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02/10/2017 12:53 pm ET | Updated 6 days ago

Intense Fear Of Guilt May Be At The Heart Of Obsessive-Compulsive Disorder

People high in "guilt sensitivity" are more vulnerable to developing OCD.

Nobody likes to feel guilt. But when a fear of doing harm to others and feeling guilty as a result gets too severe, it can become pathological.

Excessive fear of guilt can lead a person down the road to developing obsessive-compulsive disorder. An intriguing new theory suggests that in certain cases, an extreme sensitivity to the emotion may be an operative factor in a person’s vulnerability to OCD.

Obsessive-compulsive disorder affects roughly 2 percent of the population. People with OCD get caught in a cycle of unwanted, intrusive thoughts, performing ritualistic behaviors in an attempt to ease the distress. These unwanted thoughts often revolve around a fear of losing control, harming others, being exposed to germs or contamination, or having inappropriate sexual desires. The individual then looks to compulsive behaviors ― like repeatedly reciting a mantra, counting or washing one’s hands ― to rid oneself of the disturbing thoughts. 

A study by Italian researchers published last month in the journal Clinical Psychology & Psychotherapy suggests that individuals with OCD may perceive guilt to be more threatening than most people do, leading them to find it intolerable. Any thought or impulse that might inspire guilt, then, is met with extreme anxiety and with attempts to “cleanse” oneself of the mental intrusion.  

There are mixed research findings about whether being prone to guilt puts you at a higher risk for developing OCD, but the new study suggests that it’s being highly sensitive to guilt, rather than simply being guilt-prone, that’s important. 

“Most of the previous studies focused on guilt-proneness and failed to support its specific role in OCD,” Dr. Gabriele Melli, the study’s lead author, told The Huffington Post. “In our opinion, OCD patients are not more prone to guilt than other people but they fear feelings of guilt, and many rituals and avoidance behaviors are motivated by the need to avoid this emotion in the future.”

Melli also suggests that fear of guilt is involved in OCD the way fear of fear is related to panic disorders. 

The Fear of Guilt 

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For the study, researchers first developed a new scale to measure guilt sensitivity. The test featured 20 statements ― including “Guilt is one of the most intolerable feelings” and “The idea of feeling guilty because I was careless makes me very anxious” ― for which participants could rank their level of agreement. 

Then, 500 adults were asked to complete the guilt sensitivity test and also fill out a questionnaire measuring their tendency to experience guilt and tests of OCD, anxiety and depression. The results suggest that guilt sensitivity is a distinctly different trait from being prone to guilt and is more closely linked to OCD symptoms than to depression or anxiety. 

In a second experiment, 61 people with OCD and 47 with other anxiety disorders completed the new guilt sensitivity test as well as tests of anxiety and depression. The results showed that guilt sensitivity was highly correlated with checking-related OCD behaviors ― things like repeatedly making sure that the door is locked or the stove is turned off. Guilt sensitivity was especially high in individuals for whom ritualistic checking is a main OCD symptom. These behaviors may be part of a strategy for avoiding potential guilt, according to the study’s authors.  

“Guilt sensitivity may cause individuals to be vigilant and sensitive to ways in which actions or inactions could potentially cause harm, performing checking compulsions in order to avoid, prevent, or neutralize the feared feeling of guilt,” Melli said. “An individual who has high guilt sensitivity may feel driven to checking actions because he or she is not able to take the risk of being responsible for harm, injury or bad luck.” 

Somewhat related, studies have also shown “fear of self” to be a major predictor of OCD symptoms. It’s possible that a distrust of oneself ― which could play out as a fear that deep down, you are dangerous and potentially harmful to others ― and the extreme fear of guilt may work hand-in-hand to create the conditions for OCD to take root.

Cognitive behavioral therapy is currently the most effective treatment for OCD. Melli suggests that therapists with patients who may have high guilt sensitivity should help them focus on strategies for challenging their feelings of excessive responsibility to others and cultivating a greater acceptance of guilt.

“When checking rituals are primarily involved,” he said, “cognitive behavioral therapists should target also beliefs concerning the intolerability and dangerousness of experiencing guilt.”

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