Having intrusive thoughts that involve actual past events can be particularly tricky. This is known as real event OCD.
Memory is imperfect—many of us may look back on a past event and wonder if we remember everything accurately. For people with obsessive-compulsive disorder (OCD), however, concerns about memory and doubts about past events can become intensely distressing.
Since no one can ever be 100% sure about their memory, OCD latches on to the ambiguity, filling in the blanks with worst-case-scenarios. This becomes a vicious cycle: every “what if?” thought about a horrifying past event becomes something they have to prove wrong. They wonder, How can I know for sure that it happened the way I remember?
This particular theme of OCD is known as real event OCD, which involves fears surrounding real past events. Because people with real event OCD can’t remember the past event with certainty, they worry they’ve done horrible things without remembering it. They may feel responsible and guilty for causing injury to others through something they did in the past, despite having no proof this is the case.
In this article, we’ll review what exactly real event OCD is, how it shows up, and how you can treat it.
What is real event OCD?
Real event OCD is a subtype of OCD characterized by ongoing intrusive thoughts and compulsive behaviors around past actions. Someone with real event OCD spends extensive energy attempting to gain certainty about a past event and whether they’ve done something potentially immoral or wrong.
Dr. Patrick McGrath, Chief Clinical Officer for NOCD, explains, “Memory is a tricky thing. No one remembers every detail of what transpires in their lives.” But for people with real event OCD, this inability to remember everything results in assuming 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.”
While all subtypes of OCD involve two parts—obsessions and compulsions—you can think of real event OCD as having three components:
- The event: what really happened
- The obsessions: the thoughts, fears, images, or doubts 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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Real event OCD symptoms
Practically everyone experiences regret or doubt about the past. However, people with real event OCD often experience all-or-nothing thinking about these events. This is one of the main symptoms of this subtype. A person without OCD may think, “I probably shouldn’t have done that,” or “I wish that went differently,” reflect on their feelings, and move on. For someone with real event OCD, the guilt and shame can feel overwhelming.
These obsessions often pop up seemingly out of nowhere. For example, during a workday, you might suddenly experience obsessive thoughts about that time you cheated on an exam in middle school. The thoughts will take over your mind, and you won’t be able to concentrate on anything else. The fear of potentially wrong past actions drives people with this OCD subtype to engage in various compulsions aimed at gaining certainty about what exactly they’ve done and what this means about who they are as a person. To continue our example, you might go to extreme lengths to track down your middle school teacher to confess and apologize for your behavior all those years ago.
There’s no limit to the specific obsessions that people with real event OCD might experience, so it’s important to consult a qualified professional—one who has experience and training in OCD—in order to make sense of your own experience and start a journey toward recovery.
Most people probably don’t associate symptoms like these with OCD, but that doesn’t mean that they’re not common, or that they’re not just as treatable as any other form of the condition.
Common obsessions in real event OCD
Given how difficult it is to know if you have real event OCD, it can be helpful to take a look at some examples of how this subtype of OCD manifests.
- “I told my friend 10 years ago that I supported her choice of partner, and I didn’t tell her that I noticed a few potential red flags. Now they are getting a divorce. What if it’s my fault because I didn’t tell her what I really think?”
- “Last year, I gave a restaurant a bad review, and I just found out they’ve shut down. It was all my fault their business tanked.”
- “When I was 12 I laughed at my classmate. What if they are still suffering because of what I did to them?”
“When I was a teenager, I stole chips from a deli. I haven’t done anything like this since, but what if this act is still somehow a part of me? What if part of me is still a thief, and I unknowingly transfer this characteristic to my kids? What if they become thieves and it’s my fault?”
Common compulsions in real event OCD
Mental review
This is the most common compulsion for people with real event OCD. They will replay the event they are concerned about in their mind over and over until they feel like they’ve gained clarity and experienced relief. It’s usually only a matter of time before these obsessive thoughts return and the cycle begins again.
Reassurance-seeking
Someone who is concerned about the time they shoplifted as a teenager may ask questions like, “Have you ever stolen anything when you were younger?” and, “Do you think stealing one time makes someone a bad person?” These questions are aimed at giving this person relief from their fear of being guilty.
They may also engage in compulsive research online, searching things like, “How to know if you’re a bad person?” “Why do people steal?” or “How to make sure your children won’t steal?”
Confession
The guilt people with real event OCD experience can be very intense. This can drive them to confess, often sharing things that they never actually did “just in case.” A person with this subtype may consider this the only way they can experience relief from their guilt.
How real event OCD is treated
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 gold standard for OCD treatment and has been supported by decades of rigorous scientific research.
The idea behind ERP is that repeated exposure to obsessive thoughts, without engaging in compulsions, is the most effective way to treat OCD. When you continually perform compulsions, it only strengthens your need to use them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your 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, you might play out the fear that you stole something as a teenager and are still somehow a thief. What if that’s true? What will happen if your children do turn out to be thieves and it’s because of something you unknowingly taught them? Then what? Will they get caught? What happens next?
The idea behind ERP is to habituate yourself to these fearful thoughts so that they will loosen their grip on you. This process can actually occur in a short period of time: before long, you’ll develop skills and get to a point where you are comfortable with the uncertainty of the past, and you’ll actually experience less worry and anxiety about them over time.
Bottom line
Real event OCD can be a tricky diagnosis to spot, even for some mental health professionals, because it’s an unconventional and highly misunderstood type of OCD. An experienced therapist who specializes in OCD will be able to make an accurate diagnosis and work with you to create a personalized treatment plan for your individual symptoms.
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.