Dealing with frequent, intrusive thoughts that involve actual past events can feel especially complicated. This subtype of obsessive compulsive disorder (OCD) is known as real event OCD—or false memory OCD—and it’s best treated with a form of therapy called exposure and response prevention (ERP).
Since our memories are imperfect, it’s common to experience occasional doubts about your interpretations of past events. For people with obsessive-compulsive disorder (OCD), however, doubts about memory can become intensely distressing.
This can become a vicious cycle: gaps in memory cause people with OCD to question whether something horrible might have happened, leading to an intense desire to gain certainty—which is usually impossible to ascertain.
This particular subtype of OCD is known as real event OCD (sometimes referred to as false memory OCD), and it involves fears surrounding real past events. Because no one can remember the past with total certainty, people with real event OCD often worry they’ve done horrible things without remembering it. Luckily, like all forms of OCD, it’s treatable. Read on to learn more about what real event OCD is, how it shows up, and how you can learn to manage symptoms.
What is real event OCD?
Real event OCD is a subtype of OCD characterized by ongoing intrusive thoughts and compulsive behaviors around past actions. If you have real event OCD, you might spend extensive energy attempting to gain certainty about a past event, and whether you’ve done something potentially immoral or wrong.
According to Dr. Patrick McGrath, Chief Clinical Officer for NOCD, “no one remembers every detail of what transpires in their lives.” But, for people with real event OCD, this inability to recall every detail of past events can result in a tendency to assume the worst. “Because of how their brain fills in the blanks for what they can’t remember, they walk around feeling like some awful person with a secret they need to hide,” says McGrath.
While all subtypes of OCD involve two primary symptoms—obsessions and compulsions—you can think of real event OCD as having three components:
- The event: what really happened.
- The obsessions: the unwanted thoughts, sensations, images, feelings, or urges you have about what happened—which are often irrational.
- The compulsions: the behaviors you engage in to try to ease distress over the obsession or gain temporary reassurance.
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What are the symptoms of real event OCD?
Practically everyone experiences occasional regret or doubt about the past. However, one of the main symptoms of real event OCD is thinking in extremes about these memories. A person without OCD may think, “I wish that had gone differently,” reflect on their feelings, and move on. For someone with real event OCD, the guilt and shame can feel overwhelming. Their thoughts might sound more like, “what if I ruined someone’s life,” or “I’m doomed because of the way things went.”
These obsessions often pop up seemingly out of nowhere. For example, during a workday, you might suddenly experience obsessive thoughts about a time you cheated on a middle school exam. In response to the overwhelming distress you’d feel, you’d likely engage in compulsive behavior aimed at gaining certainty about what exactly occurred—and whether you’re a bad person. For example, you might go to extreme lengths to track down your old teacher to confess and apologize for your behavior all those years ago.
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Common obsessions in real event OCD
It can be difficult to know if you have real event OCD, since memory concerns can be a symptom of other conditions, such as substance use disorder, dementia, brain fog, and disassociation. In order to figure out what you’re dealing with, it can be important to check in with a healthcare provider to rule out any other concerns. It can also help to consider some more detailed examples of how real event OCD can manifest. Here are some common obsessions associated with real event OCD:
- Worrying you said something inappropriate to your friend.
- Feeling significant distress, when recalling a time you hurt your sibling as a child.
- Worrying that someone you had sex with didn’t actually consent—despite not having any reason to be concerned about this.
- Generalized concern that fears about bad things occurring means these outcomes have already happened.
Common compulsions in real event OCD
- Mental review: This is the most common compulsion for people with real event OCD. Mental review consists of replaying an event you are concerned about in your mind over and over, until you feel like you’ve gained clarity. Unfortunately, any relief gained from compulsions is typically short-lived; it’s usually only a matter of time before obsessive thoughts return and the OCD cycle begins again.
- Reassurance-seeking: This compulsion takes the form of repeatedly asking questions to gain certainty or relieve anxiety. If you are navigating real event OCD, this might look like asking questions that are aimed at alleviating a sense of guilt.
- Checking: Checking is a form of compulsion that involves examining physical evidence for clues or confirmation of what happened. For example, you may revisit a location you are concerned about, or try to access recorded footage.
- Research: Excessive research can take the form of Googling, going through news archives at the library, or consistently comparing your own experiences with others’ via forums like Reddit or Quora. People with real event OCD may engage in this compulsion to try to gain certainty about a past event.
- Confession: When someone with real event OCD has convinced themselves they are responsible for an action that happened in the past, they may experience intense guilt and the desire to confess.
- Distraction and thought suppression: You may try to distract yourself from obsessive thoughts by filling your mind with positive beliefs, or attempting to directly suppress negative ones. This could look like repeating phrases to yourself, like, “I am not a thief.” Unfortunately, thought suppression doesn’t work; when you try to push intrusive thoughts away, they come back with even more force.
- Avoidance: You may avoid situations, people, or places in an effort to ease anxiety. For example, if you’re convinced you have forgotten to pay at a restaurant, you may start avoiding the restaurant entirely.
What if you actually did something “bad”?
Sometimes, you might remember something from your past that doesn’t align with your values. Dr. McGrath says a lot of people with real event OCD worry about having accidentally violated sexual consent as a child. “They might have had an exploratory experience when they were children, and they’re trying to remember if they violated another person’s autonomy,” he explains. While it’s important to take accountability for causing harm, children often explore sexually before they fully understand what they’re doing—and Dr. McGrath explains that it’s healthy to let these concerns go. “People are really good at punishing themselves for stuff they did as a child,” he says. “I often ask members, ‘how many years of punishment are required before we can move on from this?’”
Dr. McGrath says people with real event OCD are also sometimes influenced by cultural trends. For example, during the height of the #MeToo movement, a global protest against sexual violence, Dr. McGrath saw a lot of men with OCD wondering if they could have possibly committed a sexual assault, without remembering it. These people ruminated endlessly about what would happen if they were accused of being a rapist, even though the rate for false accusations for sexual assault is extremely low.
How do you treat real event OCD?
The best course of treatment for real event OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the most effective treatment for OCD and is supported by decades of rigorous scientific research.
The idea behind ERP is that repeated exposure to fears, without engaging in compulsions, is the most effective way to treat OCD. When you continually perform compulsions, it only strengthens your need for them. However, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond—which can reduce feelings of anxiety.
Odd as it may seem, when you take one of the fears driving your obsessive thoughts and play it out to the worst possible end, the fear has less power over you. For example, consider the case in which you cheated on an exam in middle school, and feel ethically compromised as a result. Your therapist might have you write out your worst case scenario—which could include getting your higher degrees taken away.
“The idea behind ERP is to habituate yourself to these fearful thoughts, so that they will loosen their grip on you,” says Dr. Farrell. Before long, you’ll develop the skills necessary to be comfortable with discomfort and uncertainty—allowing you to experience less anxiety about your memories, and gain back time from compulsions.
Key takeaways
- Real event OCD involves intrusive thoughts about past actions, often causing intense guilt.
- Common symptoms include all-or-nothing thinking, mental reviewing, reassurance-seeking, and compulsive confessions aimed at relieving distress, though these behaviors only reinforce the OCD cycle.
- Exposure and response prevention (ERP) therapy is the most effective treatment for real event OCD, helping you face fears and build tolerance for uncertainty to reduce anxiety over time.