Did We Already Discuss False Memories and OCD?

Lately, the blogosphere and the online support groups seem to be filling with questions about so-called “false memories” in OCD. In fact, I can tell when it’s time to explore an obsession deeper when people start using it as a whole new label: False Memory OCD.

False Memory OCD refers to a cluster of OCD presentations wherein the sufferer becomes concerned about a thought that appears to relate to a past event. The event can be something that actually happened (but over which there is some confusion) or it can be something completely fabricated by the mind. It is not exclusive to any specific subcategory of OCD, but I see it talked about the most with people who are afraid of being sexually inappropriate or having committed some other irresponsible, immoral, or harmful act. Here are a few representative examples:

• A dad changes a diaper and afterwards an image pops into his head of having fondled his child’s genitals in the process. He knows he would never do such a thing, but the image is vivid. He wonders, is that just one of those random nonsense intrusions I get with OCD or is that a memory of a bad act I committed?  He plays the image over and over trying to prove that it is not a memory. When this fails to relieve him of discomfort, he returns to the child’s room to check for further proof that the child has not been harmed. Since he is unable to identify anything that proves harm one way or another, he tries to mime changing the diaper again and asks himself if that feels more like his actual memory of changing the diaper than the image in his head of having done the bad act. This also proves unsatisfying and he begins to worry that he will never be able to feel confident again that he has never harmed his child.

• A woman spontaneously recalls a night from years ago when she went dancing at a nightclub with friends. An image pops into her head of having been in the bathroom and crying about something. She can’t remember what it was that she felt upset about. She can picture herself looking in the mirror and feeling unhappy. Did she cheat on her boyfriend? Was that it? Did she kiss another man that night? She can’t remember doing that, but then she can’t remember exactly what bothered her. Wouldn’t she know if she had cheated on her boyfriend? But then she must have been upset about something, what was it? Or was she even upset that night? Could this image of crying in the nightclub bathroom just be a glitch in her memory or does it mean she blocked out something unforgivable?

• A man uses a restroom at the airport before boarding his flight. As he leaves the restroom, an image pops into his head of having a gay sexual encounter. The next thought that comes to mind is, “what if that image is a memory of something I did in the bathroom stall with someone?” He tries to ignore it, but can’t resist the urge to go back into the bathroom to see if there are any men in there that confirm or deny the image as a memory. This proves unsatisfactory because he can’t be sure of the face in the mental image. He tries to let it go and board the plane, but during his flight he begins to worry less about the potential that the act actually occurred and more about the idea that he may convince himself that the act occurred and start to believe that the thought is a memory. He imagines this mental error causing a range of problems in his life, including fearing gay denial, depression, and developing a pattern of convincing himself of other things that aren’t true.

The Morality of Uncertainty

To begin this discussion, I think we need to be careful when coming up with new titles for obsessions. OCD is OCD, so calling something “False Memory OCD” is already giving power to thoughts that the thoughts don’t deserve. OCD is a disorder that involves unwanted intrusive thoughts and a struggle to accept uncertainty about their meaning. So, there’s nothing unusual about thoughts that begin with “what if I did…” that separates that from “what if I will…” or “what if this means…” or any other what-if that comes up.

False memories are natural phenomena that occur in the mind from time to time. They are mental events that are perceived to be true about the past but are in fact false. There is reason to believe that people with OCD do actually experience more of these types of memories than the non-OCD population and that people with OCD tend to rely more heavily on a feeling of familiarity to assess whether a memory is true or a false. (Klumpp et al 2009). So, false memories (such as thinking you put your sunglasses on your desk when you really left them in your car) really may occur more for people with OCD. But often what we have come to call “False Memory OCD” is not so much about the presence of false memories but about the need to be certain about the truth or falseness of our thoughts. In other words, the obsession is often a morality concern over whether it is ok to be uncertain about the veracity of the images in our heads.

Is it ok to not know for sure if the thought in your head of having harmed a child is a true memory or a false memory? Can a “good person” just shrug and move on? Further, is it a memory at all or just a thought about what could be a memory? If I have a thought that I didn’t wash my hands earlier:

1. It may be a true memory of having walked by the sink in complete disregard of my hygiene (it probably is)
2. It may not be a true memory (I might have washed my hands and think I didn’t by accident)
3. It may be a thought that corresponds to no point in time, but just presents as a random image in my head (like most of my thoughts)

Those suffering with this obsession want to know perfectly clear distinctions between these three presentations of thought in the mind. Like all OCD, the disorder tries to get you caught in the weeds of the content of the thought rather than looking at the process of how you are relating to your thoughts.

