Guilt vs Shame in OCD

• Report from AABT by Jim Pretzer, 11/30/96
  • New Research on Cognitive Processes in Anxiety by Jim Pretzer, 12/17/96
    • Dealing with Guilt by David Alexander, 3/31/97
      
      

It certainly is true that many people lose track of the distinction between guilt and shame and that there have been extensive discussions of the distinctions between the two. The one which is usually seen as being associated with Obsessive-Compulsive Disorder is guilt.

In Cognitive Therapy, guilt is seen as the emotion persons experience when they think that they have violated moral standards (i.e. when they believe that they have been bad, have done something which is wrong). I do not remember seeing any cognitive-behavioral explanations of why guilt is associated with OCD. However, it isn't unusual for my OCD clients to report that the onset or exacerbation of their symptoms followed shortly after an event, thought, or feeling which they felt quite guilty about.

In treating OCD, I am often tempted to focus on addressing the client's guilt, particularly if it appears that the guilt precipitated the OCD. However, my experience has been that resolving the guilt does not get rid of the OCD symptoms once they have begun. On the other hand, exposure and response-prevention is quite effective, even if therapy doesn't focus on resolving the client's guilt.

This is interesting since exposure and response-prevention is seen as targeting anxiety, not guilt. Even if guilt sometimes plays a role in the onset of OCD, it appears that anxiety plays the central role in maintaining and intensifying the symptoms. Of course, while the standard cognitive-behavioral treatments for OCD focus on anxiety, if a client also has significant problems with guilt, we would treat that as well (not because this is necessary in order for us to treat the OCD but because it continues to be a problem for the client once the OCD has been treated).

• OCD & Inositol by Sid Kalcheim, M.A., 6/7/97
  • minimal help by dawn, 7/21/97
• thanks for recognizing guilt by dawn, 7/21/97
• Can OCD be Taught to a Child? by FL, 8/30/98