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Pathological guilt: A persistent yet overlooked treatment factor in obsessive-compulsive disorder

Leslie J. Shapiro, LICSW

OCD Institute, McLean Hospital, Belmont, MA, USA

Evelyn Stewart, MD

OCD Institute, McLean Hospital, Belmont, MA, USA, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

BACKGROUND: Guilt appears to be a factor that may increase the severity of obsessive-compulsive disorder (OCD) and negatively impact treatment outcomes. However, researchers and clinicians have paid little attention to addressing guilt in OCD treatment. Because guilt is an important perpetuating and mediating factor for OCD symptoms and the development of guilt-specific strategies may yield improved treatment outcomes, we hypothesized that a review of the relevant literature may provide important guidance for the field.

METHODS: To identify existing scientific contributions across psychological, biologic, and theological disciplines, we conducted a systematic review of the literature on the topic of pathological guilt (PG) in OCD.

RESULTS: Fourteen studies focusing on both PG and OCD were identified. The content of these papers consistently reflected the theme that guilt plays a significant role in OCD and obsessive-compulsive symptoms.

CONCLUSIONS: The potential influence and moderating effects of guilt require more focused attention in the clinical management of OCD. Development of routine standardized measures and treatment protocols targeting the role of guilt in OCD, in addition to consultation with clergy or other appropriate community resources, would provide valuable contributions to the literature. Addressing this affective component related to OCD may lead to improved treatment outcomes and fewer relapses for this debilitating and frequently chronic illness.

KEYWORDS: OCD, guilt, state, trait, moral, responsibility

ANNALS OF CLINICAL PSYCHIATRY 2011;23(1):63-70

CORRESPONDENCE: Leslie J. Shapiro, LICSW, OCD Institute, McLean Hospital 115 Mill Street, Belmont, MA 02478 USA E-MAIL: lshapiro@mclean.harvard.edu
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.

 
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