Responsibility OCD: Everything Is My Fault

Not so simple for people with OCD, especially if they struggle with responsibility themes. Someone with OCD might swerve and drive on, at first, because they’re running late for work. But later in the day, the bag of trash comes into their minds again.

“What if someone didn’t see the bag in time, and it caused an accident?,” they might think. “If someone had an accident because of the trash, it would be all my fault because I didn’t move it out of the way.” It doesn’t matter that dozens of other people probably also saw the trash and didn’t move it, either. Everything becomes all their fault.

They become obsessed with this fear. They ask their coworkers throughout the day if anyone saw the bag of trash, looking for evidence that they’re not a terrible person for not having moved it. They pray to their God, compulsively, for forgiveness. They might even return to where the trash bag was, trying to figure out if it may have caused someone harm. They become fixated on the fear that if someone got hurt, then they are to blame.

This is life with Responsibility OCD.

A Review of Obsessive-Compulsive Disorder

Symptoms of OCD

OCD, or Obsessive-Compulsive Disorder, is a neurological illness that is distinguished by the presence of two symptoms: obsessions and compulsions.

Obsessions are intrusive thoughts, mental images, or urges that the OCD sufferer experiences. These thoughts are unwanted, and cause a lot of anxiety and distress for the person having them. The obsessions can be about anything, from sudden thoughts about not really loving your partner to an urge to organize your surroundings so it’s “just right”. OCD obsessions do, however, often “attack” what you most value in life; for example, if you’re a deeply religious person with OCD, you may have the recurrent intrusive thought that you’re a terrible sinner.

Compulsions are the other side of OCD – the behavior that follows the obsession. Any kind of behavior can become compulsive; usually, OCD compulsions are ritualistic and repetitive mental or physical behaviors. The person with OCD performs the compulsions because they temporarily relieve the anxiety that obsessions bring.

Compulsions can be logically linkable to the obsessive thought or not. For example, someone may wash their hands over and over because of an obsession that they’re going to get sick. Another person may have the same obsession but touch doorknobs exactly three times ritualistically to avoid getting sick – a behavior that doesn’t seem to be logically connected to the fear.

Hyper-responsibility and OCD

We’ll talk about how an overwhelming sense of guilt and responsibility specifically affects those with responsibility OCD for the remainder of this article.

However, it’s important to point out that hyper-responsibility is actually a facet of all OCD. Hyper-responsibility is the false belief that we have more control or responsibility over the things that happen to us or around us than we really do.

In general, research has found that people with OCD experience a heightened sense of responsibility than people in the general population. One study found that, even compared with people with other anxiety disorders, people with OCD felt more distress in leaving potentially dangerous situations unresolved. They also took on a lot more responsibility over any harm that might come to people due to the fact that they didn’t resolve the dangerous situation.

In reality, so many things in the world are out of our control. People with OCD might know that deep down, but their disease still compels them to behave as though they will be able to somehow change the outcome of events.

For example, they might wash their hands for exactly 77 seconds to prevent getting sick. They might go back to check the locks, over and over again, so that no one will break into their home. They might avoid stepping on cracks in the sidewalk so that their mother won’t be hurt.

The thing is: even people who wash their hands religiously can’t avoid ever getting sick. Even secure houses get broken into sometimes. And many of our OCD rituals have no logical connection to whether or not we or someone else will get hurt.

Because of OCD hyper-responsibility, however, people with OCD feel like they do have some level of control over the things happening around them; that if they don’t perform their compulsions, then whatever terrible thing happens would be their fault. Most people with OCD do have some insight into the irrationality of their thought process, but they feel responsible enough that they continue with the compulsions anyway.

What is Responsibility OCD?

Responsibility OCD is not a defined subtype of the disorder, but many people with OCD can relate to its characteristics. Almost everyone with OCD suffers from some type of hyper-responsibility – but when people talk about responsibility OCD, they’re usually referring to people who experience a heightened sense of responsibility about what happens to other people, not themselves.

The Curse of Inflated Responsibility

Inflated responsibility is one of the most common cognitive distortions that people with OCD experience. A cognitive distortion is any irrational thought that a person typically resorts to when thinking about situations, especially situations that upset them. Some common cognitive distortions that people in general experience are black-and-white thinking, catastrophizing, or emotional reasoning.

When a person has distortions about inflated responsibility, they over-exaggerate their role or power over events and people around them – sometimes to the point where their thoughts are completely illogical or even take on a magical quality.

People who feel a sense of inflated responsibility feel like they have much more control over things happening around them than they really do. Everything is their fault, even the tiniest things that only marginally have anything to do with them.