Lack of Memory Confidence 

Many of these types of obsessions, though not all, spring from a heightened lack of confidence in memory. People with OCD are often doubtful of many things, including the veracity of their memories (did I mail that letter?). If this concern is heightened by experiences that corrode our memories, obsessions may be more intense. For example, a night of excessive drinking can result in memory gaps or blackouts. This gives the OCD ammunition to say something bad happened without you being able to defend yourself by saying you think you remember otherwise. You actually don’t remember in this case and can only rely on assumptions based on historical behavior. But even if you don’t drink to the point of blacking out, you may still know that you drank some and that this may have interfered in some memory retention, again fueling the OCD. Along these lines, memories from childhood can be rusty, so this opens the door for OCD to suggest that there are things you could not accept hidden somewhere in your subconscious. Since there are undoubtedly gaps in your memories from ten or more years ago, the OCD can point at those gaps and try to fill them with nonsense.

All this being said, so-called “false memories” can be the product of spontaneous intrusive images tagged with the question “is this just another intrusive thought or is it a memory of something I did?” They can also be a product of relatively uninteresting memories that have been distorted by compulsive mental review, much like overplaying an old audio-cassette. Repeatedly reviewing a thought (whether it is a memory or a random image), actually changes it and again chips away at your confidence in assessing it. Memories are not digital photographs of experiences, but actually complex combinations of data from all of your senses filtered through your emotional lens at the time you experienced the event. Looking at the same data later from another emotional state (e.g. terror that you may have done a bad act) actually changes the memory itself.

OCD Compulsions

All compulsions for false memory fears boil down to trying to prove with 100% certainty that an unwanted thought is not a true memory of an unwanted event.

• Mental review, mental review, mental review. The king of compulsions for so-called false memories is quite simply spending mental energy trying to make the distinction between a memory (the thing you don’t want it to be because it will mean you’re not worthy of being happy ever again) and an intrusive thought (the thing that you want it to be because it just means you have a debilitating mental illness). Mental review is both the hardest and most important compulsion to resist. Often you can’t preempt it, but the moment you notice you are doing it, you need to label it and jump off the mental train. Some people wash their hands, others try to wash their moral fiber, and reviewing an unwanted thought to assess its significance is a major mind wash.
• Checking can be literal as in checking to see if the thought is a memory by going back to the location where the thought originated to see if any evidence supports it being a memory. Checking can also come in the form of researching people online to make sure they were not harmed by the imagined event. It can also be more abstract, such as mentally checking to see if the thought feels more like a memory now than it did an hour ago. Research into this has suggested that repeated compulsive checking has been shown to reduce trust of one’s memories. (Radomsky et al 2006)
• Reassurance-seeking. Bringing other people into the mix (that is, other people who are not your OCD therapist) is rarely a good idea. People who care about you struggle to watch you squirm under the OCD and know that all they have to do is tell you it’s OCD nonsense. But this sends the message back to the brain that the thought is something more than a thought. Why else would you need to be reassured? Furthermore, efforts to collect objective information (e.g. texting people who might have been a witness to the event) are very likely to backfire because the answers are rarely satisfying, leading to more questions than relief.
• Confessing. This form of reassurance seeking (collecting reassurance through the reactions of those who receive your confessions) may sound like “I just want you to know that I may have done xyz.” This can also involve a variety of mental rituals that include imagining confessing your crime/sin or engaging in mental debates over whether something should be confessed.

Treating False Memory OCD 

First, stop calling it False Memory OCD. It is no different than calling it Unsure About the Content of My Thoughts OCD which might as well be called OCD OCD OCD. To understand how to tackle any manifestation of OCD, you have to understand a few core concepts:

• You don’t control what thoughts show up and when
• Everyone desires certainty that their fears are untrue but what sets people with OCD apart is the amount of life they are willing to sacrifice for this futile endeavor
• Everything you do to prove the thought untrue makes it seem more familiar and therefore more real
• It is not possible to know what one’s intentions were, only what they are in the present moment

The reason why this manifestation of OCD sometimes appears more difficult to treat is because it really combines an obsession with the past and an obsession with the future. There is an unwanted thought about a past event, real or imagined. The person with OCD wants to know that the event (or the worst possible version of it) did not occur. To tackle this obsession, the OCD sufferer has to stop trying to get certainty, which means ceasing/interfering in compulsive mental review, doing exposure to the idea that the event may have been exactly as imagined in its worst form, and letting go of all efforts to seek reassurance. In other words, like a lot of OCD therapy, a very fancy way of saying “whatever happened, happened and let’s move on.” Here’s where things get tricky. The moment this is attempted, it stirs up a related obsession, namely, what if I am a bad person simply choosing to live in denial of a bad act in the hopes that I don’t get caught? Fear of confronting this possibility can push susceptible people back into their old patterns of reviewing their memories and trying to get certainty about them again.

