All right, welcome back to the podcast. I am joined today with Kevin Foss. He is an OCD expert. He is a clinician in practice. And today we are going to be talking about something called real event OCD. This is when the past becomes a source of obsession. Some people I imagine with OCD really just have a lot of this and maybe they don't have a lot of the normal hand washing, contamination fears, but let's start it off. Kevin, tell us a little bit about real event OCD. Let's just launch into it. Awesome. Well, thanks so much for having me on. All right. So, yeah, you gave a really good snapshot of what that is. So, real event to OCD is a subtype of obsessive-compulsive disorder. And we call it real event. There aren't different diagnoses.

It's not like a whole separate thing from,

as you mentioned, contamination.

It's just another way that it manifests in.

It's kind of a colloquial way for us to get a really,

a quick shorthand to what the types of obsessions are,

the general themes that someone is struggling with.

So real event, as you said, it's going to be focused on something that actually did, in fact, happen. Whereas we contrast that with a lot of the other subtypes, they're related to things that could happen, that might happen, that if I do this or if I don't do that, then I'm going to experience some calamity or something I don't want. Whereas with real event, the obsession is about something that did happen. And then a lot of the remination is going to be about what effect that's going to have on the future, whether or not those values are, or like what value was broken, how do I atone for it, what sort of punishment should I accept or get, and or the compulsion has to do with trying to eliminate a sense of guilt and a sense of shame related to it. Okay, so you have a real event, then you have these obsessions which are unwanted thoughts, distressing thoughts. Sometimes it's like what really happened, but then sometimes they're questioning, I've had a couple patients who question if what happened, if more happened, like if they're forgetting some details that maybe like just getting real, like if they're having thoughts like, oh, did I hurt that child? When I interacted with my cousin, maybe they didn't really hurt the child at all. They didn't touch the child, but they're fearing these thoughts, these obsessions. Is that what we're talking about or is it, how would you kind of add to that? Yeah, and there's, there's, there's gonna be some, a lot of this ultimately, as we're talking about these sub types right at the end of the day it's all OCD right so it's all you know an obsessive thought of what if question right what if if then type of proposition which leads into sense of anxiety discomfort fear numbness terror whatever you want to call it an unwanted feeling state followed by a compulsion to try to undo that feeling or to try to make sure that whatever you're afraid of, whatever that feared story is, never comes to fruition. So there are going to be some disagreements and some nuances to what fits under this title of real event. And some people will kind of put it into that category of imagining what else could have happened. But regardless of all that. Yes, so to answer your more direct question, that fear of what are the compulsions that someone might do would be to go back in time in their memory and to try to figure out if something else happened, right? They might recognize, all right, I did hang out with my cousin or whoever it might be. There could be an imagined story of, well, did I do this, right? Well, I think what you're kind of alluding to also is there can be a false memory OCD, which is often attached to real event OCD. Real event again is gonna be, I know that I hung out with my cousin and we, I hung out with my cousin that day, right? False memory OCD can kind of come in and suggest, well, maybe you're not remembering everything correctly. Maybe you did something else. Maybe something else happened that would violate some sort of value that you have. You did something wrong. So in that, a lot of compulsions are going to be playing that story over and over and over again to try to figure out, was there something else that happened? I did this, they might have done this. They made this facial expression. I wonder what that means, playing all these out to try to get to a point of confirmation that nothing happened or get to this place of confirmation that something did happen so that they can take action on it. Some of the stuff that I would categorize as really clearly under real event would be things like a memory about, maybe cheating on a test in high school. Okay. They have that memory like I did cheat on that test. I know I did, right? No, it's wrong, I made that choice. But then the rumination might be about,

well, if I cheated on that test

and then if I didn't get that actual grade,

gosh, maybe I wouldn't have gotten

into the college that I got into.

And gosh, if I didn't get into that college,

maybe I wouldn't have gotten that career that I now have.

So, the long-term impacts of that

can just go and go and go. So that compulsion might be, well, I have to go back and see if I can find that same test. Like if I could prove to myself that I did know all the information on that test without cheating, well, I can feel better that getting into that college was justified. Or maybe I can go back to find my teacher and just confess to them and say,

hey, I should go to that test for them to say, you know, that's okay. You're you're absolved of this guilt and you can move on with your life. So I hope that answers your question or perhaps it makes a little bit more muddled. Yeah, and I think I think it's like what is normal guilt or grad? But, you know, first what is real event OCD?

Because I think I think it's like what is normal guilt regret? You know first what is real event OCD because I think There are people who do things that are wrong and they come to my practice and they grow You know and you set of values or they understand like oh, I did that thing and that didn't feel good and Then it's like okay. I have a value here that I didn't even know existed maybe. And then that leads to more thriving in the future. So that's different than necessarily what we're talking about here. And I think it's important to kind of differentiate the two. Right, right. I wonder what you're kind of talking about. And yeah, I can't see some of these folks as well, where they see that they might be, you know, hunting up on something or feel guilty about making a mistake in the past. The difference is gonna be with OCD is that there is this, it's persistent in the sense of guilt. It kind of doesn't let them off the hook a lot of times, right? There can be a sense of, you know, generally speaking, you know, when we see that we've made a mistake, we acknowledge it, we take ownership of it, we try to take some measures to apologize or make a tone meant for whatever those mistakes are, try to learn from it and then commit to not doing that or doing something different in the future. Someone with real event OCD, they're going to go through that process. But once they get to the end, their brain says, well, but what if it's worse than you actually imagined? So then they go back to the beginning of it and then ruminate about it again and so on, right? Or they've done the process, but that feeling just persists. So now the battle is, well, what do I have to do to get rid of this feeling and get to a sense of confidence and certainty again? Certainty, yeah. OCD, one of the things I took away from the Pinzell work, you know, episodes, Pinzell,

if you haven't listened to those on OCD, he's a leader in the field. I think you respect him quite a bit too, right? Here it is. And so he talked about how OCD is the doubting disease. Uh-huh. The shouting does not stop and I've seen these patients,

they'll spend four to six hours a day.

They'll spend every waking moment going back.

Absolutely.

...