Reassurance Seeking in OCD and Anxiety
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.
•The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
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