OCD Guilt: Why It Happens & How to Cope

What Is OCD Guilt?

Obsessive compulsive disorder (OCD) guilt is characterized by persistent and excessive experiences of guilt. Guilt can be a positive and motivating emotion, as it promotes prosocial behaviors.² But when someone with OCD experiences guilt, it can lead to debilitating cycles of shame. These shame cycles often lead to the performance of compulsions to neutralize experiences of OCD guilt.

What Causes OCD Guilt?

Research shows individuals with OCD often have a heightened sense of moral responsibility and carry the core fear of acting irresponsibly toward themselves or others.¹ They may experience an inflated sense of responsibility for their actions and may ruminate on being morally flawed based on the content of their intrusive thoughts.¹ These intrusive thoughts can trigger guilt for thinking or feeling in opposition to core values.

Types of OCD Guilt

Individuals diagnosed with OCD likely experience guilt or shame regardless of subtype. Some subtypes may experience guilt more than others due to the nature of obsessions and surrounding cultural aspects.

For example, individuals with pedophilia OCD may experience large amounts of shame connected to the obsessions themselves due to living in a culture that universally values the protection of children. Individuals with scrupulosity OCD who come from religious families and communities may experience disproportionate shame from obsessions due to the high prioritizing of religious values in their environments.

Scrupulosity OCD Guilt

Scrupulosity OCD is characterized by obsessions related to ethics, morality, or religion. Guilt may arise when intrusive thoughts are centered around the violation of ethical, moral, or religious principles. For example, someone with scrupulosity OCD may obsess over committing a particular sin and experience OCD guilt, which causes them to perform compulsions, such as excessive praying or seeking reassurance from religious leaders.

Pedophilia OCD Guilt

Pedophilia OCD is characterized by intrusive sexual thoughts about children. Guilt is triggered by discordance between the cultural belief to protect children and the experience of sexual obsessions related to children. Individuals may experience such shame from obsessions that they begin to avoid children for fear of acting on their thoughts.

Harm OCD Guilt

Harm OCD is characterized by unwanted intrusive thoughts about hurting oneself or others. Individuals may experience guilt from the thought of causing harm to someone they love. Obsessions can be particularly violent or aggressive, which may cause guilt or shame for imagining these disturbing thoughts.

Relationship OCD Guilt

Relationship OCD is characterized by doubts about different aspects of an intimate relationship. They may experience guilt as a result of their partner’s reaction to their obsessions, which can be taxing on the relationship. Examples of obsessions include doubting love or love for their partner, questioning attraction, or uncertainty around commitment.

Real Event OCD Guilt

Real Event OCD is characterized by obsessions of past events and their negative consequences. Individuals may experience guilt related to the negative outcome of an event, often believing their actions played a part. Compulsions may cause individuals to mentally re-play events or seek reassurance from others to relieve OCD guilt.

False Memory OCD Guilt

False Memory OCD is characterized by intrusive thoughts about an event that may or may not have occurred. Guilt manifests through over-focusing on whether or not events happened the way they are remembered or misattribution of personal actions as the cause for outcomes. The self-doubt inherent to this subtype may make episodes of guilt or shame more prominent.

Do People With OCD Feel Guilt More Intensely?

Research suggests individuals with OCD are more prone to experiencing guilt.³ Specifically, people with OCD often experience deontological guilt, which stems from the feeling of having over-stepped one’s own moral values.³ They are also thought to have a heightened response to the anticipation of guilt due to the fear of being unable to handle the following distress.³

Research supports that guilt sensitivity is positively correlated with checking behaviors.⁴ It is important to note correlation does not equal causation. However, some researchers speculate the performance of compulsive checking behaviors may stem from the hope of avoiding feelings of guilt.⁴

What Triggers OCD Guilt?

OCD guilt is triggered by the discordance between the content of obsessions and an individual’s identity.¹ Obsessions generally contain taboo ideas, as intrusive thoughts attack what is most important to the individual. Feeling discordance on a daily basis may provoke guilt from feeling hyper-responsible for the content of obsessions.¹ Some individuals may begin to question their identity, feeling shame when obsessions are in opposition to their personal moral code.

Impacts of OCD Guilt

OCD guilt plays a prominent role in the maintenance of obsessions and compulsions.⁵ When an individual experiences obsessive OCD guilt, they often perform compulsions to relieve themselves of distress from the OCD guilt obsessions.  Although compulsions may temporarily relieve distress, they begin to increase in frequency and intensity until they consume an individual’s time, energy, and resources.

OCD guilt impacts not just the individual but those around them. The individual with OCD may engage in reassurance-seeking behavior to neutralize OCD guilt.⁶ Reassurance-seeking consists of repeatedly asking for consolation to alleviate anxiety. Constantly seeking reassurance may damage relationships due to friends or family feeling exhausted by providing constant support or feeling manipulated into telling the individual what they want to hear.⁶

How to Cope With OCD Guilt

It is possible to manage OCD guilt through the use of healthy coping mechanisms, which can greatly improve the quality of life for an individual with OCD. Although stress alone cannot cause OCD symptoms, it can exacerbate an existing diagnosis and, thereby, cause OCD guilt. Utilizing coping mechanisms on a regular basis can mitigate the frequency and intensity of OCD guilt and shame.

