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A person with checking OCD will go back to check repeatedly to ensure everything is as it should be. And even still, they may still not genuinely be convinced it is okay.
Compulsive checking occurs when people who believe that they have a special, elevated responsibility for preventing harm, mainly to others, are unsure that a perceived threat has been reduced or removed. They repeatedly check that all is safe. The intensity and duration of the checking is determined by the sense of responsibility, probability of harm, and anticipated seriousness of the harm. (Rachman, 2002, p. 626)
Individuals who suffer from Checking OCD often fear that they will somehow causeharm to themselves or others, whether intentionally or not.
It is associated with excessive anxiety, feelings of guilt, elevated vigilance, perfectionist tendencies, resistance to change, and an inflated sense of responsibility (Radomsky et al., 2010, 2022).
Checking Obsessions
Obsessions often take the form of repetitive, persistent ideas,unwanted or intrusive thoughts, images, or bodily impulses that are experienced as distressing.
The obsessive thought creates a sense of anxiety and fear. In theory, checking OCD can involve obsessions about anything.
For example, someone who fears leaving the door unlocked may be afraid that someone may break in and steal their possessions, or cause harm, and that they would be responsible for not having checked the lock initially.
According toJon Hershfield,MFT, director of The Center for OCD and Anxiety:
“People describe for me that they are sort of reading this spam junk mail that’s coming into their feed marked as urgent and they don’t know, are they supposed to ignore it, or are they supposed to open it and reply to it, which then teaches the algorithm to send you more of that stuff.”
When people pay excessive attention to their intrusive and obsessive thoughts, they may find it more difficult to get rid of them.
Some of the more common obsessions include:
Generally, people attempt to resist thinking of the obsession and get rid of the thoughts. But as people resist, the intrusion persists.
Checking Compulsions
Compulsions are repeated patterns of ritualistic behaviors, used to reduce anxiety and prevent an outcome, following a strong obsessive urge to do so.
Individuals suffering from Checking OCD will use checking compulsions to counter their fear-based obsessions. They believe that the best way to prevent something bad from happening is to use a compulsive checking ritual.
Checking serves to reduce doubt, prevent misfortune, and protect oneself or others from harm
checking ocd
Some common Checking OCD compulsions include:
The Checking OCD Cycle
Having unwanted thoughts, images, or urges (bodily sensations) of doing or saying something that will harm yourself or others is a very normal part of how our brains work.
People with and without OCD have these thoughts. It is not the thoughts themselves that are the problem, but rather the meaning OCD sufferers attribute to them.
These obsessive concerns cause anxiety and fears, which trigger OCD sufferers to perform checking compulsions to gain certainty that something terrible has not or will not happen.
By immediately reducing fear, checking prevents the natural process of anxiety from gradually fading on its own over time. The person never learns to become comfortable with normal levels of uncertainty.
Because anxiety is only relieved in the short term, the vicious, obsessive cycle of OCD will continue with the next intrusive thought.
Put simply, some event or thought will trigger an intrusive thought which gives rise to anxiety that, in turn, is responded to with a compulsion that eventually creates a sense of temporary relief.
When the anxiety is reduced in this way, the compulsion will be reinforced and grow stronger.
Checking robs the person of the chance to learn their fears are unlikely to come true even without rituals. No one can predict the future with 100% certainty, but we have to live with some acceptable level of uncertainty.
Repeated checking actually makes people trust their memory less. So, it creates even more doubt and uncertainty, further fueling the cycle.
So, the next time an intrusive thought arises, you are even more inclined to perform a compulsion (in this case, you are more inclined to keep checking).
For Example
A woman is constantly late for work due to her obsessive checking. Even though she woke up early and was ready to leave in time, she was stuck at her house, bombarded with intrusive thoughts.
Did I remember to turn off the stove? Did I unplug the toaster? Are all of the doors locked? What if a fire starts when I am not home?
She worries that her carelessness could result in tragedy. She gets stuck in a downward spiral of anxiety, doubt, and repetitive checking.
Real-Life Examples
“I spent several months compulsively checking my social media profiles and even comment sections on Youtube, Instagram, etc., every morning after waking up and as much as possible during the day, in order to see if I hadn’t posted, commented or liked anything I didn’t mean to. Same goes to messaging apps.”
“I am always careful when I go out to check and make sure I have my purse. One day I left my purse in a restaurant, and I never got it back. There was not much money in it, but it was so difficult replacing all the cards and cancelling my credit cards.
So now I always check around and under the seat I have been sitting on and actually make a habit of touching my purse to be certain I have it with me.”
Effects of Checking OCD
As with all types of OCD, the more a person engages in the obsession-compulsion cycle, the stronger the OCD can become, and the more the individual will distrust their own memory.
The pressure and exhaustion associated with this cycle can lead to other mental health conditions, such as anxiety and depression.
Checking OCD can have a severe impact on one’s daily life. It can feel impossible to focus at work, school, or with your loved ones when your mind is constantly preoccupied with your obsessive thoughts.
The condition can make it challenging to hold a job, drive a car, maintain a relationship, or simply leave the house. Suicidal thoughts, attempts, and self-harm behaviors have also been observed in those experiencing OCD.
People with extreme OCD will spend several hours daily repeating specific checking behaviors to relieve their overwhelming anxiety.
For example, someone with Checking OCD may be unable to leave the house for over an hour due to repeatedly checking the stove.
How To Stop Repeatedly Checking Everything
Checking OCD should not be solelyself-managed, and working with a mental health professional is critical. But, in tandem with this, there are some daily self-help steps you can take to ease the impact.
