Excessive Reassurance Seeking

Defining reassurance seeking behaviour

Reassurance seeking is a behaviour characterised by the need for affirmation or confirmation from others. This can manifest in various ways, both explicit and implicit, and can be communicated verbally or nonverbally. Even when assurance has been previously provided, individuals may continue to seek it due to underlying anxieties or uncertainties.

Understanding reassurance seeking behaviour

Reassurance seeking is a natural response to uncertainty, lack of predictability, and the need for structure. It serves to calm doubts, allay worries, solidify plans of action, or guide decisions. Reassurance can be sourced externally or internally, and everyone uses a combination of both to navigate situations effectively.

Types of reassurance seeking

1. External reassurance seeking

   • Definition: Relying on others for feedback and affirmation.

   • Examples: Seeking advice from friends, asking for validation from a partner, or consulting a mentor.

   • Purpose: To alleviate anxiety by receiving support, confirmation, or guidance from others.

2. Internal reassurance seeking

   • Definition: Relying on oneself by drawing comfort and confidence from personal resources and capabilities.

   • Examples: Reflecting on past successes, using positive self-talk, or engaging in mindfulness practices.

   • Purpose: To build self-confidence and resilience by using internal strengths and coping mechanisms.

Balance of reassurance seeking

Everyone uses a combination of external and internal reassurance to handle situations effectively. The balance between these two types can vary based on individual differences and specific circumstances.

Benefits of external reassurance seeking

Support and validation

External reassurance provides emotional support and validation, which can be crucial during times of stress and uncertainty.

Perspective and guidance

Receiving feedback from others can offer new perspectives and practical advice that may not have been considered.

Building relationships

Seeking and receiving reassurance can strengthen relationships by fostering trust and mutual support.

Benefits of internal reassurance seeking

Self-Reliance

Internal reassurance fosters self-reliance and independence, empowering individuals to handle challenges on their own.

Resilience

Developing internal reassurance skills can build resilience, helping individuals to cope more effectively with stress and uncertainty.

Confidence

Relying on internal reassurance can boost self-confidence and self-esteem, as individuals learn to trust their own judgment and abilities.

Excessive reassurance seeking behaviour of concern

Reassurance seeking is characterised by a repetitive, compulsive need for affirmation from others, even after initial reassurances have been provided. This behaviour can be problematic, affecting both the individual and their relationships.

Characteristics of Excessive Reassurance Seeking behaviors

High frequency: Persistent and frequent requests to seek reassurance throughout the day.

Repetitiveness: Asking the same questions repeatedly, despite receiving consistent answers.

Dependency: Overreliance on others for emotional support and validation.

Anxiety-driven: Stemming from underlying anxieties, fears, or insecurities.

Short-lived relief: Temporary relief is quickly replaced by renewed doubts and anxieties, leading to a continuous cycle of reassurance seeking.

Psychological Underpinnings of reassurance seeking

Anxiety Disorders

Individuals with generalised anxiety disorders (GAD) or social anxiety disorder may seek reassurance to alleviate pervasive worries and fears.

Obsessive-Compulsive Disorder (OCD)

Obsessive Compulsive Disorder is characterised by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that an individual feels driven to perform in response to the obsessions.

The goal of these compulsions is often to reduce the distress associated with the obsessions or to prevent a feared event, even though these behaviors are not connected in a realistic way with what they are designed to neutralize or prevent.

It's important to differentiate reassurance seeking in obsessive compulsive disorder from similar behaviours in other disorders.

While individuals with GAD might seek reassurance about a wide range of worries, those with OCD typically seek reassurance about specific, recurrent obsessions. Similarly, while reassurance seeking behaviors in depression is often related to self-worth and validation, in OCD it is more about alleviating the distress from specific intrusive thoughts.

Seeking Reassurance as a Compulsion

When someone is obsessive compulsive, reassurance seeking is a common compulsion. Individuals with OCD may constantly ask others for reassurance to alleviate their anxiety about their intrusive thoughts.

