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 guilty feelings. Guilt can be a positive and motivating emotion, as it promotes prosocial behaviors, but when someone with OCD experiences guilt, it can lead to debilitating cycles of shame.² These shame cycles often lead to the performance of compulsions to neutralize experiences of OCD guilt.

What Causes OCD Guilt?

Research shows people with OCD often have a heightened sense of moral responsibility and carry a 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 their core values.

Types of OCD Guilt

People with OCD likely experience guilt or shame regardless of subtype, but some subtypes may experience guilt more than others due to the nature of their obsessions. 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. Those 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 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 someone 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.

Racism OCD Guilt

Racism OCD involves intrusive thoughts about the possibility that an individual is unintentionally racist, followed by compulsions to ensure that they are in fact not racist. Individuals with racism OCD experience an immense amount of guilt because they believe that the core of who they are may be harmful to others.

Do People With OCD Feel Guilt More Intensely?

Research suggests that people 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 often attack what is most important to the person. 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 someone 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 person 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 guilt and other symptoms using specialized OCD coping skills, which can greatly improve the quality of life for someone with OCD. Although stress alone cannot cause OCD symptoms, it can exacerbate an existing diagnosis and, thereby, cause more severe 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, you can begin to understand it is the meaning attached to the thought that causes distress rather than the thought itself.
2. Practice self-compassion: Guilt and shame often convinces people that 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, relaxing shower to eating your favorite meal or 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: Decide on ten minutes of the day devoted just to thinking guilty thoughts—this practice is called activity scheduling. When a guilty thought comes, postpone it until the set time. You may be surprised to find that, when the time comes, you refuse to make yourself 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 your experience and reality. Just because someone is experiencing OCD guilt does not mean they are actually guilty.
7. Put OCD guilt “on a shelf”: Visualization is a powerful tool to combat OCD. When OCD guilt comes around, visualize putting the guilt “on a shelf.” Psychologically, having a “place” for the OCD thought may help you resume your normal routines.

Treatment Options for OCD Guilt

Treatment for OCD generally consists of a combination of medication and therapy. Some people may find that 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 for OCD is considered the gold standard treatment option. 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.

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.