Reassurance Seeking in OCD

Posted by in Obsessive-compulsive disorder (OCD) Although contamination OCD and washing rituals often go hand-in-hand, many rituals in this domain do not actually involve cleaning or disinfecting. These more subtle rituals are often based around reassurance seeking behaviors that become ingrained in everyday habit. In the context of exposure and response prevention (ERP), reassurance seeking OCD rituals are just as important to address as washing rituals. If you resist washing rituals but continue to engage in reassurance seeking rituals, your recovery will eventually stall (or perhaps never get started at all). Do you believe that knowledge is power? Do you aspire to optimum health? Do you believe that an ounce of prevention is worth a pound of cure? If so, you may be vulnerable to reassurance seeking rituals. Information-Seeking vs. Reassurance Seeking Reassurance seeking rituals involve mentally preparing for potential threats. These compulsions are often based around behaviors such as asking questions or looking up information about disease prevention, transmission, incubation, or symptoms. Because reassurance seeking rituals are subtle, they might easily slip past you. You might be thinking, “These behaviors are not rituals. They’re simply responsible behaviors.” Fortunately, not all information-seeking is compulsive. When I worked at the St. Louis Behavioral Medicine Institute (SLBMI), Alec Pollard discussed the differences between information-seeking and reassurance seeking. Because information-seeking behaviors are used to become informed, they involve asking questions one time (only) to obtain needed information. Information-seekers understand the limits of knowledge and ask answerable questions, accept uncertain answers (when appropriate), and use information obtained to draw conclusions. Decisions tend to be quick and result in some type of behavior change or action. In contrast, reassurance seeking behaviors are attempts to reduce OCD doubt and uncertainty, as well as anxiety. As such, reassurance seekers often ask the same question multiple times in slightly different ways. Many sources are consulted, and often the same source is consulted multiple times to increase understanding and reduce potential miscommunication. Reassurance seekers often worry that they haven’t understood the answer properly, and they frequently ask for answer repetition or clarification. Reassurance seekers often ask unanswerable questions or questions that their conversation partners cannot (or are not qualified to) answer (e.g., “Do you think I’m going to get sick?” or in the case of scrupulosity, “Do you think I’m going to hell?”). They often know the answer they want to get in advance of asking the question and have a difficult time tolerating...
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