The reassurance trap in OCD explained and tips on how to deal with it
'Did you see me wash my hands? The husband asks his wife.
'Yes, you did', she replies.
'But did you see me do it properly?
Although not exclusive to OCD, excessive reassurance-seeking (ESR) is often a lesser-known feature of OCD. But it can often be one of the most debilitating symptoms of OCD and have disastrous consequences for relationships as those around the person with OCD become ‘recruited’ into and trapped in the OCD cycle with their loved one.
ESR can take many different forms; the husband with contamination fears repeatedly asks his wife if his hands look clean, even though they are crimson and bleeding. Or the friend who needs you to tell her that she did not run anyone over when she drove somewhere. Regardless of what form excessive reassurance takes, for the OCD sufferer, it can often feel like another trap that OCD has set; another behaviour, alongside the compulsions, that feels very necessary and is hard to stop.
This article will:
- Explain the difference between self-reassurance and reassurance from others
- Outline why people seek reassurance in OCD and how it fits into the OCD cycle
- Discuss how ESR impacts on relationships
- Give tips on how to support someone with OCD who experiences ESR
Self-reassurance vs reassurance from others
There are two different forms of reassurance seeking in OCD: self-reassurance and reassurance from others. Self-reassurance is a form of mental checking and allows the person with OCD to reassure themselves, for example, that they have washed their hands thoroughly or locked the front door.
On the other hand, reassurance from others can be seen as a safety behaviour that enables the OCD sufferer to reduce further the risk of harm or negative consequences. This can take different forms. For some, it might be simply asking someone for reassurance; for others, the OCD sufferer may employ a loved one into doing their compulsive behaviour. For example, ask them to watch whilst they complete a hand washing ritual to check it has been done right. Seeking reassurance from others can be both covert (i.e., subtle) and overt (more obvious and direct).
Why do people seek reassurance in OCD?
We all seek reassurance from others when we feel under threat or anxious or uncertain about something. It helps reduce the anxiety we feel when a trusted person tells us it will be ok. But in OCD, the reassurance is excessive. Cognitive-behavioural theories of OCD posit that ERS is primarily a safety-seeking behaviour and reduces a person's sense of threat and uncertainty in the short term. But this effect diminishes in the longer term and increases the urge to seek reassurance repeatedly when anxiety or obsessive thinking returns. Hence, a vicious reassurance cycle gets set up.
Engaging in ESR may also help an OCD sufferer feel that they have somehow transferred responsibility to another person (Halldorsson & Salkovskis, 2017). For many people with OCD, alongside the typical overestimation of a perceived threat, inflated responsibility can be a central feature of the symptoms. Inflated responsibility is a belief that the person with OCD is responsible for preventing harm to themselves, loved ones or other people.
For example, Tim experiences obsessional thoughts about causing harm to his family by somehow contaminating their food. He avoids using cleaning products in the house and washes his hands excessively when preparing food for his children because he fears that his hands are contaminated with something that would make his children sick. Most people would agree that parents have a responsibility to make sure their children are safe, but this is often the difficulty in OCD. The kernel of truth that, as parents, we need to keep our children free from harm where possible becomes distorted in OCD - the inflation of that responsibility becomes problematic. So, with Tim, this morphs into - at all times, he feels that he must eliminate all potential harm that may come to his children through his actions or inaction. Of course, it is not possible to eliminate all possible risks to our children, but in OCD, the sufferer goes to great lengths to try and make this happen.
What impact can excessive reassurance-seeking have on relationships?
Having a partner who repeatedly asks you for reassurance can be immensely frustrating and stressful. It can also be challenging for loved ones to understand the person's fears and obsessions, or they may even find them bizarre or nonsensical (Haldorsson & Salkovksis, 2017).
It can be challenging to support someone when you don't understand why they are anxious. Kobori et al (2017) asked carers about their experience of giving reassurance. They found that although carers agreed that reassurance-seeking did not help in the long term, not giving reassurance would result in the sufferer feeling much worse, hence their engagement with it. Similarly, Haldorsson et al (2015) found that carers reported persistent reassurance-seeking had negatively impacted their relationship with the person with OCD. In addition, feelings of anger, disappointment, and mainly frustration were common.
