Reassurance Seeking in OCD and Related Conditions

People with Obsessive Compulsive Disorder (OCD) who experience the pain and terror brought on by unwanted intrusive thoughts will use whatever means necessary to alleviate their discomfort. If they can’t make themselves feel sure about something internally, they reach out to the nearest person who they think can do it for them. If they are unavailable, the person with OCD will often reach out to the cold, unforgiving internet where the answers they hope not to find will always be waiting.

When the part of the brain responsible for making humans feel “sure enough” fails to kick into gear on its own, those with OCD and related anxiety-based conditions often use compulsive strategies to artificially create this sense of certainty. While this temporarily provides some assurance, the joy is short-lived, replaced by an overwhelming and seemingly unfair demand for re-assurance. As a strategy for suppressing the occurrence and effects of an obsession, reassurance seeking is a compulsion commonly employed by virtually all OCD sufferers, as well as those with related OC Spectrum Disorders such as Body Dysmorphic Disorder (BDD), Social Anxiety (Social Phobia), and Hypochondria (Health Anxiety).

The Problem with Reassurance

So why is reassurance such a big deal? To put it in clinical terms, when an individual seeks reassurance, they reinforce that they are unable to tolerate the discomfort of the uncertainty they are experiencing. At the same time, they reinforce that the best way to alleviate the discomfort of that uncertainty is to compulsively seek reassurance.

Concurrently, reassurance as a behavior sends the message to the brain that whatever unwanted thought set these events into motion must be terribly significant.  “If he goes through all of this just to know for sure, then this thought must be really important!”

Finally, reassurance is addictive. 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.

Three Types of Reassurance

For those with OCD and related conditions such as Body Dysmorphic Disorder,  Social Anxiety, and Hypochondria, reassurance seeking comes in three forms:

• Self reassurance. For individuals with OCD, the most obvious form of self reassurance is an overt checking compulsion, such as checking a door to ensure that it is locked.  Other less noticeable forms of self reassurance might include mentally reviewing an event or doing “mental compulsions”, such as such as repeating a “good” thought to ensure that a “bad” thought won’t come true. For someone with Social Anxiety, self reassurance might involve repeatedly doing a “mental review” of their performance at a party. For the person with BDD, a common type of self reassurance is body checking, wherein they compulsively look at themselves in the mirror in an attempt to get reassurance that they look OK.

• Reassurance seeking from others. Those with OCD and related conditions often ask others if things are OK, or manipulate others into telling them that things are OK. For example, a person with OCD may compulsively ask friends and family if they have washed their hands enough, or if they have run someone over with the car. Likewise, someone with Body Dysmorphic Disorder (BDD) may repeatedly ask others about their appearance, while someone with Hypochondria may compulsively ask family members about symptoms of certain medical conditions.

• Research reassurance. Individuals with OCD and related conditions frequently look for evidence online or elsewhere in an effort to prove to themselves that things are OK. One common example of this is what is colloquially known as Cyberchondria, wherein those with Hypochondria compulsively search the internet in an attempt to get reassurance they do not have a specific disease.

Managing the Urge to Seek Reassurance

Self-reassurance is the hardest of these to contend with because, like so many symptoms found in OCD and related conditions, these compulsions often go un-noticed until after they’ve been committed. Behaviorally, your best bet is to acknowledge the reassurance as soon as you notice it, and to stop it as soon as you can. Also, using Cognitive Behavioral Therapy techniques such as mindfulness and acceptance (the healthy practice of acknowledging and accepting thoughts and feelings without evaluating them or acting on them), one can learn to have an uncomfortable thought or feeling without over-valuing it or over-responding to it.

Resisting reassurance seeking from others often involves psycho-education of those who are most often on the giving end. Like the enabler to the alcoholic or drug addict, your loved ones might have a low tolerance for seeing you in pain, so they give you what you demand of them – even if it may actually hurt you in the long run. Consider your intent when asking for reassurance. Is your goal to remind yourself of what you already know? Is your goal to reduce your anxiety about something? If the answer to either of these questions is “yes”, then it’s best to resist asking for reassurance and to instead practice tolerating the discomfort.

Furthermore, be on the lookout for your own crafty manipulations. The word “manipulation” has a sinister connotation, but all it really means is the influencing of your environment to provide desired results. For example, merely mentioning the issue of toaster oven safety may be a not-so-subtle attempt to get reassurance, serving the same function as overtly asking if you really did turn the oven off.

