11 Minutes

If you are among the 2% of the world population diagnosed with obsessive-compulsive disorder, you know what it’s like to be stuck in a maze of constantly nagging, highly intrusive negative thoughts. These thoughts can sneak up on you regardless of where you are, and leave you feeling overwhelmed, anxious, and desperate for a way out. [1]

Guilt is one of the many insidious aspects of OCD that it very frequently and subtly inflicts on the sufferers. For such people, it’s not just the thoughts tormenting them but the belief that they are responsible for them.

“Why am I having these thoughts?”

“How can I even think like this?”

“Have I harmed someone by thinking or doing something?”

This obsessive guilt can be suffocating and often leaves us feeling self-critical, unworthy, and deeply flawed. But what you need to understand is it’s more misleading.

If you have been struggling with OCD and guilt, remember that help is available. People are willing to connect with you and support you out of your guilty thoughts. Professional treatment is also available to help you deal with the impact of OCD shame and guilt on your well-being.

It is quite natural to reflect on past experiences and feel shame or guilt. While most people can relate to this practice and find it common, people with OCD have it differently. For them, it seems impossible to move past these events.

In usual circumstances, experiencing guilt can help you learn from your mistakes and try to do better in the future. But if you have OCD lurking in the corner, the shame and guilt center on your inherent values and can make you less productive instead of leading you toward a positive change.

OCD guilt over past mistakes is much more intense, sometimes to the extent that it affects your ability to function well. Working through these feelings or reconciling with them to move on a hard nut to crack.

Experts now believe that OCD guilt can change how a mind processes information, potentially distorting or warping it. Also known as cognitive distortions, these thinking patterns can worsen the guilt. Some examples of the cognitive distortions include the following:

Magnification

Also called catastrophizing, your mind may perceive a minor event in a much-exaggerated manner. [2]

Example: “I have committed a terrible mistake. I cannot ever be forgiven.”

All-or-nothing Thinking

This particular thinking pattern only focuses on the two extremes with nothing in between.

Example: “Because I have not achieved the highest score, I am a failure.”

Personalization

This thought pattern may urge you to take full responsibility for an event beyond your control. [3]

Example: “If nobody enjoyed the meal in a restaurant I took them, it is my fault.”

Emotional Reasoning

Emotional reasoning may force you to believe that your feelings are proof of something.

Example: “If I am feeling ashamed, I must have hurt someone.”

In most cases, OCD guilt rises from fear of actions or thoughts that directly contradict your values, desires, or identity. In others, hyper-responsibility, a feeling that you must control things that are clearly outside of your power, is to be blamed.

Regardless of the reason, OCD and guilt can present in different ways, such as the following:

Religious OCD & Guilt

Such type of guilt comes from thoughts related to moral issues and scrupulosity. For instance, you may experience intrusive thoughts about committing blasphemy or sinning. Ruminating about past mistakes or fearing that the thoughts you are having right now will force you to engage in sinful behaviors can also add to the guilt.

Real Event OCD Guilt

This terminology describes experiencing PCD guilt over past mistakes or real-life events. For instance, constantly ruminate about a past event, blaming yourself as a bad person. Sometimes, you may obsessively go through the event over and over again to determine if you could have done something different to prevent guilt or shame.

Miscellaneous

In addition to the types of OCD guilt, the following thoughts can also contribute to obsessive guilt:

  • Unacceptable images or thoughts about violence or sex that may excessively worry you, despite having no relevant history.
  • Thoughts about killing yourself, even though you have no desire to act on them.
  • Doubts and suspicions about your sexual orientation, despite having a full understanding of your identity.
  • Doubts about your love for your partner, thinking if they are the right one to be with or to marry, even though you have been with them in a happy relationship for years.
  • Thoughts about saying, writing, or doing something improper, embarrassing, or terrible, even though you have no desire to.
  • Worry about acting on thoughts of extreme violence or harm to others, and doubts about whether it has happened in the past or may happen in the future.

Obsessive guilt can make you struggle to relieve the anxiety, and the most common way to do it is through compulsive actions. [4] So what are the compulsions your OCD guilt can put you through?

