Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences intrusive thoughts (obsessions) and engages in specific actions (compulsions) to relieve anxiety caused by the obsessions. The compulsions are often unrelated to the nature of the obsession, and the adverse consequences are almost always imagined and irrational.
Unlike most manifestations of OCD, real event OCD centers around an actual event that occurred in the past, instead of imagined expectations of future events. While everyone experiences guilt or regret, people with real event OCD become fixated on an experience that makes them question their character or morals, engaging in thoughts and actions that seek to reassure themselves.
Read on to learn more about real event OCD and its treatments.
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What Is Real Event OCD?
People with real event OCD (also called real-life OCD) become fixated on actual events or past experiences that caused them to question their morality, making them feel as though they aren’t a good person. They may replay the event over and over in their minds, analyzing all the details, and scrutinizing their role in it and any harm they may have caused through their actions.
They may worry about potential consequences of the event, such as losing a relationship with a loved one. They are also likely to take actions to reassure themselves, though this reassurance is short-lived.
The event can be something minor such as a rude remark to a customer service representative, something major like drinking and driving, or anything that makes them fear they are a bad person.
They may be focused on a recent event or something well in the past, such as an item they stole from a store as a child decades ago.
Trauma-Related OCD
OCD symptoms may also be triggered by real-life experiences, like trauma. Traumatic experiences can include abuse, neglect, or other disruptions to family life.
Examples and Signs of Real Event OCD
Real event OCD is made up of the following three components:
- Event: What really happened
- Obsession: Intrusive thoughts about what happened, often irrational or exaggerated
- Compulsions: Actions taken to try to gain temporary reassurance
For example, a person with real event OCD might experience:
- Event: You encouraged a school friend to try recreational drugs, which made them feel paranoid. Years later, they were diagnosed with schizophrenia.
- Obsession: You become convinced the person’s schizophrenia was caused by the drugs and, therefore, it was your fault. You then believe that this makes you a bad person.
- Compulsions: You research schizophrenia and its causes, ask others who were there when the person took the drug (and if they thought the person seemed reluctant to try it), replay the details of the event in your mind to see if you had pressured the person, and try to remember if you noticed any previous signs of mental health illness in the friend.
Common Obsessions
Real event OCD obsessions can arise from anything that causes the person concern about their moral character, such as whether they are a good person, or potential future fallout stemming from the event.
These obsessions may include:
- Worrying they said or did something bigoted or offensive
- Fearing they have acted inappropriately
- Fearing consequences, such as punishment or being “cancelled,” or worrying about getting caught
- Worrying their actions have caused others harm
- Feeling they may have been critical, inauthentic, or unfair
- Worrying their thoughts or actions make them a bad person
- Having intense, overwhelming feelings of shame, guilt, or embarrassment
People with real event OCD tend to overestimate the importance of their actions. For example, they may ruminate regularly on a hurtful thing they said to a classmate in elementary school, worrying it caused them lasting harm, when their classmate doesn’t remember the incident.
If they can’t clearly remember every detail of the event, they are likely to assume something bad happened.
These obsessions cause anxiety that creates an urgent need to seek answers or reassurance.
Common Compulsions
A person with real event OCD will try to relieve the anxiety caused by their obsessions through compulsive actions. These might include:
- Seeking punishment for their actions
- Repeatedly going over past behaviors, looking for wrongdoings and evaluating their actions
- Confessing or unnecessarily apologizing for their perceived wrongdoings (often after a long time has passed)
- Seeking reassurance from friends and family either that they didn’t do anything bad or that they aren’t a bad person, sometimes using progressive hypothetical situations
- Looking for ways to prove to themselves that they are a good person
- Calling authority figures to inquire about potential consequences from past actions
- Reimagining the event the way they would have liked it to go
The relief brought on by these compulsions is usually temporary. The intrusive thoughts seep back in, and the cycle begins again.
Treatment for Real Event OCD
First-line treatment for OCD is behavioral psychotherapy (talk therapy). Medication can be helpful for some people in combination with therapy.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) involves identifying problematic thought and behavior patterns and gradually changing them into healthy ones.
The main form of CBT used for OCD is exposure and response prevention (ERP).
Under the guidance of a mental health professional, people with OCD are exposed to their fears at gradually increasing intensities. For a person with real event OCD, this might mean:
- Allowing intrusive thoughts to arise
- Exposing themselves to things, such as music or images, that make them think of the event or experience
- Writing stories or songs, or creating artwork about the event or the feared consequences of it
- Visiting the location of the event
- Engaging in actions that trigger the obsessive thoughts
During this exposure, the person is urged to resist doing any compulsions or actions to try to reduce the anxiety.
Over time and repeated exposures, the person builds an increased capacity to resist the compulsions and, ideally, the obsessions reduce.
Medication
Medication like antidepressants may be used to help manage symptoms, particularly along with therapy to strengthen the effectiveness of both treatments. Sometimes, other types of medications are used to increase the benefit of antidepressants.
Antidepressant medications that may be prescribed include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Celexa (citalopram)
- Luvox (fluvoxamine)
- Zoloft (sertraline)
- Lexapro (Escitalopram)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Pristiq (desvenlafaxine)
- Effexor (venlafaxine)
- Cymbalta (duloxetine)
Tricyclic Antidepressant
- Anafranil (clomipramine)
Mindfulness
Mindfulness involves allowing thoughts to come and go without assigning them judgment.
Acceptance and commitment therapy (ACT) is a type of psychotherapy that integrates aspects of mindfulness that can be used to teach people with OCD to accept their intrusive thoughts, rather than reacting or responding to them.
One of the goals of ACT is to separate the intrusive thoughts from the thinker, allowing them to be seen as separate entities and taking actions based on a person’s values, not their obsessions. This way, they can acknowledge the thought as an “OCD thought,” not as a fact.
Thoughts can also be reframed. For example, instead of thinking, “I am a horrible person,” they might think, “I feel bad that I did that.” Labeling the action—not the person—allows room for positive change.
From there, the person can take actionable steps to make the situation better now and/or avoid repeating the behavior in the future. This helps to move past the situation in a healthy, productive way, instead of being caught in an obsessive-compulsive cycle.
OCD Support Groups
Support groups are not a substitute for professional treatments like therapy, but they can be very valuable. Talking to others who understand your experiences firsthand is a great way to foster community, share resources, and offer and receive support.
The International OCD Foundation offers great information on how to find (or start) support groups.
Diet and Lifestyle Changes
OCD cannot be treated with lifestyle changes alone, but developing healthy habits is important for overall health and can be a great support for traditional treatments.
Healthy habits worth adopting include:
- Eating nutritious foods
- Moving your body regularly
- Getting enough quality sleep
- Practicing relaxation exercises, such as yoga, mindfulness, or meditation
- Avoiding/limiting tobacco, caffeine, and alcohol
- Following your treatment plan
- Engaging in activities you enjoy
- Fostering and maintaining positive relationships
Summary
Real event OCD is a form of OCD in which a person becomes consumed by thoughts and feelings of guilt about a real event that happened sometime in the past. These thoughts cause them to question their own morality. Compulsive actions follow in an effort to manage the anxiety triggered by the obsessions.
Real event OCD is typically treated with medication and/or behavioral therapy. Healthy lifestyle habits and mindfulness may also be beneficial.
A Word From Verywell
Feeling a degree of guilt over an action that you believe caused harm is normal and can even be healthy. But if that guilt becomes consuming, is disproportionate to the actions, or you can’t seem to stop fixating on it, see a healthcare provider or mental health professional. They can help you find healthy ways to manage your feelings and move past the experience.