencing responsibility-themed OCD may obsess about the possibility that they have accidentally dropped a wrapper on the street that a young child may pick up and choke on. To prevent this “threat”, they may avoid carrying anything in their pockets. When they walk down the street, they might retrace their steps several times until they are sure they have not dropped anything.
Responsibility OCD can also include a fear of causing emotional harm or offense to others. A person experiencing Responsibility OCD may obsess about the possibility of having offended others with their actions or words. For example, they may ruminate about having potentially offended their boss by the way they worded an email and will re-read the email many times in order to analyze every word. They may also seek reassurance from another person that the email really wasn’t offensive.
In Dr. Steven Phillipson’s writings about the Responsibility OCD subtype, he describes how sufferers tend to define themselves as a “good” or “bad” person based on their success or failure in preventing others from experiencing harm. Because one can never fully prevent others from all harm, Responsibility OCD is frequently accompanied by guilt. Therefore, the compulsions or rituals serve as an attempt to reduce guilt and anxiety and to convince themselves that they are not a “bad” person.
What Are Compulsions or Rituals in Responsibility OCD?
Responsibility OCD sufferers frequently engage in mental compulsions such as reviewing and analyzing past conversations and actions as well as “figuring out” and weighing the “evidence” to determine with certainty if someone is indeed emotionally harmed or upset with them.
People with Responsibility OCD may also engage in more overt rituals, such as reassurance seeking. Reassurance seeking is posing questions to other people (or to the internet) with the goal of reducing uncertainty, anxiety, and/or guilt. Examples include asking the “potentially offended” directly if they are upset or if they truly forgive the reassurance-seeker. A person may also seek reassurance from a third party. For instance, one may ask one’s friend, relative, or partner questions such as “Do you think ____ is mad at me?” or, “Was it OK that I said/did that?”
Reassurance-Seeking: Why We Do It and Why It May Be Unhelpful
There is no need to feel shame about having fallen into the reassurance-seeking trap; we use reassurance-seeking because it provides temporary relief. It is important to note, however, that this relief is short-lived. In the long term, seeking reassurance makes anxiety worse by reinforcing the idea that feelings of guilt, anxiety, and uncertainty are unacceptable and cannot be tolerated. Additionally, reassurance-seeking can lead to more of the behavior as it provides immediate relief from discomfort. Continuing to seek reassurance prevents the opportunity to learn how one may have tolerated these feelings without it and how those emotions may have naturally subsided over time.
Asking others for reassurance is particularly unhelpful because it can also be damaging to relationships. People may become irritated with repeated requests for reassurance that they are not offended/hurt/angry and may actually become annoyed or displeased with the reassurance-seeker. In this way, seeking reassurance that you have not offended someone, can become a self-fulfilling prophecy.
What are some ways to skillfully respond to intrusive thoughts about the possibility of hurting others?
Make room for the uncertainty. Uncertainty can feel quite uncomfortable, but it is not dangerous. Paradoxically, the more you allow your uncertainty to stick around without trying to get rid of it, the less threatening it may become. You can respond to your brain’s urge for a definitive answer with statements such as “maybe they are mad at me and maybe they are not. I am willing to accept that uncertainty.”
Be willing to take the chance that you may have offended someone rather than continuing in the pattern of obsessions and compulsions. Question the feasibility of never upsetting anyone. Consider the suffering you have endured from being stuck in this cycle and the potential for a more peaceful existence where you are no longer controlled by fear.
Try to avoid or delay asking for reassurance for a preset amount of time (e.g., five minutes, 30 minutes). You might be surprised at your ability to sit with the urge to seek reassurance. Those feelings may pass, and you can seize the opportunity to demonstrate to yourself that you can tolerate uncertainty and discomfort.
Use your values to guide your behavior. A value is a person’s judgment of what is important in their life. Define and clarify your own values. Are you behaving according to those values, or are you acting to avoid discomfort?
Consider the long-term consequences of reassurance seeking. How will it affect your anxiety in the long term? What effect can it have on your relationships?
Exercise self-compassion when reviewing your behavior and interactions with others. Remember that humans are flawed and will not always act perfectly in accordance with their values. You are doing the best you can.
If you notice this is a recurring struggle for you—you are not alone!
Seek help from a professional who specializes in the evidence-based treatment for OCD. The gold-standard treatment for OCD is currently Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy (CBT). ERP differs from traditional cognitive-behavioral therapy in that it does not attempt to modify the content of obsessive thoughts (which can sometimes actually exacerbate the disorder). Rather, through practicing ERP, you can learn to teach your brain that these false alarm signals will no longer be treated as threatening.