OCD and Guilt

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If you have obsessive-compulsive disorder or are close to someone who does, then you likely understand why OCD is sometimes referred to as the “doubting disease.” Doubt is what fuels the fire for OCD, and that is why those with the disorder need to be able to embrace living with uncertainty if they are going to beat OCD.

In addition to doubt, OCD sufferers typically deal with a lot of guilt. Over what, you might ask? Well, just about everything! OCD is typically accompanied by cognitive distortions, and many of these cognitive distortions can lead to feelings of guilt. For example, my son Dan suffered from hyper-responsibility. It’s not hard to imagine how his feeling responsible for “saving the world” led to tormenting guilt when things didn’t work out as he felt they should. Some other cognitive distortions that might lend themselves to feelings of guilt include black and white thinking, personalization, and thought-action fusion. A recent study of those with OCD focused on the precuneus, a part of the brain often involved with responsibility. According to the researchers:

The level of precuneus activity was greater for individuals with greater levels of obsessive-compulsive symptoms, and the activity increased when someone experienced greater ‘thought-action fusion’ – believing a negative event would become reality.

While those of us without OCD might become frustrated at what we perceive as our loved ones overblown feelings of guilt, these emotions are very real for OCD sufferers. Telling our loved one to “stop feeling guilty,” is likely to be as successful as telling him or her to “stop obsessing.”

So what do we do?

The first step, I believe, is to find a therapist who specializes in treating OCD. In addition to using exposure and response prevention (ERP) therapy, Dan’s therapist also helped him understand the cognitive distortions he was dealing with; this awareness alone was extremely helpful. The next step was to work on ridding himself of these cognitive distortions and this greatly reduced his feelings of guilt.

Guilt is a healthy emotion for us all. A child who feels guilty for “stealing” cookies from the cookie jar, or an adult who feels guilty for purposely hurting a loved one, are both displaying appropriate guilt. But when you add OCD into the mix, “appropriate guilt” often goes haywire, and can overtake the sufferer’s life. Just one more reason to seek treatment and work toward recovery.