For example, a person with contamination fears might repeatedly ask if their hands are clean, while someone with fears of causing harm might seek reassurance that they have not hurt someone. This behavior temporarily reduces anxiety but reinforces the obsession over time, creating a cycle of anxiety and reassurance seeking.

Depression

Particularly in anxious-preoccupied attachment, excessive reassurance seeking is used to maintain a sense of security and closeness in relationships.

Insecure Attachment Styles

Individuals with depression may seek constant reassurance to combat feelings of worthlessness, inadequacy, and low self-esteem.

It is important to note that ERS behaviour exists for a variety of reasons, and is particularly prominent in people with anxiety disorder, Obsessive-compulsive disorder, Hypochondriasis (excessively worrying about having a serious illness) and depression.

Impact of excessive reassurance seeking behaviour

Strain on Relationships

Constant reassurance seeking can frustrate and exhaust friends, family members, and partners, potentially leading to tension and conflict. Individuals who frequently seek reassurance often turn to their close ones to alleviate their anxiety. Over time, this can lead to a sense of burden among those providing reassurance. They may feel responsible for managing the individual's anxiety, which can lead to frustration and resentment. This dynamic can strain relationships, as the person providing reassurance might begin to withdraw or become less supportive, exacerbating the individual's feelings of isolation and anxiety. Moreover, the constant need for reassurance can overshadow positive interactions within relationships, making them primarily focused on managing anxiety rather than fostering mutual enjoyment and support.

Reinforcement of Anxiety

The temporary relief gained from reassurance can reinforce the behavior, perpetuating the anxiety and creating a vicious cycle. When an individual seeks reassurance and receives it, their anxiety diminishes momentarily. This reduction in anxiety serves as a reward, reinforcing the behavior. However, this relief is often short-lived, and the anxiety soon returns, prompting the individual to seek reassurance again. This cycle can make it difficult for the person to develop healthier coping mechanisms. Over time, the reliance on reassurance can increase, making the anxiety more entrenched and harder to manage. This pattern can lead to chronic anxiety, where the individual feels trapped in a cycle of reassurance seeking behaviors and experiencing temporary relief, without ever addressing the underlying issues.

Impaired Self-Esteem

Overreliance on external validation can prevent the development of self-confidence and self-efficacy. When individuals consistently seek reassurance, they are relying on others to affirm their worth and validate their feelings. This reliance can impede the development of internal validation and self-confidence. As a result, they may struggle to trust their own judgment and abilities, leading to a diminished sense of self-efficacy. Over time, this can contribute to low self-esteem, as the individual feels incapable of managing their own emotions and making decisions independently. This impaired self-esteem can further perpetuate the cycle of reassurance seeking, as the individual continues to seek external validation to compensate for their lack of self-confidence.

Emotional Exhaustion

Both the individual seeking reassurance and those providing it can experience significant emotional fatigue. For the person seeking reassurance, the constant anxiety and need for validation can be emotionally draining. The temporary relief they experience from receiving reassurance is often overshadowed by the persistent nature of their anxiety, leading to chronic stress and emotional exhaustion. On the other hand, those providing reassurance may also experience fatigue from the continuous demands placed upon them. They might feel overwhelmed by the responsibility of alleviating the individual's anxiety, leading to burnout. This emotional exhaustion can affect their overall well-being, making it challenging to provide support consistently. The mutual fatigue can strain the relationship further, as both parties struggle to cope with the emotional demands.

Social Withdrawal

In addition to the points above, excessive reassurance seeking can lead to social withdrawal. The individual may begin to feel embarrassed or ashamed of their need for constant reassurance, leading them to withdraw from social interactions. This withdrawal can reduce their opportunities for positive social experiences and support, further isolating them and exacerbating their anxiety. Additionally, friends and family may start to distance themselves due to the strain caused by the reassurance-seeking behavior, leading to a reduction in the individual's social network and support system.

Example

Jenny initially asked her teacher at the beginning of the day, ‘Is mum going to pick me up at 3pm?’ When her teacher would say ‘Yes,’ Jenny would ask, ‘How do you know?’

When her teacher would answer the question, Jenny would appear to calm down; however, over time, the need for external reassurance worsened until Jenny was asking these questions several times throughout the day.

