Reassurance in OCD: An Enemy, Not an Ally
Ah, reassurance. According to the dictionary, it’s defined as the “action of removing someone’s doubts or fears.” While it’s omnipresent in Obsessive Compulsive Disorder, it’s prevalent in everyday life as well. In fact, the need for reassurance comes packaged with being human.
No Man is an Island
Certain people need lots of validation; others get by on far less (but they still need it to some degree). For example, kids who grew up without receiving adequate reassurance from their parents, who were criticized or shamed regularly, who were bullied or traumatized by peers, or who did not form healthy attachments to their caregivers may require more reassurance in adulthood. They may use this extra reassurance to fill a void, heal old wounds, improve personal confidence, and silence the voice inside their head that tells them they’re not good enough.
You don’t need a traumatic or problematic history to crave reassurance; it’s as vital to life as oxygen and even the most self-confident people need it from time to time (self-confident people may actually seek it more willingly as insecure people are more likely to pretend that they have all the answers or attempt to hide their vulnerabilities). The reason for its vitality is clear: Reassurance makes us feel good, it gives us hope, and it helps us know that, on a planet of 7.8 billion people, we matter.
Is Seeking Reassurance Healthy?
Seeking reassurance is kind of like drinking wine: In moderation, it’s healthy and beneficial but there is a boundary that swings the pendulum in the opposite direction. Reassurance helps us hone a sense of self and express vulnerability (which bonds people to one another). It improves our self-worth and our emotional wellbeing as well. Of course, it gives us plenty of comfort, too.
Giving reassurance has its own rewards, including the chance to empathize with the ones you love and the reminder that we’re more alike than unalike – we are all people with fears, worries, and insecurities.
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How Reassurance Influences OCD
In normal, everyday experiences, reassurance – as addressed above – is not a bad thing. In the context of OCD, however, it is. Even when it’s minor. Even when it’s done in moderation.
This isn’t to say people with OCD can never seek reassurance in a healthy manner; they can with one big caveat: That reassurance can’t involve their intrusive thoughts. If it does, it sidesteps healthy validation and, instead, acts as a compulsion that perpetuates the disorder.
For example, someone with Harm OCD who asks their wife if their outfit is suitable for a company holiday party is not asking for reassurance in the context of their OCD; they’re only asking for it because, as mentioned above, they’re human. Thus, in this instance, the reassurance isn’t detrimental.
On the other hand, someone with Harm OCD who asks their wife if they ran over a child when backing out of the driveway is asking for reassurance in the context of their OCD. In this instance, the reassurance is detrimental. We’ll explore this more a few sections later.
The Obsessions and Compulsions Dance
OCD is a neurobiologically-based mental illness driven by obsessions and compulsions. Obsessions manifest as intrusive thoughts that scare the sufferer. These thoughts are egodystonic (meaning they go directly against the sufferer’s genuine desires and values), uninvited (meaning they pop into the sufferer’s head against their will), terrifying, and anxiety-provoking.
The exact content of these thoughts depends on the type of OCD the sufferer has. For instance, a person with Contamination OCD may have an intrusive thought that their hands are tainted with someone else’s blood. A person with Relationship OCD may have an intrusive thought that their spouse is sleeping with their boss. A person with Harm OCD may have an intrusive thought that they’re going to stab their roommate with a screwdriver. And a person with Scrupulosity OCD may have an intrusive thought that they hate God.
Compulsions manifest as repeated behaviors or routines that sufferers engage in as an attempt to modulate their anxiety. In essence, people with OCD perform their rituals to convince themselves that their intrusive thoughts will not come true or have not come true already.
The majority of compulsions are visible – the sufferer physically performs them and engages in them in a visible manner (for instance, they might check the stove to make sure it’s off or check their car for signs of a hit-and-run). This, nevertheless, doesn’t mean they’re obvious: Many sufferers are good at hiding their compulsions and may perform them either behind closed doors or while appearing to engage in normal activity.
Some people have compulsions that exist fully in the mind – rather than engaging in physical compulsions, they engage in mental ones. These sufferers may perform their compulsions by mentally praying, silently counting to certain numbers, or saying certain words in their mind. Many people have both physical and mental rituals.
The context of the compulsions, like the obsessions, is dictated by the type of OCD the sufferer has (as the subtype dictates the obsession and the obsession dictates the compulsion).