People with responsibility OCD experience inflated responsibility about harm coming to other people because of them. They feel an excess sense of guilt, mistakenly taking on the responsibility of people around them – sometimes people they don’t even know – getting hurt.

Of course, it’s a sign of human empathy to care about what happens to the world around you, and even to try to prevent harm from coming to people. But inflated responsibility takes things much further than that – it’s a curse, not a quality. We shouldn’t confuse it with excess empathy.

In contrast to some other types of OCD (contamination OCD, for example), responsibility OCD is unique in that the irrational feeling of responsibility and guilt extends to other people, not themselves.

For example, someone without responsibility OCD may have obsessive fears that if they touch something they see as “dirty”, they will become contaminated and sick. Someone who has responsibility OCD worries that through their actions (touching something dirty), they will cause other people to become sick. They may have poisoned an innocent bystander because of their own “carelessness”, and maybe even caused them to die.

In its most extreme state, this sense of inflated responsibility can ruin the person’s life. They start to worry that every inconsequential action they take may cause severe harm to come to someone else. Magical thinking may start to come into play; they may worry that just a thought that they had will cause harm to come to someone else, even if they didn’t actually do anything at all.

They may start to compulsively avoid taking any action at all in order to avoid hurting people, but then the obsessions start to attack their inaction, too. Maybe by not taking action, they’ve caused someone to get hurt.

It goes on. There is no escape. No matter how much reassurance they seek that they haven’t caused anyone harm, it’s not enough. They need more. They keep obsessing.

The chronic sense of guilt follows them around, and life becomes almost unbearable.

Obsessions and Compulsions Related To Responsibility OCD

Of course, it wouldn’t be OCD without obsessions and compulsions. Lots of people might feel chronically guilty about things, but what characterizes OCD is the presence of these two specific symptoms.

Responsibility Obsessions

In general, people with responsibility OCD experience the constant fear that they, through their actions or inactions, have caused or will cause someone else to be put in danger or become hurt.

Some specific obsessions that a person with this theme of OCD might experience might be:

• Fear that you accidentally poisoned someone
• Fear of hurting someone through a careless mistake
• Fear that a inconsequential decision you made will somehow lead to harm coming to someone else
• Fear of causing an accident by not removing an item that could be “dangerous”
• Fear that you didn’t do enough to prevent harm from coming to someone else

Responsibility Compulsions

People with responsibility OCD may display ritualistic and superstitious behavior, especially if they’re experiencing magical thinking (“If I don’t do this ritual, then someone will get hurt.”).

Often, though, people with responsibility OCD experience mental compulsions rather than observable rituals. Responsibility OCD might be considered as a type of what used to be called “Pure-O OCD”, but although mental compulsions might not be visible, they’re compulsions just the same.

Some specific compulsions that people with responsibility obsessions perform might be:

• Compulsive prayer
• Excessive reassurance-seeking from others, even when it’s inappropriate
• Mentally reviewing memories for self-reassurance
• Checking; going back to check for possible hazards or for evidence that somebody was harmed

Gabriela: A Case Example

To illustrate further what responsibility OCD looks like, let’s take a look at the case of Gabriela, a woman in her 30s who’s been diagnosed with OCD.

Gabriela has a hard time not feeling guilty about everything that happens to people she comes into contact with.

One day, she meets a homeless man. The homeless man asks her for some change for bus fare, and Gabriela, being a helpful person, gives him some. Later, the thought enters her head: “What if the bus that the man got on crashed?” She has no evidence that the bus crashed, but she can’t keep worrying about the “what if”. If the bush crashed and he died, she thinks, then his death would be her fault, because she gave him the money to get on the bus.

This thought sends her into a near-panic, and it soon becomes completely consuming. She asks her friends and co-workers several times an hour for reassurance that she didn’t do anything wrong. She feels better when they tell her that she was just trying to help, but the fears start up again a few minutes later. She returns to the scene of her “crime”, trying to find the man. She refreshes the news every minute, looking for stories about bus crashes. She reviews her memories and her intentions over and over again; was she really trying to be helpful, or were her intentions more sinister?

After a few weeks of this, the fear about this specific man fades into the back of her mind – because it’s replaced by a new situation, a new person Gabriela believes she may have harmed. And so it goes, on and on, until Gabriela decides to get treatment.

Is All OCD Responsibility OCD?

