The causes and consequences of shame in obsessive-compulsive disorder

Research into the aetiology, maintenance, and treatment of obsessive-compulsive disorder (OCD) has largely been informed by models of anxiety. However, non-experimental research suggests that some individuals may engage in compulsions to neutralise shame, with repugnant obsessions associated with more shame than other obsessions. Violent and sexual obsessions and shame have been linked with poorer treatment outcomes, and thus, treatment modifications are needed. This experimental study aimed to examine if and how shame fits into a cognitive behavioural model of OCD. Fifty-five individuals experiencing subclinical (n = 9) to clinical (n = 46) OCD symptoms were randomly administered four different obsession induction paradigms focused on harm, sexual, contamination, and symmetry obsessions. After each induction, participants reported on their emotional states, gave appraisal ratings regarding their urges to engage in compulsions and avoidant behaviour, and completed manipulation checks. Harm and sexual inductions elicited greater shame and anxiety and were considered more immoral than contamination and symmetry inductions. Shame responses were also independently associated with compulsion and avoidance behaviours in repugnant obsessions, controlling for anxiety. Theoretical models and treatment for OCD should be adapted to address shame.