First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, they may feel guilt afterwards. If someone shows themselves up at a party by getting drunk and doing something unheard of, they might feel a sense of shame and guilt the next day. The list goes on… you get the general idea.

Levels of normal guilt

Normally, unkind thoughts and misdoings tend to have a relationship in terms of the level of guilt a person feels. The intensity of guilt however does not usually preoccupy the person’s mind for too long, not in the general sense of things at least. Even on occasions when a person is likely to feel overly guilty for various reasons, such as fearing being morally bad for a particular wrongdoing or perceived indiscretion, they are still able to eventually move on and let the emotion pass.

Guilt associated with Scrupulosity

However, when Scrupulosity plays a role in this otherwise natural emotion (guilt), it’s fair to say that it isn’t a fluke that OCD has found the person’s vulnerability about what matters to them most. As a result, a person’s moral standards are thus affected because the misplaced guilt intrudes on the way they believe they should think, feel and behave according to their values, religion or other doctrine.

What is an example of a person’s experiencing normal guilt?

Let’s take “John’s” situation as an example. His family is religious. They have brought him up to have strict moral standards. Still, when he was 15 years old he had thoughts to steal money from his local church’s donation fund. One day he gave into those thoughts. Later that day he felt shame and guilt.

chuch donation jar

John’s guilty conscience followed with a series of what-ifs? For example, what if he went back into the church and the priest announced that he saw him steal the money? What if the priest were to tell his parents? What if he were to call the police? There were lots of worst case scenarios going on, and all tangible, because something really did happen for John to feel shame, guilt and regret.

Time passed and when John grew to adulthood he happened upon one of the Ten Commandments on Wikipedia whilst Googling something for his religious studies. The words “Thou shalt not steal” triggered thoughts about the earlier theft incident. The nature of what he did all those years ago started to play on his conscience. Thoughts crossed his mind about whether he should have owned up to stealing the money; or at least prayed for forgiveness.

On reflection, John decided it would be better for him to put the theft incident to rest rather than dwell on it. He felt he could do this because internally he knew he had done wrong and was sorry for that. He was aware that having a conscience was enough to know that he’d been dishonest and that this in itself was punishment enough. And so from this perspective he was able to pray for God’s forgiveness, forgive himself and move on.

In the above example, you can see how, when OCD is separated from natural guilt, the “what-ifs?” are appropriate in this situation, because this is a factual story, and so the resolve for John was in accordance with the emotions experienced.

Now let’s take a look at another example that considers the relationship between OCD and guilt…

This time John experienced intrusive blasphemous thoughts about God. Added to this were sexual images and impulses towards religious figures. He was 16 years old and beside himself with guilt and shame. But the thoughts were driven on a biological level and so he had no control over these involuntary obsessions.

None-the-less, he would conjure up good images to block the intrusive ones. John didn’t understand why he had these thoughts and often asked himself “what-if” questions such as: “What if I’m not worthy of going to church?” “What if the priest is suspicious of my thoughts and knows that my mind repeatedly “sees” him naked as he gives his sermons?” “Should I go to confession?” “What if God punishes me and sends me to hell?”

Again, lots of worst case scenarios going on, just like in the actual theft situation, but in this case the “what-ifs” were hard to define. They were hard to define because intrusive thoughts have no substance. They are intangible simply because they are not subject matter. Obsessional thoughts had latched on to what mattered most to John, except at that time he hadn’t realised that OCD was the crux of the problem. Subsequently, he failed to see that his intrusive thoughts were at odds with his true moral values, or at least doubted this.

Time passed by and John soon reached adulthood. The intrusive sexual thoughts had become less intense overtime, but John suddenly found himself becoming preoccupied with trying to make sense of them. His preoccupation was triggered after reading about a religious sex scandal in his local newspaper. This had him wondering why he’d ever had such thoughts and he began to think that his conscience hadn’t been cleared. He labelled himself sexually immoral and decided that perhaps “confessing” to his past obsessions could be the answer to relieving himself of the “guilt” and “shame” that he felt now. The thought of being morally unacceptable was too much for him to cope with. Once again OCD had found its grip and the the frequency and strength of the obsession began to invade his mind again. Subsequently, he felt urged to “tell” his closest and most trusted friend about his perceived “immorality” and felt a sense of relief because his friend reassured him that all was fine. However, it wasn’t long before he started to think that perhaps he should seek out reassurance by “confession” one more time, and so it went on.

Exactly how did OCD play a role in this otherwise natural emotion for John? How could he forgive himself and move on, just like he did with the theft incident?  But wait… Was there anything to forgive?

No, because John’s past/present experience of intrusive thoughts was/is a counterfeit situation. Earlier it was noted that usually an actual misdeed has a complementary relationship with the level of guilt experienced. Yet, when someone has an OCD episode one feels false guilt, not actual guilt. This is the part that is hard to define. Thus a resolve can never be in accordance with the emotions experienced because both are invalid. Put simply, John never committed any misdeed, and so “confessing” to something that is already null and void was, and is, pointless.

So what’s the solution?

First, and as seen already, Scrupulosity involves holding strict standards of religious, moral, and ethical rightness. There tends to be no grey areas for people who live their lives according to their particular religion, or other codes of living. Obsessive fears that one may have sinned or acted immorally in some way causes the person to experience great distress to the extent he or she believes they’ve disappointed God. Consequently, they fear being severely punished. Others live in terror believing their family will go to hell for their perceived misdeeds; or that some other punishable event will occur.

So back to the solution. In John’s situation it would be wise for him to first accept that intrusive thoughts were, and are, just that. Cognitive behavioural therapy with exposure response prevention is the treatment of choice. The cognitive side of therapy helps to alter thinking errors that link to entrenched earlier beliefs. With new healthier beliefs people who have the same experiences as John place themselves in a better position to then identify that their recently established praying, blocking, “confessing” and/or other compulsions to relieve anxiety no longer need to be given into. This is because the rituals only serve to reinforce and feed their Scrupulosity obsession, plus a secondary obsession comes into play – the secondary obsession is that their conscience hasn’t been cleared and the ritual is ruminating on what-ifs, e.g., “What if God rejects me?”

Yet, there is no conscience to clear because obsessions are not concerned with realities or actual instances; thus, rational perspective in therapy firmly addresses and resolves misplaced guilt. Finally, practising resisting ALL COMPULSIONS builds distress tolerance and leads gradually to habituation.

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