Seeking reassurance is a very common symptom of OCD, but also normal human reaction to worry or doubt, which makes it a particularly complex part of OCD to navigate, both for the person with OCD and the people in their life. Like with intrusive thoughts, reassurance seeking is something that every person experiences, and research has found that there isn’t much difference in the topic, but rather in the degree of distress experienced by people with OCD compared to others.
What is Reassurance?
Assurance is making sure of something, and makes sense in any context, especially when there is doubt.
Reassurance is making sure of something again, and this is what can become a compulsion in OCD, as the person will be making sure again and again, instead of the doubt being resolved by assurance. Often the person will consciously or logically be aware that they don’t need the reassurance, but the doubts brought on by the OCD will bring them to keep seeking it.
Reassurance seeking can take various forms
The most noticeable version is explicitly asking something, often something that has been answered already or is obvious. Some common questions might be “Did I do a bad thing?” “Are you upset at me?” “Is a bad thing going to happen?” but as with everything in OCD they can be about any topic.
Another form of reassurance seeking is watching something to make sure it happens, for example the person with OCD might watch their partner wash their hands to reassure themselves that they’ve actually done it, even though they do believe the partner when they say they have.
A more subtle way of seeking reassurance is to mention something and watch other people’s reactions. For example saying “I bumped into someone while crossing the street” and checking whether the person seems concerned by this.
Reassurance Seeking in OCD
Within the cycle of OCD, compulsions are used to relieve the anxiety that is brought on by intrusive thoughts. These can be used to prevent the perceived danger, like washing hands to avoid spreading germs, or to reduce the anxiety itself, like avoiding places that trigger intrusive thoughts.
Reassurance seeking falls into both of these categories through reducing the sense of responsibility that the person with OCD feels. Through reassurance seeking, a person draws the attention of others to the perceived danger and shares the responsibility of making sure things are safe, thereby reducing both the likelihood of the danger and the burden they feel to resolve it.
Like with all compulsions, the initial relief in anxiety that the person feels when they get reassurance does not keep the anxiety at bay. The OCD will be telling the person that once they get just enough reassurance they will feel better and be able to move on from the concern, but in reality the doubt eventually resurfaces, or a new one will take its place. Even though the person will feel less and less reassured with time, it will still be more than if they didn’t receive any reassurance at all, which is why they will keep seeking reassurance even though the anxiety keeps coming back.
Like with any other compulsion, reassurance seeking provides relief from anxiety in the moment, and the anxiety will “bounce back” after some time. In the long term, which can range from days to years, it will sustain the person’s worries and encourage the pattern of seeking reassurance for their anxiety.
So should I refuse to give reassurance?
Seeking reassurance can take up a lot of a person’ time and energy, and can be very frustrating to feel stuck in. It is also difficult for the “seekee” – the person offering reassurance. It can be distressing to watch someone they care about be so anxious, and offering reassurance is an instinctive way to try and help. It can also be frustrating to keep reassuring someone all day or to keep going through the same reassurance repeatedly, but it’s often difficult for the “seekee” to think of an alternative.
Refusing to give someone reassurance is much like turning the water off or physically stopping someone from carrying out their compulsions – not only will this make them more anxious in the moment, but it will just result in them finding an alternative way to get relief from their anxiety. The key is not to block the compulsion but rather to support someone to choose to stop seeking reassurance.
Research done on reassurance seeking has shown that, if the person with OCD is not in treatment, the spike in anxiety when someone is refused reassurance is worse than the constant return of it after receiving reassurance. The same pattern has been found in guilt levels for carers and loved ones involved in the reassurance seeking. Carers have been found to be quite accurately aware of the anxiety levels of the person with OCD, so offering reassurance to avoid a spike in anxiety helps them feel like there’s something they can do to help.
Once someone is in treatment (medication, CBT, or self-help), they are better able to work towards reducing reassurance seeking, supporting them with this is very important. If the person is attending CBT with ERP, it’s important that their carer be invited into a session to discuss how to best support with this.
Tips for carers (of people receiving treatment)
Over time, a person’s OCD takes over everything – their thoughts, emotions, time, energy, and life! It can also take over their relationships with people, and reassurance seeking can become the main form of interaction with loved ones. When working towards reducing reassurance seeking, it’s important to reclaim and rebuild the relationship. Find things to do or ways to relate to each other again outside of reassurance seeking.
Not seeking reassurance in a moment of high anxiety takes a huge amount of effort and can be very challenging. Acknowledging this is important and can be very valuable to the person and your relationship with them. It can also help the person feel more confident in asking for help with calming down or soothing, for example by asking for a hug or a cup of tea.
When asked for reassurance, think about whether it’s reasonable, keeping in mind the difference between assurance and reassurance. Repetitiveness is the issue, so focus on supporting and encouraging the person not to keep asking.
Sometimes the person you’re caring for will be in a very anxious state, and you will need to go along with the reassurance seeking in order to get the day going. It is very difficult to try to find an alternative or strategy in the moment when the anxiety is so strong, so don’t try to figure it out in the moment. Rather, take some time to discuss it in a moment of calm – people with OCD are generally quite good at coming up with strategies. If they are in therapy, encourage them to talk about it with their therapist as well.