Like we said before, most, if not all, people with OCD suffer from a heightened sense of responsibility – so, in some ways, we can say that any subtype of OCD can also be responsibility OCD, depending on what’s underlying their obsessions. If they’re obsessed with the possibility of being guilty for harm coming to others rather than themselves, then that could be considered responsibility OCD. Some specific examples of other OCD themes with responsibility undertones might be:

• Contamination OCD: Rather than be afraid that they’re going to make themselves sick, a person obsesses over the worry that perhaps because they touched something contaminated or didn’t wash their hands enough, they were going to accidentally poison their loved ones.
• Checking OCD: Someone feels like they need to check their locks over and over again, not because they’re afraid of any harm coming to themselves, but because they don’t want to be responsible for their pet getting hurt while they’re out.
• Suicide OCD: Someone is afraid of accidentally comitting suicide, not because they don’t want to die, but because they’re terrified of how hurt their mother would be if that happened.
• Relationship OCD: Someone is obsessed with whether or not their partner is really right for them; they’re not afraid of being alone, but they’re terrified of hurting their partner on accident and being held responsible.

How To Overcome Responsibility OCD

What Doesn’t Help Responsibility OCD

Before what we talk about how to overcome responsibility OCD, let’s talk about what you need to stop doing first. Many people with OCD, no matter what the nature of their obsessions are, feel that they need to avoid certain situations or ask for reassurance to just get a little relief from the unrelenting guilt.

This is a mistake. These types of behaviors are compulsions, and they don’t help – they hurt. In short, all the things that OCD drives us to do in response to worries and fears – like checking to just make absolute sure that we haven’t hurt anyone – are what keeps feeding OCD, making it more powerful and keeping us locked into this disease.

OCD doesn’t care about your, or anyone else’s, logical explanations. If we could win the unrelenting arguments in our heads with our OCD thoughts using logic, then OCD wouldn’t be the debilitating condition that it is.

OCD will never listen to your rational arguments and say, “That makes total sense! Okay, I’ll stop complaining, then.” It will never hear your friend telling you that you’re not a horrible person and be satisfied and go away.

Remember that OCD is called the doubting disease. That’s because no matter what, as long as OCD is controlling your life, that “What if…?” will always be there to torture you. If someone reassures you that you’re not a terrible person responsible for the deaths of many, OCD will say “But what if… this friend just doesn’t know you well enough to be able to tell that you actually are a terrible person?” If you review your memories for the hundredth time looking for some sort of “proof” that you didn’t actually hurt anyone, OCD will be right there with: “But what if… you’re remembering things completely wrong?”

To beat OCD, we need to stop the behaviors that keep us locked in the endless obsession-compulsion cycle. That’s an extremely hard thing to do – but it’s not impossible, especially with the right treatment.

CBT Can Help With Reducing Responsibility OCD Symptoms

All subtypes and themes of OCD are treated with the same interventions: usually a combination of Cognitive Behavioral Therapy (CBT) and psychiatric medications.

The general theory of CBT encompasses a fairly large range of psychological interventions; the CBT treatment that helps with OCD symptoms is called Exposure and Response Prevention, or ERP.

ERP helps people to 1. intentionally expose themselves to the intense anxiety that their obsessions bring and 2. work to prevent responding to the obsession with compulsive behavior. The idea is that we all get intrusive thoughts; the difference in people with OCD is that they place a huge amount of importance on the thoughts, ruminating on them and inferring meaning onto them until they become all-consuming.

Then, they feel like they need to perform a compulsion to mitigate the anxiety that this brings. The compulsion, of course, only brings temporary relief, so the person becomes locked into this never-ending cycle of obsessions and compulsions.

Instead of trying to challenge the obsessions themselves (remember, OCD will never be convinced by logical arguments), ERP helps people with OCD to break out of this cycle by getting comfortable with allowing these thoughts to be present without resorting to compulsive behavior to push them away.

So how would this work with responsibility OCD specifically? That depends on the exact obsessions that the person is experiencing.

Let’s take Gabriela as an example, taking her obsession that she’s responsible for this man’s death. Gabriela’s ERP therapist would help her expose herself to this fear through imaginal exposure, scripted exercises, or en vivo exposure. For example, perhaps Gabriela would read a news article in which someone with good intentions was persecuted for manslaughter.

Gabriela’s OCD would probably propel her to ask others for reassurance, to avoid (to stop reading the article), to pray for forgiveness, or any other compulsive behavior she usually employs. The key with ERP would be for Gabriela to remain present with the anxiety that the exposure brings without doing any of these things. Her thoughts might remain, but she will become much more able to brush them off without feeling like she has to do anything about them. She becomes free of the obsession-compulsion cycle.

ERP is hard, but it’s worth it. Over time, the obsessions will start to have less and less power over you, and may even start to feel silly. This is how people with OCD become free of the disease’s shackles.

At Impulse Therapy, we employ ERP as well as other evidence-based techniques to help people heal from OCD. Our self-guided audio program walks you through OCD recovery step by step, and even includes guided meditations and sleep sounds to ease anxiety.