OCD and Reassurance

One of the most common manifestations of Obsessive Compulsive Disorder is the need for reassurance. “Are you sure it is okay if I do this or that?” “Are you sure nobody got (or will get) hurt?” “Are you sure something bad won’t happen?” “Are you sure, are you sure, are you sure?” While the above questions are obvious appeals, they are not the only way that OCD sufferers seek reassurance. Indeed, the very nature of OCD centers around making certain that all is well. Obsessions are always unwanted and cause varying degrees of stress and anxiety, and compulsions temporarily alleviate these feelings. Compulsions are always, in some way, shape, or form, a quest for reassurance; a way to make everything okay.

When my son Dan was dealing with severe OCD,  he was always apologizing, he couldn’t eat, he was tied to the clock, and he had many mental compulsions. Though he knew none of his thoughts or actions made any sense, he just could not stop. And therein lies one of the big problems with reassurance: It is addictive.

Psychotherapist Jon Hershfield says:

“If reassurance were a substance, it would be considered right up there with crack cocaine. One is never enough, a few makes you want more, tolerance is constantly on the rise, and withdrawal hurts. In other words, people with OCD and related conditions who compulsively seek reassurance get a quick fix, but actually worsen their discomfort in the long-term.”

So how can those with OCD “kick the habit?” It’s not easy, as sufferers continually wrestle with the feeling of incompleteness, never truly convinced that their task has been completed. There is always doubt.

But there is also always hope. Exposure Response Prevention (ERP) Therapy, as I’ve mentioned before, involves facing one’s fears and then avoiding engaging in compulsions. No reassurance allowed.  So basically the OCD sufferer is going through “withdrawal.” While it is incredibly anxiety-provoking initially, it gets easier with time. And with a lot of hard work and dedication, the addiction can be beaten.

I know I am over-simplifying things as OCD can be quite complicated, but I think it may be helpful to look at the need for reassurance in the context of addiction. It is so hard for those who do not suffer from OCD to understand why someone just can’t stop washing their hands, stop checking the stove, or stop performing other countless compulsions. Looking at the need for reassurance in this way may not only help shed some light on OCD, it may also give non-sufferers an appreciation for why treatment can be so difficult.

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41 Responses to OCD and Reassurance

  1. 71 & Sunny says:

    It is extremely difficult to not seek reassurance. Sometimes, I’m looking not just for reassurance, but actual permission to do something, like touch a dirty item. It’s like I need to be told that it’s the right and moral thing to ignore the obsessions. Seems strange, but the thinking that goes along with OCD is all mixed up and at times you can’t even tell which way is up or down and you can’t trust your own judgement about anything. Very frustrating.

  2. ocdtalk says:

    Thanks for your comment which confirms that OCD is rarely straightforward and often complicated……

  3. This was one of my major compulsions. I needed reassurance all the time, and I confessed constantly. This is really difficult for friends and family members to know what to do with, because there is a fine line between being helpful/truthful and enabling the OC.

  4. ocdtalk says:

    You’re right about that fine line….for us it was helpful to talk with Dan and let him know we would not be reassuring him or enabling him (knowingly anyway!) We would just say something like “We’re not going respond to that question, or request.”

  5. Tina says:

    This post gave me a new perspective on seeking reassurance. I have depended on reassurance from others as a kind of salve on my doubt. I didn’t think of it as enabling, but I guess it is. And it begs the question, why do I need to depend on someone else to tell me it’s OK when deep down I know it is? OCD is something else . . .

  6. Suzane says:

    Yes, it is extremely difficult not to do these reassurances, I’m trying, but when I don’t do it, I feel myself in a mess…

  7. ocdtalk says:

    Thanks for the comment, Suzane. I’m wondering if you have a therapist you are working with to help you?

