Written by Lillian Reuman
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We all seek reassurance from one another, particularly as children. For individuals living with obsessive compulsive disorder (OCD) and related conditions, reassurance seeking can become automatic. Individuals seek reassurance from many sources – themselves (checking), others (asking), and research (the internet, etc.). However, the compulsion to “just make sure everything’s okay” usually reinforces the worry or obsession. Without psychoeducation and therapy, this habitual act may become all-consuming.
In seeking reassurance, individuals attempt to dispel their distress – whether or not the oven was turned off, whether or not their hands are clean, or whether or not that bump in the road was actually a person. By asking a friend or loved one for reassurance, the individual may feel a brief sense of relief: “the oven is off,” and “your hands are clean.” However, for individuals with OCD, this relief is short-lived and quickly replaced by an overwhelming demand for subsequent reassurance, just in case. This temporary anxiety reduction actually reinforces the compulsion. Individuals with OCD usually want more, as once is never enough.
Reassurance sought by those with body dysmorphic disorder (BDD) usually revolves around appearance concerns. For example, adolescents with BDD may constantly ask their parents if “[my] nose is too big” or they may take photos to inspect themselves. Like in OCD, these quests for reassurance may do more harm than good. A brief “you look great/fine” to an individual suffering from BDD may yield unintended consequences.
Many individuals with BDD have a hard time and may even become upset by compliments.” Individuals with BDD may…
– Interpret compliments as a joke.
– Overanalyze the compliment. Imagine this thought process: “he complimented my hair today … does that mean it looked awful every other time?”
– Believe that “they’re just saying it because they are my friend/mom, etc.”
Because these compliments conflict with the patient’s negative self views, this may lead to a loss of trust between the individual with BDD and those from whom s/he seeks reassurance. Alternatively, the shift from reassurance requests to reassurance demands can lead to increased arguments or the all-too-common fear: "what if they're lying just to make me feel better?”
In most situations, offering a compliment or a brief statement of reassurance to a friend or family member can be healthy and adaptive. However, for individuals with OCD and BDD, reassurance and appearance related compliments are likely to result in internal and interpersonal turmoil, even if they might produce a temporary reduction in anxiety. As a family member or friend, it makes sense that you’d want to do everything possible to reduce your loved one’s anxiety. In many cases, this may mean an end to reassurance.
Although reassurance seeking can be a challenge for all involved, it can be overcome. Appropriate psychoeducation and therapy (CBT) can help sufferers learn skills to gradually decrease reassurance seeking. Friends and family members can also learn steps to help refrain from offering reassurance.
Consistency is challenging but key to success. Remember that everyone is on the same team, with the common goal of supporting your loved one and not their disorder!
©2012 Massachusetts General Hospital OCD and Related Disorders Program | Reprint only with permission