Following are some examples:

  • Making repeated confessions or constantly apologizing for your perceived wrongdoings, even after a long time has passed since you supposedly did them.
  • Looking for ways to punish yourself for your actions.
  • Dwelling repeatedly on past behaviors and evaluating your actions to look for any wrongdoings.
  • Seeking reassurance from family members and friends that you aren’t a bad person or that you did not do anything wrong
  • Using hypothetical situations to seek reassurance that you did nothing wrong.
  • Looking up the internet on how to forgive yourself or get forgiveness from others.
  • Going out of the way to engage in good deeds to make amends for your wrongdoings.
  • Constantly looking for ways to prove yourself as a good person.
  • Constantly confessing the negative things that you previously said or did.
  • Closely observing the person you believe to have harmed to check if your actions impacted them in any way.
  • Repeatedly apologizing to the person you believe to have wronged.
  • Excessively engaging in certain behaviors to become a better person.
  • Avoiding any reminders related to wrongdoing, including images, people, or places.
  • Contacting authoritative fighters to evaluate the potential consequences of your past actions.
  • Reimagining a past event in a way you would have liked it to have happened.
  • Constantly thinking about what you could have done differently if you had to go over an event once again.

While the compulsions mentioned above may bring some relief, this comfort is usually temporary. As the intrusive thoughts slowly seep back in, the cycle of self-blame and guilt begins.

If you have been juggling between OCD and guilt for a long time, professional help is available. Behavioral psychotherapy or talking therapy remains the first line of treatment to overcome the issue, but many people benefit from a combination of therapy and medication.

Cognitive Behavioral Therapy

Also known as CBT, cognitive behavioral therapy, aims to help you identify problematic behaviors and thought patterns and slowly replace them with healthier ones. The CBT sessions take place under the supervision of a mental health professional where they are gradually exposed to their fears. [5]

Exposure and Response Prevention (ERP) is a type of CBT that specifically targets and helps people struggling with OCD and guilt. More about this therapy is explained below.

Exposure and Response Prevention (ERP)

This evidence-based treatment has been thoroughly investigated and is the gold standard to keep OCD under control. [6] The procedure involves exposing you to your fears and helping you become less reactive to the triggers. The therapy takes place in a safe space and aims to increase your ability to tolerate discomfort, doubt, and guilt while reducing distress related to triggering situations and thoughts.

Following are some examples of exposure used during ERP:

  • Visiting a location where a past event took place
  • Seeing images or listening to music that remind you of the event
  • Imagining different ways that your words or actions could have negatively impacted others
  • Penning down a narrative of the event
  • Writing down a confession of what exactly happened
  • Penning down the worst-case scenario of the event along with its negative consequences
  • Writing a story of how your behavior will lead to negative consequences, such as facing rejection or getting away after committing a crime

Following exposure, ERP focuses on the prevention of response to eliminate compulsions and the risk of engaging in deconstructive rituals. Some examples of how this is achieved include the following:

  • Refraining from being apologetic
  • Refraining from constantly seeking reassurance or conducting research on social media or the internet
  • Refraining from avoiding any reminders, including people, images, or places, that directly relate to the event
  • Refraining from repeated confessions about things said or done in the past
  • Learning how to redirect the mind to a neutral topic to break mental reviewing compulsions
  • Refraining to engage in any other compulsive behavior to get more clarity about the event and its aftermath
  • Seeking out positive experiences and enjoyment without withholding any joyful experiences

Medication

In more severe forms of OCD and obsessive guilt, experts may suggest a combination of therapy and medications to manage symptoms. Antidepressants are the most common type of medication used in this context; however, other categories have also been found to be helpful.

Following are the examples of some commonly prescribed antidepressants for OCD and guilt: [7]

Selective Serotonin Reuptake Inhibitors

  • Fluoxetine
  • Paroxetine
  • Escitalopram
  • Citalopram
  • Sertraline

Tricyclic Antidepressants

  • Clomipramine

Serotonin-Norepinephrine Reuptake Inhibitors

  • Desvenlafaxine
  • Venlafaxine
  • Duloxetine

Mindfulness

Understanding how to differentiate between obsessive guilt and self-blame unrelated to this psychiatric condition is a critical management step. For this purpose, the first step is to understand that your intrusive thoughts do not define who you are and that your obsessions do not reflect your desires.

Instead, remind yourself that your guilt is coming from a fear of what you do not wish to happen. This is the reason why intrusive OCD thoughts often tend to focus on sabotaging what you truly care about.

Whenever you feel guilty due to an obsession, use mindfulness to move past this feeling without being self-critical or judgmental. Try to visualize it as something connected to your obsession instead of an emotion associated with a behavior.

