Guilt in OCD
25th October 2019
Obsessive Compulsive Disorder, a condition characterised by obsessive thoughts and compulsive behaviours, is often accompanied by the terrorising trio of guilt, shame and disgust.
Taboo thoughts and feelings can lead suffers to experience guilt as the content of their obsessions become directly opposed to their morals or beliefs. For example, a religious person who experiences blasphemous intrusive thoughts may experience extreme guilt as a result of these thoughts as they believe them to be morally wrong. This has been well known and documented in OCD and is a symptom that many sufferers experience. However, research has suggested that guilt may play a more intrinsic role in the development of OCD rather than just being a symptom.
For a while researchers have investigated the idea that a risk factor for OCD is being especially prone to guilt (e.g. being more likely to experience bad feelings about committing perceived transgressions, even when these are private). However, this has produced inconsistent results. Research has instead suggested that an intense fear of feeling guilt may an underlying component of OCD.
Whilst guilt is an uncomfortable feeling for most people, when a fear of feeling guilty becomes disproportionate, or too severe and overwhelming, it can be problematic.
Studies have found that individuals with OCD are more likely to have a perception that guilt is more threatening and less tolerable than individuals without OCD. This is described as ‘guilt-sensitivity’; “the tendency to overestimate the negative consequences of experiencing guilt.”
High levels of guilt sensitivity may mean that any thought, action or belief that brings on feelings of guilt is likely to produce a lot of anxiety for the person and may result in attempts to avoid, or reduce this feeling, leading to compulsions as seen in OCD.
This is supported by research which shows that guilt sensitivity, as measured by the guilt sensitivity test, is highly correlated with compulsive checking behaviours, such as repeatedly returning to check that a door is locked. This link between guilt-sensitivity and checking behaviour remains even when considering individual’s levels of general anxiety and obsessional beliefs.
This of course makes sense – a person with extreme guilt sensitivity may feel the need to avoid feeling guilt at any cost, as they deem is unbearable. Therefore, they may become hyper-vigilant and repeatedly check that their actions have not, or could not, lead to any harm which could result in them feeling guilt.
These findings could have potentially significant implications and uses in the treatment of OCD. At the moment, Cognitive Behavioural Therapy for OCD generally attempts to target the sufferer’s obsessional beliefs of inflated responsibility, such as the belief that they are responsible for preventing harm. However, this research suggests that it would also be beneficial for CBT to target the individual’s beliefs and perceptions around guilt and distress.
Whilst the research into this relationship is still in it’s preliminary stages, it could be an important step to improving understanding of OCD and promoting efficacy of treatment – exciting stuff!
References:
https://www.ncbi.nlm.nih.gov/pubmed/28093822
https://www.apc.it/wp-content/uploads/2013/03/2015-individual-differences-GSS.pdf
https://www.jstor.org/stable/44318608?seq=1#page_scan_tab_contents
https://www.huffingtonpost.co.uk/entry/guilt-sensitivity-ocd_us_5898b015e4b09bd304bc8d1d