How to Manage and Treat Real Event Obsessive Compulsive Disorder (OCD)

Hallmark symptoms

The driving force behind OCD is doubt. You may ask yourself questions such as:

• Did you turn the stove off?
• Will the stove start a house fire if you didn’t turn it off?
• Did you lock the door before you got into bed?
• Will you be robbed (or worse) in your sleep?
• Is the door handle to your apartment dirty?
• Can you even clean the door handle well enough to avoid germs?

These are a few types of obsessive thoughts. They typically deal with theoretical situations, or something that might arise.

With real event OCD, however, the recurring thoughts are of a specific event that happened to you. That means the obsessive thoughts and compulsions are typically related to something you did or did not do.

Symptoms of real event OCD include:

• Mental review. People with real event OCD spend excessive time replaying events in their minds. They analyze them from every angle and perspective. They play every word, action, and event back in their minds. Often, they try to decide something black and white about the event: Do their actions make them a bad person? Did they make the right choice?
• Reassurance seeking. People with real event OCD cannot answer their worries. So, they may bounce the events and their feelings off other people in their lives to seek reassurance that the worst things they’re thinking aren’t going to come true or haven’t happened.
• Catastrophizing. People with real event OCD create cognitive distortions. In other words, they take something that would quickly pass through the mind of another individual and sit on it for longer than they should. They often twist or change it, so they find problems with it. From that, they draw the worst conclusions about what happened and about themselves.
• Emotional reasoning. People with real event OCD confuse feelings for facts. People with this condition might convince themselves that because they feel guilty, they must have done something bad.
• Urgency. To people experiencing this cycle of intrusive thoughts, finding resolution to situations can be increasingly important. They may feel that they have to find the answer now. This may make the compulsions worse.
• Magnification. People with this condition may have a difficult time separating themselves from the significance of an event because of the intense focus on the event. In other words, an inconsequential choice becomes highly significant and meaningful because of the distortions caused by OCD.

Types of events that trigger it

It’s unclear why some people develop real event OCD and others don’t. Even two people who experience the same event together may have different responses. One may develop OCD, while the other doesn’t.

For that reason, it’s hard to know precisely what types of events trigger real event OCD, but anecdotal evidence suggests that these situations may play a role:

• abuse
• neglect
• family disruption
• relationship changes or interpersonal issues
• traumatic events

Then again, the event may not amount to a single significant life event. It may result from a chronic stressful situation, or a stressful life event like moving.

Although events like these are ordinary, for someone with OCD the stress may be so significant that it triggers the obsessive thoughts and compulsions.

For example, someone with real event OCD may focus on an interaction they had as a student, decades before the time the obsessive thoughts begin. This focus may be the result of a similar experience.

It may also come back up if you see the other person again or if something happens to them.

How to tell if you’re experiencing this

OCD is a persistent state of doubt. Everyone has doubts from time to time, but people with this mental health condition face doubts and anxieties that are obsessive and intrusive.

Indeed, they feel that they cannot manage them. That, in turn, can interfere with daily life.

Your doubts and worries about something that happened in your life could indicate symptoms of real event OCD if you:

• feel “stuck” thinking about the same event(s) over and over
• cannot control the thoughts
• cannot find resolutions
• seek reassurance but don’t find the support sufficient
• experience significant problems in your daily life due to these thoughts
• have trouble focusing or being productive at school or work
• have strained relationships from your obsessive thoughts and doubts
• have previously experienced OCD

How to treat it

Real event OCD can be treated. As with other types of OCD, it may require a combination of treatments to find something that helps you. But you do not have to live in this cycle.

The most common treatments for real event OCD include:

• Medication. Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed for people with OCD. These medicines impact the brain’s natural chemistry to help stop or slow the overactive thoughts.
• Psychotherapy. Therapies such as cognitive behavioral therapy (CBT) and habit reversal training are used for OCD treatment. These types help people with real event OCD learn how to stop and redirect the intrusive thoughts before the compulsive cycle begins.
• Exposure and response (ERP) therapy. This type of psychotherapy is used often with OCD. With this therapy, a mental health professional will develop ways to expose you to your triggers. Together, you will learn to unpair the real event from the feelings that have caused so much doubt and anxiety.

How to manage in daily life

In addition to traditional treatments, other practices may help you eliminate obsessive thoughts. These include:

• Mindfulness. Blocking or stopping thoughts may not work. The practice of mindfulness encourages people to experience thoughts and feelings, and “sit” with them. They can experience thoughts as they happen, and usher them out.
• Mental exercises. With a mental health professional, you can try mental health exercises to stop your compulsive examinations. They might include refocusing or negotiating with your mind. It will take time and attention to make this work, but recognizing the compulsive thoughts helps stop them.
• Take care of yourself. A tired mind may be difficult to manage. Get adequate sleep, eat a balanced diet, and exercise regularly. These practices can help your overall health and treatments.

Where to find help

If you think you’re experiencing real event OCD, consider talking with a healthcare professional to determine next steps. These resources can help:

• Your healthcare provider. Talk with a doctor, nurse practitioner, or other clinician to find a mental health professional in your area that may be able to help you answer questions and find treatment.
• Substance Abuse and Mental Health Services Administration (SAMHSA). Their treatment referral hotline (1-800-662-HELP or 1-800-662-4357) can connect you with resources in your area. Their Behavioral Health Treatment Locator can also be a good resource.
• National Institute of Mental Health (NIMH). The NIMH Help for Mental Illnesses page lists a variety of resources that can guide you to the best providers.

The bottom line

Many people experience these feelings because of past events:

• regret
• shame
• stress

That’s typical. But what isn’t typical is an inability to stop thinking about those feelings.

People with real event OCD cannot always manage their obsessive thoughts and compulsive actions. They often seek to clarify what happened and find a “resolution.” But that’s not always possible.

However, with treatment and continuing mental health exercises, people with real event OCD can find relief from their obsessive thoughts.

And they may manage their daily lives without the worry of these doubts and anxieties overrunning their minds.