Hyper-Responsibility and OCD
Hi Everyone,
As always I hope this post finds you healthy and happy. I’ve had a number of clients recently who have struggled with the issue of (hyper-)responsibility and that made me think it might be a good topic for the blog. I hope you find this helpful.
An Inflated Sense of Personal Responsibility
The issue of (hyper-)responsibility and the accompanying guilt shows up everywhere in OCD and across all forms of OCD. For many clients it is the core of their struggle with OCD. It can show up in a variety of ways. When experiencing an intrusive thought or image (“I could hit someone in that intersection!” Or ”What if there is asbestos or lead in my home!”) most of us would take reasonable precautions and then would drive through the intersection or continue to replace the old flooring in our homes, but when we have OCD we take this “threat” more seriously and are more likely to engage in excessive avoidance or safety behaviors to be absolutely sure that nothing bad can happen. If the avoidant and safety behaviors are not engaged in, the result is usually very strong feelings of guilt and shame.
Errors of Omission and Commission
Individuals with OCD also often believe they are responsible for preventing any possible negative outcomes that might arise from their obsessions (e.g. “If I imagine something bad happening, then I am responsible for making sure that it does not happen”). Errors of omission (not acting to prevent a negative outcome) are as bad as errors of commission (performing a bad act).
I am Responsible for My Thoughts and They Reflect Who I Really Am
Another way (hyper-)responsibility and guilt show up is in response to more general intrusive thoughts such as “If I think bad things, that is as bad as doing bad things!” or “If I think bad thoughts, then I must be a bad person!” These beliefs reflect more of a general attitude toward our intrusive thoughts and can lead to both excessive avoidance, safety behaviors and usually lots of guilt. People with OCD can believe they are responsible for the content of their obsessions and that their thoughts are actually a reflection of some dark/hidden side of their personality (which is not true). This is especially an issue (and particularly painful) with Pedophilia OCD (POCD) and Harm OCD (HOCD) where the person with OCD fears they might engage in inappropriate sexual behavior with a child or fears they could physically harm either a vulnerable individual or a loved one.
Some Examples
The young man I mentioned in my last post with Hit and Run OCD (fearing that every bump in the road was a person he just hit) was especially worried when he would drive after consuming Cranberry Juice Cocktail because the word “cocktail” suggested there might be alcohol in the juice (there isn’t!) and thus he would be driving impaired and be even more responsible for any accidents that occurred.
Another place where I often see this issue of inflated responsibility is when checking. When it comes to checking door locks upon leaving home, if my client is the last one to leave home they feel an extra sense of responsibility because it’s up to them to make sure the doors are properly locked, whereas, if their partner is the last one to leave then the responsibility is much reduced because it’s up to their partner to be the one who made sure the door was closed and locked properly.
Sometimes, the compulsion/safety behavior/avoidance relates directly to the fear. For example, you might believe that if you don’t check your door lock several times, your house will be broken into. At other times, the connection might not be clear. For example, you might believe that if you don’t turn three times to the right and then turn three times to the left, a loved one might die. Many of us knock on wood to prevent something bad from happening, which is a mild example of this issue.
So How Do We Treat This Issue of Hyper-responsibility?
Once again we return to Exposure and Response Prevention (ERP). Recognizing how OCD makes us believe things that are either simply not true or are greatly exaggerated is a great first step. All of my previous posts about ways to treat OCD and how to use ERP would apply here. At times literally ignoring what OCD is telling you, treat what it is telling you as irrelevant and not engaging in the compulsion, safety behavior or avoidance. And then doing this over and over again. Of course…much easier said than done.
As always, let me know if I can be of any help and I’m happy to answer any questions you might have. This post isn’t meant as a substitute for therapy and so if you’re struggling with anxiety/OCD please consult a qualified therapist.
If you know someone who might benefit from this post, please forward it to them and if someone was kind enough to forward this post to you and you’re interested in subscribing you can go here.
If you’re struggling with OCD then you might want to consider attending the annual International Obsessive Compulsive Disorders annual conference this summer in Denver, CO. I’ve attended many conferences and this one is hard to beat.
Stay Safe,
Dr Bob
PS: I thought I’d share with all of you my co-therapist “Georgie”. When I was seeing clients in person she was in the office with me every day and, if you were OK with it, she would gladly sit on the couch next to you throughout the entire session. I think she was more popular with many of my client’s than I was! Since my work is all remote these days, she is more or less retired but still is great to have around.
