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Summary
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A reader with Obsessive-compulsive disorder (OCD) fears that a vivid mental image proves they harmed someone and forgot it. They ask how to distinguish a real event from doubt-driven thoughts or a possible dissociative memory gap.
The response explains how obsessive doubt and anxiety can generate convincing scenarios and undermine confidence in memory, without making those scenarios evidence of an event.
It notes that some dissociative states involve amnesia but does not treat the feared event as established, and encourages psychotherapy focused on OCD and anxiety.
Question
Reader · Identity withheldI’m very worried that I might have done something completely against who I really am and forgotten.
\nI have OCD and a complex personality disorder so I often create thoughts in my mind that feel so real, but aren't. I sometimes fear I have touched people in inappropriate ways even when I haven’t. The thoughts feel very strong.
\nRight now, I’m struggling because I keep having thoughts that I may have hurt someone and blocked it out for about two years. I’m scared that I might have done something awful that disgusts me.
\nIs it possible that, during a dissociative state, I could have done something like this and forgotten it? Now, I have a detailed memory in my mind of what I think happened.
\nHow can I tell if this terrible thing really happened or if I’m just imagining it?
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Answer
Allan Schwartz, Ph.D.One of the classic features of OCD is doubt. Doubt is so strong that the person with OCD must question everything. Sometimes that questioning takes the form of repeatedly checking that something was really done, such as locking the car door or that the gas stove was turned off after cooking.
Another form it often takes is the fear of touching someone. If you are incorrectly convinced that you touch is harmful to others then you live in fear that you could have injured or infected a loved one.
\nAll of this is driven by huge amounts of anxiety and the wish to control and even eliminate that anxiety. It can get so bad that people with OCD can create all types of scenarios in their heads of disaster occurring as a result of something they fear they did or did not do. Basically, anxiety equals doubt.
\nBeing plagued with doubt can also affect memory, just as you are experiencing. Did I remember that even correctly? Did I forget something I should have remembered?
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It is true that certain types of dissociative states do include amnesia. One of them is what is referred to as a fugue state. Much like sleep walking, people can do things that they later have no memory of.
\nHowever, this is not true of most dissociative disorders. Therefore it is not likely you would have done something two years ago and not remembered it.
\nHowever, in the hands of someone with OCD, a “little knowledge” can cause lots of problems because that knowledge feeds the doubt. If you believe or even suspect that you might be dissociative that could strongly enhance your tendencies to doubt whether you did something disgusting or embarrassing. It doesn’t mean you did it. It just means you think you Might have done it.
\nPlease keep in mind that this type of anxiety disorder can and often does exist alongside personality disorders. By the way, personality disorders are complex.
\nI hope you are in psychotherapy, particularly cognitive behavior therapy for the OCD as well as for the anxiety. Research shows that Cognitive behavioral therapy (CBT) is effective both.
\nBest of luck.
Subject matter expert
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Integrative mental health care
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