How to support someone who seeks excessive reassurance
Traditional psychological treatments have typically emphasised that people who experience OCD should stop seeking reassurance and that the family should ignore or withhold reassurance requests. This should, in theory, break the vicious cycle that is set up whereby the OCD sufferer has to seek reassurance to alleviate anxiety. But research has found that stopping/not reassurance-seeking can actually increase distress for the family member and produce negative emotional and behavioural responses from the OCD sufferer (Halldorsson et al 2016).
An alternative approach is to help the person experiencing OCD to seek support rather than reassurance (Neal & Radomsky, 2019). Receiving reassurance helps reduce the uncertainty someone is feeling - they need to check what they think is true/not true and therefore gain certainty to reduce anxiety. On the other hand, seeking support with difficult thoughts (obsessions), feelings (anxiety) and urges (to get reassurance and certainty) enables the person with OCD to learn to tolerate and manage more helpfully feelings of uncertainty and anxiety. So, some responses to reassurance seeking could be:
I can see that you are really anxious about (feared consequence/obsessional thought). But remember, I am here for you.
The reassurance seeking is showing up, isn't it? Shall we just notice that and think about what else might help you manage the anxiety?
I know you want me to give you lots of reassurance right now, and I know it's hard. What might be a more helpful way of dealing with your anxiety right now? How can I help you with that?
Are you asking me to reassure you? Ok, I know that this is challenging for you. But, I wonder if you could do something else to cope with the anxiety? Shall we think together about what might help?
In these examples, the responses contain at least two of the following elements:
Noticing the person's distress or need to be reassured
Naming the reassurance-seeking as an internal urge that is showing up
Giving a sense of support and encouragement
A question about what is going to be more helpful in enabling the person to manage their anxiety and distress, empowering them to seek out an alternative behavioural response to the urge.
It is important to remember that such a response may not be helpful at times of very high anxiety, so a flexible approach is best.
Sometimes giving reassurance may be the best thing to do at that moment. At other times, when there is not so much anxiety, trying out the responses above may be helpful. If the person is in psychological treatment for OCD, talking with their therapist about how best to respond to reassurance and coming up with a plan together will be important.
Reassurance seeking is another behaviour in OCD that can be debilitating and cause problems in a person's relationships. Often family or carers of people with OCD do not know how best to manage a person's need to be reassured, and there can be conflicting messages about whether to give reassurance. As outlined here, encouraging the person to seek support with the urge to get reassurance or certainty is a useful alternative to giving reassurance. Used flexibly, it may help to gradually loosen the grip that OCD has on someone's life.
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Kobori, O., Salkovskis, P. M., Pagdin, R., Read, J., & Halldorsson, B. (2017). Carer's perception of and reaction to reassurance seeking in obsessive compulsive disorder. The Cognitive Behaviour Therapist, 10.
Halldorsson, B., Salkovskis, P.M. (2018). Why Do People with OCD and Health Anxiety Seek Reassurance Excessively? An Investigation of Differences and Similarities in Function. Cogn Ther Res 41, 619–631.
Halldorsson, B., Salkovskis, P. M., Kobori, O., & Pagdin, R. (2015). Reassurance Seeking in OCD, Journal of Obsessive-Compulsive and Related Disorders, http://dx. doi. org/10.1016/j. jocrd. 2015.11. 003.
Halldorsson, B., Salkovskis, P. M., Kobori, O., & Pagdin, R. (2016). I do not know what else to do: Caregivers' perspective on reassurance seeking in OCD. Journal of Obsessive-Compulsive and Related Disorders, 8, 21-30.
Neal, R.L. & Radomsky, A. (2019). How Do I Say This? An Experimental Comparison of the Effects of Partner Feedback Styles on Reassurance Seeking Behaviour. Cognitive Therapy and Research, 1-11.