Here are seven tips for coping with OCD guilt:

1. Say the thought out loud: Intrusive thoughts gain power through existing only in the mind. Through externalization, individuals begin to understand it is the meaning attached to the thought that causes distress rather than the thought itself.
2. Practice self-compassion: Guilt or shame often convinces individuals they aren’t worthy of compassion. Ignoring this voice and practicing self-compassion will actually reduce the intensity of OCD guilt. Simple ways to foster self-compassion could range from taking a long shower to eating your favorite meal or even saying a self-affirming mantra.
3. Utilize your support system: When feeling guilt or shame, there can be a tendency to self-isolate. However, acting on this impulse will only worsen the OCD guilt. Seeking help from family, friends, or the community can help temper these strong emotions.
4. Practice dialectical thinking strategies: Dialectical thinking is the recognition of two appearing conflictual things that can exist at the same time. For example, you can feel intense guilt from OCD and still practice fostering acts of self-compassion.
5. Create a time for OCD guilt: Individuals can decide on ten minutes of the day devoted just to thinking guilty thoughts. When a guilty thought comes, they postpone it until the set time. Individuals may be surprised to know when the time comes, and they refuse to make themselves think negative thoughts!
6. Label thoughts and feelings: Learning to label guilty thoughts as thoughts and the feeling of guilt itself as a feeling may help with the recognition that there is a difference between our experience and reality. Just because someone is experiencing OCD guilt does not mean they are factually guilty.
7. Put OCD guilt “on a shelf”: Visualization is a powerful tool to combat OCD. When OCD guilt comes around, individuals can visualize putting the guilt “on a shelf.” Psychologically, having a “place” for the OCD thought may help some individuals resume their normal routines.

Treatment Options for OCD

Treatment for OCD generally consists of a combination of medication and therapy. Some individuals may find therapy alone is effective enough to treat symptoms. Through receiving therapy for OCD, individuals can learn different ways to manage and cope with OCD guilt and shame. A therapist will teach them effective coping mechanisms that, over time, decrease the frequency, intensity, and duration of symptoms.

Treatment options for OCD include:

• Exposure-response and prevention therapy (ERP): ERP is considered the gold standard treatment for OCD. ERP therapists help clients develop an exposure hierarchy to gradually increase tolerance of distress caused by OCD obsessions. The client learns how to prevent OCD compulsions in response to distress.
• Medications: Medications for OCD are typically SSRIs, although in some cases, other medications such as SNRIs, tricyclic antidepressants, benzodiazepines, or antipsychotics may be prescribed. SSRIs, SNRIs, and tricyclic antidepressants work by regulating neurotransmitter functioning in the brain, while benzodiazepines and antipsychotics may reduce the frequency or duration of unwanted OCD compulsions.
• Cognitive behavioral therapy (CBT): CBT for OCD helps clients change the relationship between their thoughts, feelings, and behaviors. A CBT therapist teaches clients how to replace maladaptive thoughts, feelings, or behaviors with healthy and rational alternatives.
• Habit reversal training (HRT): HRT is a short-term therapy designed to help clients correct maladaptive OCD habits through awareness coaching and response training.
• Mindfulness-based cognitive behavioral therapy (MBCT): MBCT is a therapy that combines cognitive and mindfulness principles to help clients develop a new relationship between thoughts and emotions. Through MCBT, individuals learn how to co-exist with negative OCD thought patterns and emotions without becoming distressed and using maladaptive behaviors.
• Imaginal exposure therapy (IE): A therapist may use imaginal exposure to help a client for whom traditional exposure therapy is too intense. Through imaginal exposure, clients imagine themselves in stressful situations based on their OCD obsessions. Through repeated exposure to these imaginings, the therapist helps them with anxiety reduction.

When to Seek Professional Support

If OCD guilt is causing daily distress and symptoms are not improving with stress management, lifestyle changes, and help from your support system, it may be time to seek professional support from a therapist using an online therapist directory or online therapy platform. If you are already seeing a therapist or counselor and symptoms are still not improving with talk therapy, it may benefit you to look into online psychiatrist options for combination treatment.

In My Experience

As a systems thinker, I believe in the healing power of relationships. Guilt and shame gain power through isolation. By seeking support from friends, family, groups, or communities, you can empower yourself to feel less alone in your experiences of OCD guilt and shame. If you have a particular spiritual, racial/ethnic, or other cultural community you identify with, sometimes these groups can offer additional support and encouragement specific to your identity. For example, clients who have been diagnosed with OCD and also identify as LGBTQ+ may find additional resources and coping mechanisms from mentors in their community who have also dealt with experiences of guilt and shame.

Fostering self-compassion is particularly important for individuals with diagnosed OCD. Figure out what physical and emotional self-soothing strategies work best for you and incorporate them into your life. Making a list of these strategies when you are feeling stable can provide a great coping resource for when you are in crisis. Notice when you feel your best and ask yourself what facets of life contribute to feeling good. Self-compassion is best practiced as a daily routine, so it’s important to find self-soothing strategies that are manageable and compact. You may not be able to carve in an hour of yoga every day, but taking five minutes to meditate during an afternoon slump is reasonable and sustainable.