False Memory OCD and Real Event OCD

False Memory OCD is a subtype of obsessive–compulsive disorder in which individuals experience intrusive, unwanted doubts or fears that they may have committed a serious moral, ethical, or criminal act in the past. Unlike real events, these thoughts involve uncertainty—the person does not know whether the event actually happened. This uncertainty triggers intense guilt, shame, and anxiety. Attempts to resolve these doubts often result in compulsive behaviors and mental rumination aimed at finding certainty or neutralizing the anxiety.

Blackout OCD, often included in false memory OCD, involves worries about having done something during a blackout, whether from alcohol, other substances, or dissociative experiences. Individuals obsess over whether they acted in ways that contradict their values, often replaying the period mentally to check for evidence of wrongdoing.

Real Event OCD involves intrusive thoughts and persistent rumination about an event that the individual knows actually occurred. The OCD focuses on overanalyzing or obsessively replaying the act, exaggerating its perceived moral, legal, or ethical implications. Even though the event is real, the individual experiences excessive guilt, shame, and anxiety and often engages in compulsive behaviors or mental rituals to try to manage these feelings.

The critical difference between the two subtypes is certainty: False memory OCD, revolves around uncertainty about whether something occurred, while real event OCD revolves around an event that actually happened but is obsessively reviewed and analyzed.

The Fallibility of Memory in False Memory OCD

Human memory is inherently reconstructive, meaning it doesn’t function like a perfect recording device. Instead, each time we recall an event, our brain reconstructs the memory, which can be influenced by various factors, including stress, trauma, suggestibility, and the passage of time. This process is known as memory reconsolidation. PMC

When we repeatedly revisit a memory, especially under distressing conditions like those experienced in false memory OCD, the act of recollection can inadvertently alter the memory itself. This phenomenon occurs because the memory trace is malleable during the reconsolidation window, making it susceptible to integration of new, sometimes inaccurate, information. PMC

In false memory OCD, individuals often engage in compulsive mental reviewing of past events, attempting to ascertain whether something inappropriate or harmful occurred. This repetitive checking can lead to the incorporation of imagined details or doubts into the original memory, transforming it into a distorted version that feels just as real as the original. Sheppard Pratt

Understanding that memory is not a static, photographic record but a dynamic process subject to change can be empowering. It highlights that the intrusive memories experienced in false memory OCD, are not definitive evidence of past wrongdoing but rather reflections of the mind’s tendency to reconstruct and sometimes distort recollections.

Common Obsessions in False Memory OCD and Real Event OCD

False Memory OCD, (including Blackout OCD):

• Worrying that one might have committed a moral, ethical, or criminal act without being sure it happened.
• Obsessing over possible actions during memory gaps or blackouts.
• Intrusive mental images or “flashbacks” of potential past events.
• Rumination over ambiguous or partial recollections.
• Fear that uncertainty about one’s actions reflects a flawed character.

Real Event OCD:

• Replaying the actual event in detail and analyzing every action.
• Fear of judgment from others or being perceived as immoral or dangerous.
• Worrying excessively about legal, social, or moral repercussions.
• Feeling intense guilt or shame for having committed the act.
• Questioning one’s identity or morality in relation to the event.

Common Compulsions in False Memory OCD and Real Event OCD

• Reassurance-seeking: Asking others if they are “safe,” moral, or acceptable.
• Mental checking and rumination: Reviewing past memories, blackout periods, or interactions repeatedly.
• Avoidance: Steering clear of reminders or triggers associated with ambiguous or real past events.
• Mental neutralization: Praying, repeating affirmations, or mentally “undoing” past actions.
• Confession: Disclosing thoughts or possible actions to others to relieve guilt.
• Over-monitoring emotional or physiological responses to detect moral failing.

These compulsions, especially mental rumination, provide only temporary relief and reinforce the OCD cycle.

Treatment for False Memory OCD and Real Event OCD

Evidence-based treatment combines ERP, Acceptance and Commitment Therapy (ACT), mindfulness-based approaches, cognitive therapy:

• ERP:
  • In vivo exposures: Confronting real-life reminders of feared or ambiguous events while resisting compulsions and rumination.
  • Imaginal exposures: Deliberately visualizing feared or ambiguous events (e.g., possible blackout scenarios) while resisting mental rituals.
• ACT and Mindfulness: Tolerate uncertainty about past events or memory gaps without compulsive reviewing and act according to values.
• Cognitive therapy: Challenges beliefs about thought–action fusion, moral contamination, and exaggerated responsibility.

ERP Examples in False Memory OCD and Real Event OCD

• In vivo exposures: Visiting places or contexts related to ambiguous past situations (e.g., bars, social gatherings) while resisting rumination or checking.
• Imaginal exposures: Writing or vividly imagining a possible past act or blackout scenario without mental neutralization.
• Mental ritual prevention: Allowing intrusive thoughts to arise without analyzing, neutralizing, or reviewing them.

False memory OCD, including blackout OCD, causes intense distress when individuals are uncertain about things they may have done in the past. Real event OCD involves obsessive rumination about an actual event. Both types can lead to overwhelming guilt, shame, and compulsive mental checking. Learning to accept that human memory is fallible can help individuals recognize that gaps in memory do not automatically mean wrongdoing. Evidence-based treatments can reduce compulsions, help people tolerate uncertainty, and allow them to live their lives without being overwhelmed and stuck in their intrusive thoughts and memories.