Intrusive thoughts or memories—which are uncomfortable and unwanted, even for people without any mental health condition—are nearly universal, and completely normal. What’s more, many people can push them aside because they know they’re not real.
Unfortunately for people who have Obsessive-Compulsive Disorder (OCD), these intrusive thoughts skew their reality, and they’re not sure if something actually happened or not. Intrusive thoughts aren’t about some great vacation memory that you forgot about or one of the best meals of your life—they can be thoughts, fears, or images suggesting that you may have caused harm to someone else unintentionally and without knowing it, or conversely that something bad happened to you. The idea that you could have forgotten or erased something so horrible eats away at you until you do something to feel better about it, like repeatedly checking to make sure that it didn’t happen. This can be called a false memory.
If you feel as if you’ve been having false memories or are becoming increasingly worried that you can’t trust your own memory, read on to learn about what it might mean and what you can do about it.
Understanding False Memory Syndrome
A false memory is defined as “a distorted recollection of an event, or most severely, recollection of an event that never actually happened,” according to the American Psychological Association (APA). False Memory Syndrome (FMS) describes potential occurrences when adults recollect unreliable memories of being abused during their childhood, and this often happens during therapy. According to the Association, FMS is not a psychological diagnosis and it is highly controversial, as it may be that therapists or others suggest these memories themselves, triggering such strong doubts or beliefs in the first place.
Stories about recovering repressed memories in therapy gained attention in the 1990s, but public understanding shifted upon widespread reports that these memories were indeed false.
“Much of false memory syndrome has fallen by the wayside. I don’t see evidence of the idea that large numbers of people are having all these repressed memories,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. Today, it’s considered rare to have a recovered memory, says the APA.
The Complex Nature of OCD
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by a chronic cycle of obsessions and compulsions. Obsessions are distressing unwanted, intrusive thoughts, images, sensations, or urges, as defined by the International OCD Foundation. Compulsions are the repetitive behaviors—such as checking, reassurance-seeking, or mentally reviewing events—done to neutralize the distressing feelings or in hopes of preventing a “bad” thing from happening.
Though intrusive thoughts are common among everyone, they create extreme anxiety in someone who has OCD, and the actions they feel they must take as a result (the compulsions) can have a huge effect on their quality of life, taking up large amounts of time or impairing daily functioning, notes the Foundation.
That said, while anxiety is a result of an obsession, OCD is not anxiety. Though OCD was once considered an anxiety disorder, it was recategorized a decade ago into its own category called Obsessive-Compulsive and Related Conditions (these related conditions include Body-Focused Repetitive Behaviors, Hoarding Disorder, and Tic Disorder).
It’s also important to understand that memory can be affected in OCD, which can contribute to the creation of worry and doubt about false memories in OCD. As research in Psychological Medicine in 2022 points out, “People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one’s cognitive processes.”
If you don’t feel confident that you can remember things correctly, you’ll doubt your own memory—and your OCD will grasp the opportunity to step in and ask you to find proof that something did or didn’t happen. That’s where compulsions come in—they’re done in an effort to improve your certainty that something did or did not occur. If you replay in your head every step you took this morning to quell the nagging (if irrational) doubt that you could have sexually assaulted someone on the subway on the ride to work this morning, you are engaging in a compulsion.
Interestingly, the research mentioned above reviewed 19 studies and concluded that people with OCD are less confident in their memory than they should be. There’s a significant gap between their reality and perception. It’s not actually unreliable memory that triggers such extreme symptoms, but a distrust in one’s own cognitive functions that fuels the fire. OCD is known as “the doubting disorder,” after all.
Overlapping Traits: False Memories in OCD
When it comes to OCD, false memories come into play when your OCD asks you what if you did something, and you don’t know you did it? “OCD really grabs onto slight uncertainties. ‘How can you guarantee to me that this didn’t happen or provide enough reassurance that I’m not guilty?’” explains Dr. McGrath.
What really distinguishes behaviors related to OCD from other worries and doubts is whether you are also engaging in compulsions to neutralize these worries. “We all have doubts about things. I can’t tell you with 100% certainty everything I did yesterday. That’s okay. But with OCD, that might not be okay. I would feel a strong need for absolute certainty,” he explains.
One example: Yesterday, you drove home. Everything went normally. In hindsight though, a fear creeps in: Are you certain you didn’t hit someone? You know that cyclists ride on the bridge you drove over, so how do you absolutely know there wasn’t one on the bridge that you swerved into unknowingly, and ran them off the side? You actually might have been a bit distracted right around that point.
A compulsion here might involve going to the same bridge later to check for evidence of a bike accident. Or you might research news stories online to see if there were any accident reports at the bridge. You might ask a friend or family member to help you figure it out and reassure you that it didn’t happen. “With OCD, you never fully trust your own judgment of the situation,” Dr. McGrath says. To add fuel to that fire, the more people with OCD engage in compulsive memory checking, the more they continue to doubt themselves. It’s a never-ending, vicious cycle.
