Send Your OCD Guilt On A Trip

How to overcome chronic guilt and self-indicting thoughts.

Written by Ezra Cowan, PsyD

Send Your OCD Guilt On A Trip

01 Intrusive thoughts commonly come with reactions like guilt, shame, and self-indicting thoughts.

02 Sometimes, these reactions serve as reassurance.

03 Dr. Ezra Cowan explains how this hidden compulsion works, and ways to manage it using ERP.

Obsessive Compulsive disorder (OCD) is a condition involving frequent uncomfortable thoughts followed by behaviors aimed at reducing one’s state of discomfort and vulnerability. These behaviors are called compulsive because one often feels compelled to engage in them and sees little alternative to engaging in them. Recovery from OCD involves a therapy known as exposure and response prevention (ERP) and offers the recovering individual an opportunity to learn to withhold from the compulsions by choice. In order to recover from OCD, it is imperative that all compulsions are eliminated to undo the OCD cycle. 

Occasionally, not all compulsions are targeted. This is sometimes the case with individuals with OCD that have chronic feelings of guilt, shame, and self-indicting thoughts such as “you are a terrible person.” What I have found is that these negative thoughts and emotions serve as compulsions, and thus need to be effectively addressed with ERP. The focus of this article is to understand how these emotions and thoughts look, why they are actually compulsions, and how to effectively overcome them.

Dr. Phillipson Talks Science, Symptoms & Treatment of OCD

You may be familiar with the crushing feelings of guilt and shame that often occur in response to having intrusive thoughts. It might be a thought related to being a pedophile (POCD), harming someone else (Harm OCD), or not being interested in your partner (ROCD), to give a few examples. Following the flood of guilty emotions, you might also respond by telling yourself, “I’m a terrible person,” “I don’t deserve to enjoy life,” or other self-indicting thoughts. Needless to say, it is an extremely unpleasant and unsettling experience. 

Turns out, these thoughts and feelings may actually give you some temporary relief, serving as a compulsion. Yes, you read that correctly.

One of the greatest difficulties with OCD —  Pure-O forms in particular — is that when you have a frightening thought that leaves you feeling vulnerable to a terrifying possibility, there is a desire to end the vulnerability with concrete information. Problem is, it is hard to get solid data to “make sure” that you are safe.

There is a desire to end the vulnerability with concrete information.

For example, if you have an intrusive thought indicating you may be a terrible person, it makes sense to want information proving otherwise. The problem is that there is no real “test” to give a binary yes/no to the question of whether you are actually a bad person — there is no test with 100% accuracy for pretty much anything. So, the brain gets creative and produces (basically unconsciously) its own test:

I will think to myself that I am a pedophile/racist/murderer/cheater/fill-in-the-blank, and then I will see how I respond. If I respond in a relaxed manner (e.g. I don’t care that I thought that), then it means that I am indeed a bad person. However, if I protest the thought of being a terrible person, then it must mean that I am really not a bad person. 

So your brain gives it a try. It has the thought, “I want to kill someone” only to be met with, “I’m such a terrible person for thinking that.” The assumption here is that only good people respond to such thoughts with resounding protest and guilt. In other words, there is reassurance embedded within the guilt-ridden reaction. The “real you” is observing your protest while you tell yourself, “That’s what I wanted to see. You passed the test!”

Rose Cartwright on Pure O

This is where things start to head in the wrong direction. Once you get a taste of that reassurance, you naturally and understandably want more of it. So, you repeat it again: think a certain thought, then respond with guilt and shame. While you like knowing that you're responding in a manner inconsistent with bad people, you also get stuck with constant negative thoughts and terrible feelings of guilt. Additionally, once you start engaging in this “test,” not responding with guilt-ridden thoughts and feelings will make you feel vulnerable to the possibility of being a terrible person. 

The bad news is that we cannot control these thoughts and feelings from showing up. The good news is that because guilt, shame, and self-indicting thoughts are compulsions, they can be effectively treated with ERP. This means you can “spoil” the compulsion, or undo the reassuring effect that OCD wants from the guilt.

Once you get a taste of that reassurance, you naturally and understandably want more of it.

For example, if you have the thought, “I might kill someone” and have it followed by feelings of guilt, you can respond to that by saying, “I might want to kill someone and I am only feeling guilty to try to prove to myself that I am not interested, but I actually might still be interested in killing someone.” In other words, you are responding to the brain's attempt for reassurance by spoiling the compulsion and keeping open the possibility of the feared outcome. 

When you respond enough times in this manner, the brain loses interest in this type of compulsion. I have found that the guilt and self-indicting thoughts become less frequent and often even disappear. By not letting the guilt become reassuring, you can send the guilt away on a one-way trip back home. And if it pops in for a visit, you will know what to do.


Dr. Ezra Cowan holds a doctorate in psychology and specializes treatments for OCD, misophonia, and perfectionism. He currently works in the Center for Cognitive Behavioral Psychotherapy in New York City, NY under the mentorship of Dr. Steven Phillipson. Dr. Cowan can be contacted through [email protected] or his website

Original Series

Support our work

We’re on a mission to change how the world perceives mental health.