When it comes to the discussion and treatment of obsessive-compulsive disorder (OCD,) whether in childhood, adolescence or adulthood, the focus is usually on the compulsions that plague the affected individual. The image one has of obsessive-compulsive people is that of an individual engaged in repetitive activities, whether this is continual touching or relentless hand washing rituals.
However, much less easily treated and readily understood is the internal form of OCD. In this form, the person is haunted by feelings of anxiety, frustration and especially guilt, often over actions that haven't occurred.
What is the Connection between Guilt and OCD?
The external and internal forms of OCD or the compulsions and the obsessions are very often related. Those with OCD frequently feel a responsibility to engage in certain acts that are associated with their duty to others, often an imagined rather than a real correlation. The person with OCD may see garbage on the street and the individual will be incapable of leaving it there. This impulse can be a positive one but when it's connected with guilty voices, it can also be detrimental.
The individual might think that if they don't pick up the garbage then terrible consequences will result. Worse, they may feel that they are directly responsible, and that if anyone grows ill or injures themselves as a result of the garbage, that it is they who are at fault. Even more problematic, the person with OCD can convince themselves that they secretly wished ill-harm on others and that this is why the garbage is in the street, potentially leading to illness or injury. They can also imagine that they are responsible for world hunger or global war or other devastation.
What Role Do Rituals Play in Potentially Assuaging Guilt?
For those struggling with the internal voices of OCD, the only form of relief, however momentary, is the performance of rituals that attempt to assuage the relentless guilt. The obsessive compulsive firmly believes that by undertaking repetitive acts, they will be released from the inner torment of guilt. The acts also soothe their feelings of complicity in whatever terrible consequence they may or may not have caused.
Unfortunately, performing the rituals ultimately proves counter productive. The rituals themselves are part of a seemingly unbreakable pattern and when they are undertaken the very cyclical nature of these acts leads to guilt as no matter how many times they are performed the inner torment of guilt is not assuaged. It literally becomes a vicious cycle of thought leading to act and vice versa.
How Does an OCD Sufferer Diminish Guilt?
If the rituals don't really work to heal the guilt that a person with OCD suffers then what can help? Those who undergo Cognitive Behavioral Therapy with or without medications find several tactics useful. First, a person must remind oneself that he/she is a worthy being, regardless of whether they engaged in potentially harmful or detrimental acts. Secondly, they need to resist the desire to undertake the ritual. Though this may be challenging, if the impulse is resisted then the pattern of thought leading to act is broken. The sufferer can then see more clearly that the world won't fall apart if they do not perform that supposedly guilt-assuaging ritual.
With time, the guilty thoughts lessen along with the repetitive rituals and a new sense of reality is created in which the OCD is not allowed to control the individual's life.
Source: http://www.ocdonline.com/articlephillipson2.php
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