Guilt Experience in Patients with Obsessive-Compulsive Disorder

Abstract Background: Clinical observations suggest that many patients with obsessive-compulsive disorder (OCD) suffer from severe feelings of guilt. These observations, which are consistent with psychoanalytic assumptions (overly strict super-ego), have rarely been subjected to systematic empirical investigation. Even cognitive approaches broach the issue of guilt as a facet of OCD only indirectly. The purpose of our research was to investigate whether more patients with OCD report feelings of guilt as compared to healthy controls. Patients and Method: One hundred individuals (34 males, 66 females) participated in our study. Fifty participants were OCD patients according to IDCL criteria and in stationary treatment. An additional sample of 50 participants consisted of healthy controls matched for age, gender, and job status. All participants were interviewed via Structured Clinical Interview for DSM-IV. Two scales measured proneness to guilt: (a) Trait Guilt Scale (TGS) and (b) Test of Self-Conscious Affect (TOSCA). A new guilt-inducing scenario-based test (SIT) including two scales (SIT 1, SIT 2) served the same purpose. The SIT was developed by the authors and uses scenarios derived from interviews with patients and experts. Finally, we assessed depression (Beck Depression Inventory; BDI) and obsessive compulsiveness (Yale-Brown Obsessive Compulsive Scale; Y-BOCS) in the OCD sample only. Results: Our data confirm stronger feelings of guilt among OCD patients as compared to matched controls. Patients and controls differed mostly on the TGS and the 2 SIT scales. TOSCA guilt scores did not differ reliably between patients and controls. Finally, as a side result, OCD patients reported elevated depression scores. Discussion: The results of this study suggest that feelings of guilt should receive more attention than previously in the treatment of OCD. OCD patients suffer not only from their compulsive cognitions and actions but also from feelings of guilt. Exposure therapy of OCD should be complemented by treatment components that specifically address feelings of guilt.