What is Hyper Responsibility OCD?
There is a specific subtype of Obsessive Compulsive Disorder known as Responsibility OCD in which the individual struggles with an exaggerated sense of responsibility for external factors which are largely out of their control. People with this OCD subtype often harbor excessive guilt, absorb blame that is not theirs to take, and overly apologize for situations that do not warrant apology. Due to a fear of making a mistake or a fear of disappointing others, these individuals might engage in compulsive checking or reassurance seeking to prevent others from being upset with them.
What are some examples of obsessions and compulsions that are seen in people with Responsibility OCD?
People with hyper responsibility OCD may fear spreading illness to others and, in turn, wear a mask at the first sign of possible illness symptoms. In fact, they may wash down every surface they encounter or may choose to avoid contact with others at all cost.
People with Hyper Responsibility OCD may fear they have caused harm to others, such as accidentally hitting a pedestrian with their car. They may compulsively check the road for bodies, seek reassurance that the bump they felt was nothing to fear, or they might avoid driving altogether.
People might fear they left the stove on or the door unlocked and, if there were a fire or a burglary, it would be because of their negligence. They might compulsively check kitchen appliances and door locks, often not trusting what they see or what their brain registers. They may rely on others to reassure them of safety measures.
Unfortunately, the compulsive checking and reassurance seeking only alleviate anxiety in the short-term and ultimately reinforces the long-term fear response. The dependency on others to check for danger, harm or potential mistakes creates a feedback loop which contributes to the pathological doubting of the individual with hyper responsibility OCD.
What is the difference between excessive kindness and Hyper Responsibility OCD?
Excessive kindness originates from the desire to be helpful and generous whereas hyper responsibility comes from a fear of not doing enough or being enough. Although the two can overlap, kindness and generosity allow a person to stay in balance and feel a sense of pride. Yet fear-induced compulsions contribute to low self esteem, burn out, a loss of control, and possible resentment.
What is magical thinking and what is its role in Responsibility OCD?
When individuals do not feel in control of a situation, they might engage in magical thinking. It is a coping mechanism in which the anxious individual denies reality in hopes that by performing a particular ritual, they can control an outcome.
Often magical thinking is accompanied by intrusive thoughts about something bad happening. They might engage in mental counting, touching or blinking a certain number of times with the hope of a positive outcome or with the hope of warding off a negative one. People might engage in mental rituals in which they think of a positive thought in a magical attempt to neutralize a negative one.
Is perfectionism a characteristic seen in people with Hyper Responsibility OCD?
Most certainly people with an overvalued sense of responsibility tend to set high expectations for themselves and feel significant disappointment and shame when they do not meet these unrealistic or unfair demands. This self-imposed pressure can cause all kinds of anxiety responses, including chronic fear of making mistakes, compulsive checking for errors, seeking reassurance, magical thinking, over apologizing, over explaining, overthinking, avoidance, time management issues and procrastination.
How does Hyper Responsibility OCD relate to individuals feeling overly responsible for other people’s actions and feelings?
People with this type of OCD take on responsibilities that do not belong to them. They may go above and beyond reasonable expectations in order to make those around them happy. If someone around them is disappointed, they might feel they have failed to do everything in their power to ensure that person’s well-being or have failed to make them proud. People who have an overvalued sense of responsibility often surrender their own well-being in order to appease others.
In a social environment, people with this type of OCD may mentally review conversations they had, worrying that they may have said the wrong thing and could have hurt someone’s feelings. They might check over an email compulsively for fear of saying something insulting. They might even ask people for reassurance in case they inadvertently offended someone and would need to apologize.
Why is it difficult to set boundaries when struggling with Responsibility OCD?
People pleasing can often be linked to hyper responsibility.
Surrendering your own needs to make others happy is a common characteristic of this type of OCD. Feeling like you must overextend yourself at work or in your personal life just to avoid seeing others upset can make boundary setting challenging. It may feel easier to absorb excess responsibility than to deal with the wrath of your own mind telling you failed to do everything in your power to prevent the upset.
What is the treatment for Responsibility OCD?
The gold standard for treating OCD is a specific type of cognitive behavioral therapy (CBT) known as Exposure Therapy and Response Prevention (ERP). A trained specialist will be able to isolate the types of recurrent thoughts, worries, fears and preoccupations that lead to compulsive behaviors. And proper treatment will allow the person to break free from the perpetual cycle of ritualistic behaviors and thinking patterns.
About 80% of people who participate in this type of treatment will show significant improvement in their OCD symptoms. Length of treatment is generally between 3 to 5 months and sessions are usually structured to be weekly.
In ERP therapy, you will be encouraged to face your fear triggers while surrendering to the urge to perform a compulsion. An example of ERP would be if your doctor asked you to quickly turn on and off the stove, or unlock and lock the door, or send a quick email out to everyone on a list serve. Then, as you imagine a house fire, a burglar and an email riddled with profanity, you do not perform any checking rituals. These exposure will be systematic, going at a pace that is reasonable and agreed upon.
As you become stronger and more confident in tolerating these thoughts and feelings, you will become less dependent on obtaining short term relief from the rituals. You will view your thoughts and fears as a warning as opposed to a threat. You will recognize that the goal is not to rid yourself of thoughts, rather to learn how to manage your anxiety in the face of them without reaction. You will break free from this self-perpetuating cycle of anxiety as you understand your capacity to sit in uncertainty and discomfort.
Dr. Suzanne Feinstein is a Columbia University-trained Clinical Psychologist who specializes in evidence-based treatments such as Exposure Therapy and Response Prevention (ERP), cognitive reframing, mindfulness training and other CBT techniques to help people overcome symptoms of Obsessive Compulsive Disorder (OCD). In addition to OCD, she specializes in treating the full spectrum of anxiety, mood disorders, body focused repetitive behaviors and impulse control disorders.