One thing that seems to be very helpful with family members and partners is the formation of a reassurance contract. Simply put, the person with OCD or a related anxiety-based condition gives permission for their loved one to refuse reassurance or to reduce it to a bare minimum. When the individual asks for reassurance, the family member participating in the contract can say something like, “Remember you asked me to help you, and that means I can’t answer this question. Now let’s go do something else…”

Finally, when it comes to resisting the wealth of information (and misinformation) available from the web and other sources, it’s best to turn the computer off altogether when you find yourself just wanting to know something “for sure.” In fact, there’s no time like the present…so let’s see if you can move on from this blog without knowing for sure if you fully understood it.

•Jon Hershfield, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted jon@ocdla.com.

Tags: Acceptance, Body Dysmorphic Disorder (BDD), Cognitive-Behavioral Therapy (CBT), Health, Hypochondria / Health Anxiety, Mindfulness, Obsessive-Compulsive Disorder (OCD), Reassurance Seeking, Social Anxiety / Social Phobia

9 Comments to Reassurance Seeking in OCD and Related Conditions

1. 

   Great article, Jon. Thanks for the definition of cyberchondria. I hadn’t heard that one before, but it fits the description perfectly.

   One thing that I’ve found useful in working with clients affected by OCD is to engage in an externalizing discourse about the problem. As in, “Is it OCD (or perfectionism, or whatever the preferred identification of the problem is) that wants me to check, or do I want to check?” In this way, we can see the problem at a distance where we can understand the extent of its influence, and the instances where the client has mastery over that influence.

   Thanks for some interesting reading.
Shannon Armitage on February 3rd, 2010
2. 

   An excellent article on reassurance seeking in OCD and anxiety spectrum disorders. I, too, enjoy working with OCD sufferers and frequently give homework assignments around resisting the urge to seek reassurance, or enlist spouses to understand the importance of not giving reassurance. Keep up the great work.
Christian Jansen-Yee, PsyD on February 3rd, 2010
3. 

   Thank you for this concise and useful article on reassurance seeking. The pull for the immediate gratification of relief is strong, but as you say, the relief is short-lived. In my work with people with anxiety disorders, I focus on the short and long term gains of any behaviors employed, and certainly try to help my clients focus on the long-term gains of distress tolerance. The mindfulness concepts have proved quite helpful. Thanks again!
Carolyn Nowakowski, Psy.D. on February 4th, 2010
4. 

   Thank you for a thought provoking article. In my work with couples who are rebuilding trust and intimacy after an affair, I typically give permission to the betrayed spouse to ask for reassurance from the spouse who had the affair when insecurity or suspicious thoughts arise. This article is a good reminder that reassurance can become addictive and counter productive at a certain point and that it needs to be balanced with the goal of increased tolerance of uncertainty (i.e. “I’ll never feel 100% certain that my spouse won’t cheat again, but I’ve made a decision that the joy my relationship brings to me is worth the risk”).
Anna Larsen, MS, ALMFT on February 5th, 2010
5. 

   Hi Shannon,

   Thank you for your comments.

   Your note on “externalizing discourse” reminds me of Jeffrey Schwartz’ book “Brain Lock” – specifically his suggestion that those with OCD consciously state to themselves “that’s not me, it’s the OCD”. It also reminds me of Steven Hayes’ ACT approach in which one is advised to accept unwanted thoughts and feelings, but to not base actions upon them.
OCD Center of Los Angeles on February 5th, 2010
6. 

   Hi Christian,

   Thanks for your insights.

   Assignments that help the client develop the ability to resist the urge to seek reassurance (or any compulsive urge) are critical in managing OCD symptoms. We frequently give assignments along these lines not just to the client, but to family members who have been accommodating the OCD by providing reassurance.
OCD Center of Los Angeles on February 5th, 2010
7. 

   Hi Carolyn,

   Thank you for your comments, especially about “distress tolerance” and “mindfulness”. My experience has been that these and other “third wave” CBT concepts are extraordinarily helpful for clients learning to reframe their thoughts / feelings as being tolerable.
OCD Center of Los Angeles on February 5th, 2010
8. 

   Hi Anna,

   Thank you for your insights, especially how too much reassurance can be addictive and counterproductive for those trying to move beyond a spouse’s affair. I hadn’t thought of applying these principles to that type of situation, but I think you are right on target.
OCD Center of Los Angeles on February 5th, 2010
9. 

   Hi everyone

   That was a very good article, I am still a student, but with reading post, and reading articles like this I will have quiet a reinforcement of knowledge as part of my educational experience. I have learned a lot from reading all the feedback. This is the week of my finals and we are discussing mental illnesses and the therapy’s that are best suited.
Sileh on February 7th, 2010

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