For instance, a person with Contamination OCD who has an intrusive thought that their hands are tainted with someone else’s blood may repeatedly scour their skin with scalding hot water or bleach. A person with Relationship OCD who has an intrusive thought that their spouse is sleeping with their boss may check their spouse’s emails or text messages to look for evidence. A person with Harm OCD who has an intrusive thought that they’re going to stab their roommate with a screwdriver may check their roommate for wounds or check the screwdriver for hints of blood (or they may “avoid” the screwdriver by getting rid of it or throwing it into the rafters, out of easy reach). A person with Scrupulosity OCD who has an intrusive thought that they hate God may pray, repeatedly ask God for forgiveness, or go to confession.
Intrusive Thoughts in the General Population
Intrusive thoughts, even those similar to the ones mentioned above, are prominent in the general population (in other words, you don’t have to have OCD to have them). But the normal brain views these thoughts as meaningless, allowing the person to ignore them (which makes the thoughts go away or, at least, appear infrequently enough that they do not interfere with everyday life).
The OCD brain takes intrusive thoughts seriously, giving them power and causing the thoughts to pop into the mind more and more often. The reason for this likely has to do with neurobiological variations in the OCD brain. People with OCD typically have brains that are structurally and functionally abnormal, exhibiting problems with communication, a hyperactive amygdala (the part of the brain always on the lookout for threats), and lower-than-normal levels of key neurotransmitters (like dopamine and serotonin).
As a result, OCD sufferers possess several dysfunctional beliefs, including those that overestimate threats and those that erroneously cause the OCD sufferer to believe they are responsible for things they can’t control (defined as “hyper-responsibility”). People with OCD also suffer from thought-action fusion or the idea that thinking about something is the same thing as doing it. But, perhaps above all, those with OCD struggle greatly with uncertainty: In short, their disorder tells them that they need 100% assurance, 100% of the time.
Reassurance as a Compulsion
The need for certainty in people who have OCD leads them to seek reassurance as a compulsion (in truth, all compulsions provide reassurance to the sufferer, which is why they engage in them to begin with). In reassurance-seeking specifically, reassurance becomes one of the rituals, the routines OCD sufferers rely on to regulate the fear and anxiety caused by intrusive thoughts. Simply put, seeking reassurance in those with OCD is as compulsive as handwashing or repeatedly checking the coffee pot to make sure it’s off.
This reassurance ritual is performed in a variety of ways. Sometimes, people with OCD are obvious about reassurance-seeking. For example, someone with Contamination OCD who touches a mall escalator and fears that they might have come into contact with blood may ask their partner (assuming their partner was with them) if they felt anything wet on their own hands or if they saw anything red on the rail. They may also seek reassurance from medical professionals, either visiting their own doctor and requesting an HIV test or going online and asking HIV experts about the odds of contracting HIV from an escalator rail.
Someone with Relationship OCD who fears that their spouse will leave them may constantly ask their spouse if they love them and if there’s anything they can do to make their relationship stronger. They may seek reassurance so often that it proves problematic for their relationship, especially if their partner doesn’t understand OCD. In these cases, the partner might assume that the repeated requests for reassurance indicate a lack of trust.
Someone with Harm OCD who is driving with a passenger in their car may ask the passenger if they ran over a pedestrian whenever their car hits a pothole or road debris. Or, if they pass a bike rider on the street, they may ask their passenger to look in the side mirror to make sure the biker is still peddling behind them.
Someone with Health Anxiety OCD who is suffering from intrusive thoughts that they have a tumor may turn to the internet for reassurance (which is a terrible idea since the internet tells everyone that they’re dying). When the world wide web fails to give them this reassurance, they may request an MRI from their doctor by manufacturing symptoms.
But asking for or seeking this reassurance isn’t always this direct. People with OCD are extraordinarily clever in how they perform their compulsions (and how they get others to enable them) and many have developed sly tricks to get reassurance any way they can.
For example, someone with Harm OCD may be afraid of harming the child who lives next door. They may seek reassurance by asking others if they’ve seen the child around lately or if they’ve heard of any crime being committed in the neighborhood.
Someone with Checking OCD who is afraid they left the stove on when leaving for a trip may find clever ways of seeking reassurance from their spouse. They may ask their partner if they were in the kitchen or if they microwaved anything (reasoning that, if the stove is right below the microwave, the spouse would have noticed a lit burner).