The Role of Anxiety in Memory Formation
Anxiety can indeed interfere with your memory, Dr. McGrath says. “If you’re really focused on trying to survive the situation, you may not catch every detail of what’s going on,” he explains. It’s one reason why when multiple people are present at a distressing event, they’ll remember and describe different details.
This is all part of the fight, flight, or freeze stress response, says Dr. McGrath. “During a traumatic event, we’re fully focused on the ability to survive the experience,” he says. The same goes for other things that may make you anxious: You’re tuned into the source of your anxiety, and tuned out of other things that are going on around you.
Dr. McGrath recounts a story of when he defended his family in an attack. He can clearly remember the image of the buttons on his shirt popping off as it was ripped. Though this all happened so quickly, he says, that time felt as if it slowed down. “A lot of fascinating things happen in this fight, flight, or freeze response. But it can make you wonder—since time seemed to change for me, could I have done something in that time that I wasn’t aware of? Everything seems a bit off in retrospect, so how can I be certain about any of it?”
Case Studies and Personal Experiences
Picture this: you’re driving home one night and pass by an accident on the road. Could you have caused the crash? How do you know for sure that you didn’t swerve and cause damage? When you don’t get enough reassurance, you may consider going to extreme lengths to alleviate your anxiety, like paying for the other driver’s lawyer or going to the police to turn yourself in, says Dr. McGrath.
This happened for one of his clients who saw a hit-and-run on the news and consequently reported themselves to the police because they thought, “What if it was me?” But their car didn’t match the description of the perpetrator’s car, and there was no damage to their own car. They hadn’t even driven that day. But still, their doubts remained, says Dr. McGrath: “They just kept worrying and seeking reassurance, because nothing was enough to satisfy OCD. They thought, ‘What if they had driven but just can’t remember?’” In the end, they were nearly arrested for filing a false police report.
Another client recalls meeting someone two decades ago in a bar, where they did drugs together in the bathroom. The client still scans local websites to see if there are any kids of the right age addicted to drugs. Why? He reasons that another woman could have gone to the bathroom, put her purse on the area they had been doing drugs, picked up the drugs on the bottom of her purse, and then tracked in residue that ended up on her baby’s food. That first taste, he worries, could have started an addiction. Now, he’d like to pay for any lawyer’s fees for the now-addicted adult because he feels responsible. The sites report that there is no one who matches the description of the person the client is searching for. “There is no ‘too far’ in OCD. You can sustain a doubt no matter what. Nothing is too far-fetched for this disorder,” Dr. McGrath says.
“OCD relies on shame and guilt and the fear that a person may have harmed someone, which is what can drive people to call the police on themselves, even in the most irrational circumstances,” he explains.
In treatment—which we’ll discuss below—it’s important to work with experts who will provide affirming care in order to combat the intense, lasting self-blame that arises from these fears, doubts, or false memories.
Treatment Approaches
If you experience false memories related to OCD, then seeking treatment can help you. The best approach is exposure and response prevention therapy (ERP), which is an evidence-based, gold-standard approach for treating OCD.
During ERP, you will need to be prepared to trigger an obsession—in this case, a doubt that puts the potential of a false memory into your head. As a result, you will feel those what if questions arise: What if I caused harm? What if I did get into an accident? How do I know I went straight home after being at my friend’s house? How can I be sure? And then what you’ll do, with the help of your therapist, is sit with those questions, uncertainty, and anxiety.
Then comes the most important part: resisting compulsions. “What you won’t do in ERP is go out and check something, seek reassurance, research, or ask someone else if something happened,” says Dr. McGrath. Instead, you sit with your doubt and insecurity, and allow yourself to work through the experience. Eventually, you will move through that discomfort and come out on the other side. You learn that you can handle these feelings without trying to do something about them, make up for your “what ifs,” or attempt to gain perfect certainty. You will learn that anxiety, like any feeling, is temporary and will simply dissipate with time.
When the process is repeated many times over, your brain will create new connections to show you that you don’t need the compulsions to feel safe in the face of uncertainty, and that the feelings of safety provided by compulsions is only an illusion of safety. Uncertainty is a normal, universal part of life, not an automatic sign of danger as OCD would like you to believe.
To access ERP therapy, NOCD has a team of experienced clinicians who provide virtual face-to-face therapy. Because intrusive thoughts are unpredictable, you won’t know when you could be triggered by a false memory. For that reason, NOCD also offers in-between appointment support with your clinician or the community of people who have been through ERP therapy and understand what you’re going through. To learn more about how ERP therapy may help you, schedule a free 15-minute call with the NOCD Care team.