    • Suzane says:

      You’re welcome! Well, actually, I’ve been consulting a psychiatrist and some psychologists, but none of them understood my ”situation”, I think, I’m sure they don’t have specialization on it.
      I only got irrited…after that, I never returned to a consult. But now I’m thinking about looking for someone who really understands this. It’s a little hard, because I live in a very small city and specialists live far from here, you know…I have to go to a big city….
      But this year I intend to search for a good therapist.

  8. ocdtalk says:

    That is still such a common problem….therapists who do not understand OCD and do not know how to treat the disorder. I assume you live in Brazil? You might want to try contacting the International OCD Foundation (their link is on my sidebar) for assistance in finding a competent therapist. You definitely want someone who specializes in treating OCD and uses Exposure Response Prevention Therapy. Good luck and please keep me posted!

    • Suzane says:

      Yes, I live in Brazil. I’ve read a lot about Exposure Response Prevetion Therapy…and even practiced it.
      I’ve also talked to some therapists from Sao Paulo by email.
      I could notice that they understand more about it than the therapists here in my area.
      At the moment it’s difficult for me to travel there to consult with some of them.
      While I can’t do it, I continue communicating with them through the Internet.

    • Suzane says:

      I’ve read the article, it’s very interesting.
      I’d like to ask you something…Yesterday, I was watching TV, and a therapist was talking about OCD.
      And she said a thing that made me discouraged…she said a person with ocd, will never heal by itself…and the symptoms only get worse…If she’s a therapist and said it, I believe, and I do know that a treatment with the help of a therapist is very important, essential.
      But I’ve tried in the last months reduce and even avoid my rituals, my reassurances…and I’m getting this, I’ve eliminated several of them. What I do is: (these rituals are automatic isn’t?) …So I stop, I calm down and think: Why am I doing these rituals? What is holding me back? To do these rituals will not change anything!
      So I explain to myself, that rituals are unnecessary …then every time I feel that need to do them, I don’t do, and I don’t feel bad, because previously I became aware that it’s okay if I don’t do…this way, I’ve eliminated a lot of them….
      What do you think about this? Do you think these improvements mean nothing?

      (sorry for my huge text, )…

      • ocdtalk says:

        Hi Suzane,

        I am not a therapist but I can give you my opinion. My guess is that perhaps the therapist was referring to someone with OCD who is not engaging in any therapy at all or making any effort to fight their OCD. You are consciously refraining from doing rituals and and have seen improvement. That’s a huge step forward and that means a lot. You are working toward getting well and making progress!
        Just because someone is a therapist doesn’t mean he or she is an expert on YOU! My son Dan’s OCD was so severe he could not even eat and at least one of his therapists doubted he could improve much. That was several years ago and today he is living life to the fullest and his current therapist describes his OCD as mild……..OCD, no matter how severe, is treatable!
        If you’d like to correspond, my email is: ocdtalk@yahoo.com. Of course I love to receive your comments on my blog as well. Email is just another option.

    • Suzane says:

      So good to read that! (your answer)!
      It has been very good to discuss with you about OCD, you understand it well, although not being a sufferer. It’s rare someone who doesn’t have OCD to understand this way, even the parents.
      Thank you for your attention to me! and for sure, anytime I’ll correspond by email, thanks!

  9. margaretlucy says:

    I wanted to let you know how much I enjoy your writing. In particular, though I don’t suffer from OCD, your point about seeking reassurance resonated with me and struck a cord with both the mental illnesses I am dealing with and the blogs I have followed regarding all sorts of mental illnesses.

    Also, I wanted to let you know that I nominated you for The Versatile Blogger Award: http://musingsofanoveranalyticalmind.wordpress.com/2012/01/08/versatile-blogging/

  10. ocdtalk says:

    Thanks for the kind words margaretlucy, and for the award nomination! I’m heading over to your blog to see what it’s all about.

