For some people, OCD obsessions and compulsions can lead to feelings of guilt. Here are some reasons why — and how you can begin overcoming the guilt.
According to the Diagnostic and Statistical Manual 5th edition, text revision (DSM-5-TR), symptoms of obsessive-compulsive disorder (OCD) can include obsessions or compulsions. Often, people experience both.
Obsessions are recurring, intrusive, and unwanted thoughts or images that cause significant distress. Obsessions and compulsions are often attempts to relieve fear and anxiety.
Many people with OCD feel that their compulsions can prevent bad things from happening — and when bad things do happen, they may have a sense that they are responsible, leading to feelings of guilt.
In many cases, OCD guilt stems from a fear of thoughts or actions that go against your authentic identity, values, and desires.
In others, it may be due to hyper-responsibility that often arises with OCD — the feeling that you can, and must, control things that are actually outside your power.
Just like OCD symptoms can present differently from person to person, so can OCD guilt. The condition can cause different types of self-blame depending on your obsessions.
Religious OCD and guilt
Religious OCD involves obsessions and compulsions related to scrupulosity and moral issues.
Someone with religious OCD may have intrusive thoughts about sinning or committing blasphemy. They may engage in compulsions centered around these obsessions. They may also ruminate about past mistakes or fear engaging in behaviors they believe to be “sinful.”
Real event OCD guilt
Real event OCD involves obsessions and compulsions that arise from real life events or past mistakes.
If you have real event OCD, you may obsessively review all details of a past event to determine if there was anything you could have done to prevent it from happening.
Further, ruminating about a past event may make you feel like you’re a “bad person” or lead to extreme self-judgment.
Other types of OCD guilt
Guilt is not an officially recognized part of the OCD criteria, but it’s a common experience for people with OCD.
In addition to religious and real-event OCD guilt, other types include:
- Violence or harm. Some people have intrusive thoughts or fears that they will impulsively harm others or themselves with acts of violence. This can be the case even for individuals without a history of violence.
- Sexual guilt. You may experience intrusive sexual thoughts and images. You may fear that they reflect your true desires and cause shame and guilt.
- Feelings of incompletion. Some types of OCD cause compulsive behaviors driven by a sensation of something being incomplete. This can cause a feeling of guilt over not doing enough.
Experiencing guilt related to OCD can be incredibly distressing. It is possible to learn to cope with the discomfort of obsessions, compulsions, and accompanying guilt.
Receiving effective treatment for OCD can help relieve guilt. OCD treatment often consists of:
- medication, in some cases
Working with a doctor or therapist is important when deciding on the best treatment plan for you. Finding what works may take time and effort, and you might need to try several strategies.
Psychotherapy is often the first-line treatment for OCD.
A common type is exposure and response prevention (ERP) therapy. With ERP, a therapist gently and safely exposes you to situations that may bring your obsessions to the forefront. Over time, the goal is to slowly desensitize you to fear, anxiety, and guilt.
Instead of suppressing unwanted thoughts with compulsive behaviors, you will learn to confront your fears without engaging in compulsions. ERP may also help reduce distress when intrusive thoughts arise.
Cognitive behavioral therapy (CBT) may also be effective for OCD with guilt.
Although rare, a medical professional may prescribe medications alongside therapy to manage OCD symptoms.
Common medications used for treating OCD include:
- serotonin reuptake inhibitors (SSRIs)
- certain tricyclic antidepressants
- NMDA receptor antagonists
Only a doctor can prescribe medication for OCD. If you are prescribed a medication, it’s important to follow the guidelines when taking it.
Distinguishing OCD guilt from self-blame unrelated to OCD symptoms is an important step. The first step is understanding that your intrusive thoughts are not who you truly are.
Your obsessions do not necessarily reflect your true desires. Instead, OCD guilt often stems from a fear of what you don’t want to happen. It’s common for intrusive thoughts to focus on harming or sabotaging what you care most about.
When you notice guilt arising from an obsession, it can help to use mindfulness to observe the guilt compassionately and without judgment. Consider observing it as connected to your obsession rather than an emotion related to actual behavior.
Your mind uses OCD thoughts to try to protect you from perceived or anticipated harm. It may help to remind yourself that these thoughts can cause distress disproportionate to any actual threat.
It’s common for people with OCD to experience guilt. These feelings are often connected with fearful or intrusive thoughts related to:
- harming others
- sexual activity
- real life events
- religious or moral scrupulosity
While dealing with OCD guilt can be challenging, treatment is possible.
If you’re experiencing guilt related to OCD, it may be helpful to consult a doctor or mental health professional for treatment. Treatment for OCD often consists of therapy, and sometimes medication and self-care.