This way of OCD trapping you between one unacceptable reality and another may sound familiar. Consider that people who obsess about sexual orientation often oscillate between the fear of being gay and the fear of avoiding having to live as a gay person only by being in denial about being gay. Treatment, therefore, needs to operate along both fronts. The sufferer has to identify and abandon the review of the perceived past and eliminate all forms of reassurance, but also has to do exposure to the idea that doing so may reflect denial or a moral failure, a possibility that they may have to learn to cope with. Fear of not being able to let go of the false memory is as potent as fear of the false memory being true. Efforts to treat the memory obsession without also treating the fear of not being able to live with the possibility that they let something bad simply fade into the past will likely result in relapse.

Because “false” memories are sandwiched between presumably “true” ones, the OCD may place the cruelest demand of all on you, to be certain of your intentions in the past. If I remember sitting in a chair and then I can’t remember what I did after that, then what were my intentions when I got out of the chair? Compulsive efforts to answer this question and start investigating only lead to further doubts about what happened in that memory gap.

Some exposure strategies that may be helpful: 

• Writing imaginal ERP scripts in which you describe the false memory being true
• Writing scripts in which you describe coming to the conclusion that the false memory is true and having to live with the memory of a bad act that is in fact not true
• Writing scripts about not having OCD and instead living as a fugitive from taking responsibility for your (imagined) bad act
• Engaging in behaviors that trigger false memory concerns (e.g. changing diapers if you fear false memories about harming children)
• Spending time with people who you obsess were or could have been impacted by the imagined act

Cognitive Considerations

Challenging and reframing distorted thinking can be tricky with false memory fears because the key to beating the obsession is to stop working on the thinking. That being said, emotional reasoning (the distorted belief that things are true primarily because they feel that way) obviously plays an important role here. If your calling out the emotional reasoning helps you step back from responding to the thoughts with compulsions, then it might be worth noting. Magnifying, or viewing things as more important than they are, plays a key role here too since the obsession thrives on the belief that the presence of the thought alone is a big important reason to engage in compulsions. And, of course, catastrophizing, the assumption of negative outcomes that can’t be coped with, is common here, especially when the fear presents as an obsession with getting stuck with a false memory or never being happy without resolving it.

Mindfulness 

False memory obsessions are a mindfulness problem. No “doubt” about that. If mindfulness is the state of non-judgmental observation of your thoughts and feelings, then concern with false memories is a deficit of mindfulness and little else. Mindfulness is not a tool in the sense that it is something to be “used” in fighting a thought or getting it to go away. Mindfulness is a skill and as a skill it can enable you to expand your mind wide enough to make space for any thought, feeling, or combination thereof. To be mindful of your false memory obsession is to acknowledge that you are grappling with a thought and thoughts are not necessary to fight with. Thoughts are there to be observed as they pass by, but you have to let them pass by. These thoughts about some terrible thing you may or may not have done, over which your salvation depends on some elusive label (“intrusive thought” or “memory”) are really just interesting ideas. You noticed an interesting idea and you noticed that it came with a drive to eliminate it. What if this thought is not just the typical OCD junk I experience with some regularity, but is actually a memory of some terrible thing I did? What if I let it just be a thought and I’m wrong? Who does that make me? That is an interesting idea indeed.

But maybe it’s not really all that interesting. Maybe it’s a con. Maybe it’s just OCD doing what OCD does best, baiting you into distraction. In the end, you have to be willing to guess like everyone else about the content of your thoughts. Chances are if it didn’t bother you then, but it bothered you later, it’s OCD. If you take that chance, you might find that the baited question of whether this is an intrusive thought or a memory is not so interesting after all. You might be willing to do the hardest exposure there is and commit to treating OCD like it’s OCD and take the risk of acting as if all this junk mail in your head is irrelevant even when it feels like it could be something else.

References:

Klumpp, H., Amir, N., & Garfinkel, S. N. (2009). FALSE MEMORY AND OBSESSIVE–COMPULSIVE SYMPTOMS. Depression and Anxiety, 26(5), 396–402.

Radomsky AS, Gilchrist PT, Dussault D. Repeated checking really does cause memory distrust. Behav Res Ther. 2006;44:305–316.