1. Do not identify with OCD
You are not the disorder, and your OCD does not define you. Yes, it is something you are dealing with, but you are not a defective human because of it.The intrusive thoughts you experience are not necessarily a reflection of who you are and do not say anything about you as a person. Try to remember that intrusive thoughts are common and do not always align with your core values, beliefs, and morals.Learn to appreciate yourself for who and how you are and practice leaning in, embracing, and accepting your unwanted thoughts, feelings, and sensations.
2. Why Compulsions Make Your Intrusive Thoughts Worse
People perform these compulsions in order to suppress their anxiety and neutralize their fears. They also carry them out to keep things safe, make sure that the thoughts do not come true, and make sure that something bad does not happen.However, while compulsions might “help” in the short term, they only make the intrusive thoughts worse and serve to keep the OCD cycle going long-term.Every time one engages in a compulsion related to the obsession, the thoughts will only become stronger in a powerful and debilitating loop.Compulsions will never make the intrusive thoughts go away; they will only reduce your anxiety and give you a short-term reprieve from your thoughts.If your brain has a pattern of carrying out a compulsion each time you get an intrusive thought, you will never learn to recover.
3. Do Exposure Exercises
Remind yourself habituation takes time. Urges and anxiety will eventually decrease on their own if you don’t perform compulsions.Keep records of what happens after you manage to sit with your intrusive thoughts and resist the urge to engage in compulsions. Use these records as a way to build confidence in your own memory and to reduce the amount of checking you do.
Treatment
Like with most types of OCD, the best course of treatment for Checking OCD isExposure and Response Prevention(ERP) therapy.
ERP is a type of Cognitive-Behavioral Therapy that is considered the gold standard psychotherapy for OCD and has been found effective for 80% of people with OCD.
In ERP for Checking OCD, patients are exposed to intrusive thoughts or feared situations to set off compulsions. This therapy is intended to purposely invoke more anxiety in attempts to disrupt the neural circuit between the processing and action parts of the brain.
Over time, patients learn to resist the urge to perform compulsive rituals and manage their OCD thoughts and actions. By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts and nothing else.
For example, for a patient who fears leaving the stove on and burning their house down, the goal of ERP therapy would be to allow this patient to leave their home without needing to re-check the stove multiple times.
The person is then instructed to refrain from checking the stove before leaving home. They eventually learn that despite their thoughts, the feared outcome won’t occur, and the anxiety will subside on its own.
This habituation process of repeatedly invoking anxiety and exposing the brain to a stimulus disrupts the neural circuit between the processing and action parts of the brain.
By sitting with the feared thought and leaning into the discomfort and uncertainty, patients learn that they don’t need their compulsions to cope, and that their fearful thoughts have no power over them.
Here is an example of a fear hierarchy for Checking OCD
The fear hierarchy is a collaborative effort between the individual and their therapist. The goal is to gradually expose the individual to the feared situations or stimuli while preventing them from engaging in compulsive behaviors or mental acts.
The list is arranged in a hierarchical order, starting with the least anxiety-provoking situation or stimuli (0% anxiety) and gradually progressing to the most anxiety-provoking (100% anxiety).
This exposure helps the individual to learn that they can tolerate the anxiety without resorting to compulsions or mental acts, and that the anxiety will eventually decrease on its own.
ERP takes time, effort, and practice, but people learn to cope with their thoughts without relying on ritualistic behaviors.
The compulsion to avoid anxiety is a powerful driver of OCD. Still, ERP is one of the most powerful tools available for treating OCD because it directs the patient to live with the anxiety and see that nothing bad will happen.
How to Help Someone with OCD
Here are some tips for family members to help someone with checking OCD based on the attached article:
Sources
Cougle, J. R., Lee, H. J., & Salkovskis, P. M. (2007). Are responsibility beliefs inflated in non-checking OCD patients?.Journal of Anxiety Disorders,21(1), 153-159.
Hershfield, J., & Corboy, T. (2020).The mindfulness workbook for OCD: A guide to overcoming obsessions and compulsions using mindfulness and cognitive behavioral therapy. New Harbinger Publications.
Rachman, S. (2002).A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40, 625-639.
Radomsky, A. S., Alcolado, G. M., Dugas, M. J., & Lavoie, S. L. (2022). Responsibility, probability, and severity of harm: An experimental investigation of cognitive factors associated with checking-related OCD.Behaviour Research and Therapy,150, 104034.
Radomsky, A. S., Shafran, R., Coughtrey, A. E., & Rachman, S. (2010). Cognitive-behavior therapy for compulsive checking in OCD.Cognitive and Behavioral Practice,17(2), 119-131.
Strauss, A. Y., Fradkin, I., McNally, R. J., Linkovski, O., Anholt, G. E., & Huppert, J. D. (2020). Why check? A meta-analysis of checking in obsessive-compulsive disorder: Threat vs. distrust of senses.Clinical Psychology Review,75, 101807.
Florence Yeung
BSc (Hons), Psychology, MSc, Clinical Mental Health Sciences
Florence Yeung is a certified Psychological Wellbeing Practitioner with three years of clinical experience in NHS primary mental health care. She is presently pursuing a ClinPsyD Doctorate in Clinical Psychology at the Hertfordshire Partnership University NHS Foundation Trust (HPFT). In her capacity as a trainee clinical psychologist, she engages in specialist placements, collaborating with diverse borough clinical groups and therapeutic orientations.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Julia Simkus
BA (Hons) Psychology, Princeton University
Julia Simkus is a graduate of Princeton University with a Bachelor of Arts in Psychology. She is currently studying for a Master’s Degree in Counseling for Mental Health and Wellness in September 2023. Julia’s research has been published in peer reviewed journals.