The degree of her questioning also increased to a series of questions like, ‘Is mum going to pick me up at 3pm? How do you know? What if there’s a traffic jam? What will happen if mum gets here at 3:30pm? Will you leave if my mum isn’t here?’

It seemed as if the more questions the teacher answered, the more questions Jenny had. Jenny now asks these questions constantly, and the teacher can almost see that Jenny isn’t listening to the answers but thinking of the next question.

The example highlights how the need for external reassurance can become a never-ending cycle. Providing the external reassurance only relieves the child’s fear, worry and unease momentarily, but as soon as the external reassurance ends, the anxiety returns.

This happens because when the child feels anxious (e.g. What if mum doesn’t come to pick me up?), they seek safety through reassurance, which makes them feel better.

This bolsters their belief that if they hadn’t sought reassurance from an adult immediately, their anxiety may have increased, and the feared consequence may have happened.

Thus, the ERS behaviour is reinforced, which can snowball into the child requiring more and more reassurance over time.

Hence, ERS affects everyone involved and the child who is seeking reassurance requires necessary help to learn positive ways of behaving and managing their emotions.

Health Anxiety and Its Relationship with OCD ERS

Health anxiety, also known as illness anxiety disorder or hypochondriasis, is characterised by an excessive preoccupation with having or acquiring a serious illness. Individuals with health anxiety often misinterpret normal bodily sensations or minor symptoms as indications of severe medical conditions. This preoccupation can lead to significant distress and impairment in daily functioning.

Relationship Between Health Anxiety and OCD

Obsessive-Compulsive Disorder (OCD) and health anxiety share several similarities, particularly in how they manifest anxiety and compulsive behaviors:

1. Intrusive Thoughts:

   • OCD: Characterized by intrusive, unwanted thoughts (obsessions) that cause significant anxiety. These obsessions often revolve around fears of harm, contamination, or other specific themes.

   • Health Anxiety: Involves intrusive thoughts focused on health and illness. Individuals may obsess over the possibility of having a serious disease.

2. Compulsive Behaviors:

   • OCD: Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions. Common compulsions include washing, checking, and counting.

   • Health Anxiety: Compulsions include repeated checking of the body for symptoms, frequent visits to doctors, excessive research on diseases, and constant seeking of reassurance about health status.

3. Reassurance Seeking:

   • OCD: Individuals seek reassurance to neutralize intrusive thoughts and reduce anxiety. This reassurance seeking can be specific to the nature of their obsessions (e.g., seeking confirmation that they have not harmed someone).

   • Health Anxiety: Reassurance seeking is primarily focused on obtaining confirmation that they do not have a serious illness. Despite repeated assurances from medical professionals and loved ones, the anxiety persists, leading to a cycle of reassurance seeking behaviours.

Positive behaviour support resource for excessive reassurance seeking

Positive Behaviour Support (PBS) focuses on evidence-based strategies and person-centred supports that address the needs of the individual and the underlying causes of excessive reassurance seeking, to enhance the quality of life for both the individual and those that support them.

PBS recognises that there is no single cause for excessive reassurance seeking behaviour. It is a complex behaviour that is a product of the interaction between multiple factors contributing to its development and persistence.

Excessive reassurance seeking behaviour is like the tip of the iceberg so it is essential to look beneath the surface to work out the why before we can address the problem and help the individual stop seeking reassurance.

Based on the evidence-based approach of Positive Behaviour Support (PBS), E for Excessive reassurance seeking is a step-by-step guide that will help you develop a comprehensive PBS plan step-by-step. You will learn how to do the following:

1. Determine why your child is excessive reassurance seeking (assess),

2. Respond appropriately when your child seeks reassurances excessively (manage,) and

3. Prevent them from seeking reassurances excessively (prevent).

Use the practical tools (checklists, forms, and strategies) provided to develop comprehensive PBS plans that can be used to support children of all ages consistently in all contexts. This invaluable resource is useful for parents, caregivers, childcare educators, primary and secondary educators, supervisory, allied health professionals, and mental health professionals.