  11. Loved the post. It seems we’re on the same wavelength this week! Thanks for sharing your link with me. Some research indicates that the need to know in OCD might be mediated by hyperactivity in the anterior cingulate (ACC), which is a part of the brain that is involved in feelings of closure/completeness. It’s thought that OCD-related hyperactivity in the ACC is experienced subjectively as a persistent “error signal.” In efforts to shut off or reduce this error signal, individuals often complete rituals or ask for reassurance.

  12. ocdtalk says:

    Wow, that is so interesting….I’m assuming this must be relatively recent research? Thanks for reading my post. I look forward to more of yours. FYI..I’ve added you to my OCD Resources Sidebar.

    • Thanks for adding me! The research picked up momentum in about ~2000 and several good studies were conducted in 2005. This research area has benefited significantly from the increasing availability of fMRIs, etc. A lot of the studies are based on a phenomenon called error-related negativity (ERN). Here’s a sample article that includes a short review at the beginning: http://bit.ly/zeqeM9

      Apologies in advance…the language is pretty technical. The part of the picture that is less well understood is how activity in the ACC is experienced subjectively. Although it is thought to be related to a lack of closure/completeness, this is probably an oversimplification. Sachdev & Malhi (2005) wrote a nice article in which they characterized OCD as a disorder of decision-making. I couldn’t find a link to their article, but I summarized some of their argument here (http://bit.ly/nZ797k) and here (http://bit.ly/nmor0z).

      Again, sorry that the language is technical. This was an excerpt from my dissertation.

  13. Lisa says:

    Ah, but it gets almost physically painful when I don’t know if someone is angry at me, so I have to ask!

  14. Suzane says:

    Very interesting this research cited by Steven…..”errors signal”….
    It made me think…
    I mean, nobody would like to have these disturbing thoughts in mind, and to ”fix” them, is like a natural defense we found…anyone who had these thoughts would do the same thing…but, who would know it is called ocd….at least not me at the time I started with the reassurances. =/
    Whatever, now I know, and I’m struggling like everyone else ocd sufferers!

  15. Jason bowles says:

    I suffer from OCD. The last eight months have been hell for me. I would consider myself a pure O type as I do not perform any compulsions. I do seek reassurance all the time. In fact, i recently made a pact with my wife that we needed to reduce the reassurance to once per day. I have found it difficult – but am managing. Am I on the right track here or do I need to completely eliminate the reassurance. I guess my goal is slowly to ween myself down to everyother day, etc….

  16. ocdtalk says:

    Hi Jason, I am sorry to hear you’ve really been suffering these past months. It sounds to me like you are definitely on the right track. However, I’m not a therapist, and if at all possible, I would highly recommend finding a therapist who specializes in ERP Therapy as discussed in this post. If that’s not possible for you, there are self-help books that will give you tips………there are also online resources, and even apps now, to help with ERP Therapy, though they are meant to supplement your therapy with a competent therapist. Good Luck, and please keep me posted. Though ERP Therapy is difficult, every OCD sufferer I’ve been in contact with says it is worth it……..and, done properly, it works!

  17. Jason bowles says:

    Actually, I have my first appointment tommorrow with a therapist who specializes in OCD therapy. I am excited – yet scared because it is going to be difficult. I do not know what to expect. I guess i am afraid she is going to tell me the reassurance has to stop immediately and that is going to be very difficult for me. I am hoping that she can teach me how to deal with it before the reassurnace has to stop altogether. I have made good progress trying to wean myself off the assurance. Hopefully, that will continue. It will be very hard to stop reassurance altogether.

  18. ocdtalk says:

    I am so happy to hear you will be seeing a therapist tomorrow. From what I understand, you will probably start out by making a hierarchy of your obsessions and what causes you the most stress, and therapists never begin with the most stressful situations. My guess is he/she will have you reduce your requests for reassurance gradually…….you’ve already started doing this yourself, but hopefully the therapist will give you more insight into your OCD and structure for your treatment. Good Luck!