Mindfulness can help you remind yourself that the thoughts you are experiencing are just an exaggeration and a source of distress disproportionate to the actual threat. Once you master the art of mindfulness, you can tame your guilty thoughts more easily and even completely block them out.

Having OCD can make you prone to feeling guilty about your behaviors, thoughts, and sometimes both. Despite knowing that your intrusive thoughts are out of your control, you may still end up feeling guilty. The compulsions secondary to these thoughts further add to the guilt, despite having an understanding that they aren’t rational.

Regardless of where your obsessive guilt is coming from, it is crucial to manage it. In addition to seeking professional help, the following are some ways to complement the healing journey: [8]

Talk to someone

Find someone who understands OCD and share your struggles with them. A counselor, therapist, or any other mental health professional can be the best people to go to for this purpose as they are trained to extend support and help you develop healthier coping strategies.

Focus on the present

For most people with OCD, their guilt is often linked to something that happened in the past. Try to remind yourself that no matter what you do, it will not change what has happened. Instead, try to focus on the present moment and make it as better as you can.

Challenge your thoughts

Make it a habit to challenge every thought that crosses your mind. For example, if you start feeling guilty for making a mistake, remind yourself that mistakes can happen to anyone and that you are doing the best you can.

Show yourself some compassion

Don’t forget to be gentle with yourself and treat yourself with the same level of kindness you would show to someone else.

Adopt healthy habits

While dietary and lifestyle modifications alone are not enough to keep OCD under control, they can certainly contribute to overall health and support the other ongoing treatments. For this purpose, consider adopting the following habits:

  • Eat healthy foods
  • Stick to your proposed treatment plan
  • Try to exercise regularly
  • Focus on getting 6 to 8 hours of high-quality sleep every night
  • Foster and maintain positive relationships
  • Limit the use of caffeine, alcohol, and tobacco
  • Enroll in meditation or yoga classes to relax your mind
  • Engage more in activities you truly enjoy

Guilt is a normal emotion and may not always be a bad thing. In normal circumstances, it can motivate you to do the right thing and even learn from past mistakes. That said, guilt can easily become debilitating, especially if you have been struggling with OCD in the past.

Remember that obsessive guilt is a trick of the mind that can completely distort reality for you. Having intrusive thoughts cannot make you a bad person and you do not need to feel guilty for it. These thoughts are simply a signal that your brain is misfiring which needs to be controlled.

Once you have recognized this, it can become easier to break free from the cycle of guilt that OCD perpetuates.

1 Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry. 1997;58 Suppl 12:7-10. PMID: 9393390.

2 Sansone RA, Sansone LA. Rumination: relationships with physical health. Innov Clin Neurosci. 2012 Feb;9(2):29-34. PMID: 22468242; PMCID: PMC3312901.

3 Kalanthroff E, Wheaton MG. An Integrative Model for Understanding Obsessive-Compulsive Disorder: Merging Cognitive Behavioral Theory with Insights from Clinical Neuroscience. J Clin Med. 2022 Dec 12;11(24):7379. doi: 10.3390/jcm11247379. PMID: 36555995; PMCID: PMC9784452.

4 Mancini A, Granziol U, Gragnani A, Femia G, Migliorati D, Cosentino T, Luppino OI, Perdighe C, Saliani AM, Tenore K, Mancini F. Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups. J Clin Med. 2022 Aug 10;11(16):4673. doi: 10.3390/jcm11164673. PMID: 36012911; PMCID: PMC9409889.

5 Gragnani A, Zaccari V, Femia G, Pellegrini V, Tenore K, Fadda S, Luppino OI, Basile B, Cosentino T, Perdighe C, Romano G, Saliani AM, Mancini F. Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study. J Clin Med. 2022 May 13;11(10):2762. doi: 10.3390/jcm11102762. PMID: 35628888; PMCID: PMC9145175.

6 Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019 Dec 24;12:1167-1174. doi: 10.2147/PRBM.S211117. PMID: 31920413; PMCID: PMC6935308.

7 Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol. 2019;17(8):710-736. doi: 10.2174/1570159X16666180813155017. PMID: 30101713; PMCID: PMC7059159.

8 Holmberg A, Martinsson L, Lidin M, Rück C, Mataix-Cols D, Fernández de la Cruz L. General somatic health and lifestyle habits in individuals with obsessive- compulsive disorder: an international survey. BMC Psychiatry. 2024 Feb 5;24(1):98. doi: 10.1186/s12888-024-05566-w. PMID: 38317127; PMCID: PMC10840209.

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