If this question is familiar to you then you are almost certainly dealing with responsibility OCD on a daily basis. Responsibility OCD far outnumbers contamination OCD in terms of clients presenting for therapy now whereas the opposite was true in 2003 when I first started my practice. And confusingly, responsibility OCD can also be ‘disguised’ as contamination OCD therefore it takes some expertise to disseminate the two and get to the root of the problem. But those who are either spending hours a day online checking the symptoms of OCD or seeking numerous assessments from therapists are trying to reassure themselves that it is OCD and they aren’t ‘bad’ people. They believe they need confirmation that the violent/sexual/abusive images or thoughts don’t suggest something more sinister and/or pathological exists within them. Driving this overwhelming need for reassurance is an underlying sense of low self-worth, a long-standing dysfunctional relationship with themselves which culminates in placing others’ safety and happiness above their own. A history of being bullied, marginalised or abused often exists or there may be a self-imposed sense of not being good enough that has persisted despite achievements or success. Just by having OCD and considering they are a person with a mental health problem can underpin low self-acceptance.
The obsessional categories associated with responsibility OCD tend to fall in to these main areas:
- Worries about emotionally or physically abusing or harming others, particularly the vulnerable, e.g., children, elderly, etc. (sexual abuse features frequently as a subset of this obsession)
- Worries about abusing or harming themselves (due to the distress caused to others)
- Contamination, more specifically, contaminating others with germs or disease
- Committing crimes that impact others, e.g., fraud, theft, arson, etc.
- Road traffic offences, e.g., accidents, hitting cyclists or pedestrians
- Damaging other people’s property
- Damaging their own property (if funded by others)
The moral and ethical dilemma at the heart of responsibility OCD means that treatment must be holistic in nature, with a long-term focus upon addressing self-worth issues. We have developed a category of behaviour work within an overall treatment protocol that looks at self acceptance alone and comprises at least 20% of the therapy content. Without this focus, the very core of responsibility issues will not improve. Or if they do, they are in danger of morphing into another responsibility-based obsession.