  19. Briana says:

    I’m glad I read this. I thought I just suffered from the “O” in OCD (I used to suffer from both – obsessive fears and cleaning). However, when I have what I call an OCD episode, I begin hounding my family for reassurance. I may no longer wash my hands and clean, but I have traded that in for compulsively asking for reassurance! Makes sense to me! Now I have to work on it. Easier said than done.

  20. ocdtalk says:

    Hi Briana, I think understanding what’s going on in terms of your OCD is a huge step. I know recovery isn’t easy, but it is possible! Good Luck and please keep me posted on how you are doing.

  21. Elizabeth says:

    Hello,
    I have OCD, but never have been diagnosed with it. It is simply by the grace of God I have gotten to the point where I am without medication or a therapist. Just recently my daughter,14, has been diagnosed. I have seen symptoms since she was 5, but they have come and gone over the years. Now in 8th grade, it has reached a boiling point, to where she has depression as well. She has gone to a Christian school since 3, so if you know about OCD, it has latched on to her religion. It really touches on all aspects of thinking. She is super smart, straight A student, and a perfectionist. This is a long battle I know we have to fight, but I pray to win. It seems to me that she wants to tell others how she feels in a attempt to make herself feel better. She says she feels alone, and I just hate it for her. We start ERP therapy in March, so I hope this will help her gain control of her thinking. I always wondered why I had OCD and now I know, so I can take care and understand my daughter. God Bless everyone!

  22. ocdtalk says:

    Hi Elizabeth, Thank you so much for sharing your and your daughter’s struggles. Starting ERP Therapy is such a positive step. Good luck to both of you on her journey to recovery, and please let me know how things are going.

  23. emelie4 says:

    Reassurance is definitely like a drug – it takes away the intense anxiety that I feel right away and sometimes for a couple of days but it doesn’t ever take away my fears for good. I’ve gotten addicted to this momentary feeling of reassurance despite it eventually making things worse because I hate feeling anxious. However, I need to train myself to look at the long-term picture which is really hard to do when the anxiety gets bad. I see reassurance as OCD’s ultimate weapon – it gives momentary comfort for the person yet ensures the OCD’s survival and the continuation of future anxiety.

    • Thanks so much for sharing, Emelie, and I like your description of reassurance as “OCD’s ultimate weapon.” I always find it fascinating that someone can have such a good understanding of her OCD (as you do) and know what needs to be done, yet it is still such a battle. It just shows how insidious and powerful OCD can be. I wish you all the best as you continue your fight!

  24. Manel says:

    Hello,

    I am from Sri Lanka. OCD is not well known in the 3rd-world so that is why thought of searching the net. I have these obsessions & compulsions which have now become a nuisance to me. I want to get rid of them. My main concern is ‘contamination’. I don’t like to get food on body, clothes, desk, computer or anything I use. I don’t have germ phobia. I don’t think I will die or my loved ones will die (I live alone by the way). I just have a icky feeling.

    I don’t like sticky substances, like oily food, food gravy, in my body or computer etc. Even things like tea which has sugar is sticky. I don’t feel good inside when I touch my computer with sticky hands, and then have the compulsion to wash the affected area with wet-wipes.

    My compulsions might take about 15 to 30 minutes of time in total for a day. I just want to get rid of this. Do I have OCD?? Is it mild OCD or moderate OCD?

    Any help would be so greatly appreciated.

    Thanks & Regards,
    Manel (manel_n@mail.com)

    • Hi Manel, I am not a therapist so I can’t diagnose you. To meet the criteria for OCD, compulsions typically need to take up at least an hour of your time each day. That being said, you are obviously suffering so it doesn’t matter if it’s OCD or not – you still want help. If there are no good therapists where you are I recommend going onto the IOCDF website (on my sidebar), and checking out the websites and workbooks that have been created to help those with OCD.Specifically, you want to make sure they use exposure and response prevention (ERP) therapy, a form of Cognitive Behavioral Therapy. There are resources listed on my sidebar of my blog and in the resource section of my book. Good luck as you move forward and let me know how things are going!

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