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Real Incident Obsessions

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"Real event" Obsessive-Compulsive Disorder (OCD) involves intrusive and distressing thoughts, doubts, or fears about past events that are perceived as significant and distressing. Individuals with "real event" OCD may become preoccupied with the fear that they have caused harm, made a mistake, or acted immorally in the past. These obsessions often centre around the perceived consequences of their actions and may lead to compulsive behaviours aimed at seeking reassurance, undoing the perceived harm, or preventing future harm. Here are key aspects of "real event" OCD:

Types of "Real Event" Obsessions:

a. Harm to Others:

  • Individuals may obsessively fear that they have caused harm to others, intentionally or unintentionally. This may involve concerns about physical harm, emotional harm, or damage to relationships.

b. Mistakes and Responsibility:

  • Obsessions may revolve around the fear of having made a mistake with significant consequences, such as financial errors, professional errors, or mistakes with lasting impacts on oneself or others.

c. Moral Scrutiny:

  • Individuals with "real event" OCD may engage in intense moral scrutiny of their past actions, questioning whether they have acted in ways that conflict with their moral or ethical values.


Compulsive Behaviours:

a. Reassurance-Seeking:

  • Individuals may seek reassurance from others or repeatedly analyse the events in question to gain certainty about the consequences of their actions.

b. Mental Review:

  • Mental compulsions involve constant mental review or rumination about the past events, attempting to analyse every detail and evaluate the morality or consequences of their actions.

c. Avoidance:

  • Avoidance behaviours may include avoiding situations or people associated with the feared events. Individuals may also avoid activities that trigger distressing thoughts.

d. Self-Punishment:

  • Some individuals may engage in self-punishment rituals, such as self-blame, self-criticism, or attempts to "make amends" for perceived wrongs.


Impact on Daily Functioning:

a. Interference with Daily Life:

  • "Real event" OCD can significantly interfere with daily functioning, affecting work, relationships, and overall well-being. The constant preoccupation with past events can be mentally exhausting.

b. Emotional Distress:

  • Individuals may experience intense emotional distress, including guilt, shame, anxiety, and depression, related to their perceived role in the past events.

c. Isolation:

  • The fear of causing harm may lead to social withdrawal or isolation as individuals try to minimise their perceived impact on others.


Treatment Approaches:

  1. Exposure and Response Prevention (ERP):

  • ERP involves exposing individuals to the feared thoughts and situations related to the past events while preventing the engagement in compulsive rituals. This helps individuals learn to tolerate uncertainty and reduce the need for reassurance.

  1. Cognitive Restructuring:

  • Cognitive restructuring focuses on challenging and changing maladaptive thought patterns associated with "real event" OCD. This includes addressing cognitive distortions and developing a more balanced perspective on past events.

  1. Mindfulness-Based Approaches:

  • Mindfulness techniques can help individuals observe and accept intrusive thoughts without judgment, reducing emotional reactivity and the urge to engage in compulsive behaviours.

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