Someone with Contamination OCD who kisses someone else and then fears that that person exposed them to HIV may find a way to inquire about that person’s sexual history or whether or not they have any open sores in their mouth.
Someone with Relationship OCD who fears their wife is in love with their coworker may say something negative about that coworker as an attempt to check whether or not their wife agrees with them.
Sometimes, the reassurance-seeking is so subtle that the person providing reassurance isn’t aware that they’re doing so.
Why Reassurance and OCD Don’t Mix
As previously addressed, reassurance isn’t always a bad thing. Even in those with OCD, it’s not harmful as long as that reassurance does not involve the obsessions and compulsions.
But, interestingly, people with OCD may not ask for everyday or “regular” reassurance as frequently as members of the general public. This is because OCD sufferers are all-too-often consumed by their obsessions, so much so that other worries fall by the wayside. It’s difficult to be concerned about whether or not an outfit makes you look fat when your OCD is telling you that your brother will die in a car accident because you didn’t pray hard enough last night.
When reassurance is sought in the context of OCD – when it’s used to neutralize an intrusive OCD thought – it’s done so in an attempt, on the sufferer’s part, to relieve anxiety. If given, this reassurance does tend to relieve anxiety on a temporary basis. But it’s always temporary: OCD, as a rule, is never satisfied, an imp in the mind that wants a mile for every inch you give it. The reassurance may sate the sufferer for a few minutes, a few hours, or perhaps a few days or weeks, but it’s only a matter of time before OCD rears its head again, instilling fresh doubt in the sufferer and a fresh need for more reassurance.
This is one of the reasons reassurance and OCD don’t mix: Like all compulsions, it’s futile because the anxiety always comes back. Yet the true danger in seeking and getting reassurance is that the reassurance ultimately worsens the disorder in the long run.
Like any compulsion, be it checking or counting or bathing, reassurance validates the intrusive thoughts, telling the sufferer, “These thoughts matter. They have meaning. They say something about you.” And this validation gives OCD power, making it bolder, bigger, and harder to ignore.
ERP and Reassurance
Exposure and Response Prevention (ERP) is generally the first type of therapy used for OCD (and by several accounts it is the most effective form of treatment). This type of therapy is extremely hard for the sufferer to do, resulting in lots of stops, restarts, and incomplete practice. Medication doesn’t eliminate OCD thoughts but it does reduce their sting, which is why it’s used in conjunction with ERP therapy. It makes the ERPs easier to complete.
During ERPs, the sufferer is asked to expose themselves to their intrusive thought and then refrain from engaging in their compulsion. To use the classic handwashing example, the sufferer may be asked to touch something they could perceive as contaminated (a toilet handle, a doorknob, a trash can) and then refrain from scouring their hands.
In a reassurance-focused ERP, the sufferer is instructed to expose themselves to their intrusive thoughts and then refrain from asking others for reassurance (or seeking it another way). Unlike most ERPs, where refraining is solely on the sufferer, ERPs around reassurance may involve others.
In reassurance-seeking, the OCD sufferer essentially outsources their checking to someone else (family, friends, spouses, or coworkers). Thus, during ERP, family, friends, spouses, or coworkers are instructed to refrain from giving the OCD sufferer reassurance, no matter how much they beg for it.
Like all ERPs, this is easier said than done, especially because the loved one sees the sufferer in distress and wants to relieve this distress (which they can do by providing reassurance). But, as previously addressed, this relief is short-lived and only compounds the illness in the long run.
OCD sufferers may be obvious in their attempts to seek reassurance (asking for it clearly or directly), which makes the ERPs more straight-forward. But, as noted earlier, people with OCD are extremely creative and may trick people into providing reassurance unknowingly. A good rule of thumb is this: If it feels like a compulsion, it probably is.
In the end, the need for reassurance comes with being human (though anyone who has ever had an eighty-pound dog sit on their lap during a rainstorm can probably argue that plenty of animals need it too). When sought in moderation, and in the context of everyday life, reassurance isn’t bad and may prove beneficial to self-worth, emotional wholeness, and relationships. But – in regard to OCD – reassurance, any reassurance, ultimately doesn’t help the sufferer at all. When it comes down to it, reassurance only reassures the OCD.