Unveiling Guilt: A Comparative Analysis of its Role in Obsessive-Compulsive Disorder and Depression

Study Design, Setting and Participants:

This cross-sectional study was conducted on three groups: 50 individuals diagnosed with OCD and 50 individuals diagnosed with Depressive Disorder according to the ICD-10 Diagnostic Criteria for Research (WHO, 1993) recruited from hospitals and private clinics in Kolkata, West Bengal, India. 50 people were recruited from the community as healthy controls. Purposive sampling was employed, and the three groups were matched based on age (between 18-50 years), sex (male and female), and education level (minimum tenth standard).

Inclusion and Exclusion Criteria:

Participants in the OCD group were included if they had comorbid minimal or mild depressive episodes as high co-morbidity of OCD with depressive disorder is expected, while only moderate or severe Depressive episodes in the Depression group were considered. The healthy control group was required to have no history or diagnosis of any mental illness. Individuals with a history of serious medical, neurological, or developmental disorders, as well as childhood-onset OCD or Depression, were excluded from all groups. Additionally, individuals with comorbid moderate or severe depressive episodes or other psychiatric disorders were excluded from the OCD group, while those with comorbid OCD, mild depressive episodes, or other psychiatric disorders were excluded from the Depression group to avoid data contamination.

Measurement:

The Yale-Brown Obsessive Compulsive Scale (Goodman et al., 1989) was used to assess OCD symptom severity, Beck Depression Inventory (Beck et al., 1961) for subjective experience of Depression and Hamilton Depression Rating Scale (Hamilton, 1960) for clinician rating of depressive symptoms were used for two clinical groups. The General Health Questionnaire-28 (Goldberg et al., 1979) was administered to the healthy control group to assess psychiatric morbidity. Guilt was examined in all three groups using the Revised Mosher Guilt Inventory (Mosher, 1966, 1968).

Comparative Analysis of Guilt between the Groups:

Mosher and Cross (1971) defined sexual guilt as “a generalized expectancy for self-mediated punishment for violating or anticipating violating standards of proper sexual conduct”. In India, a vast section of people consider sex as a private and largely tabooed topic. These ingrained feelings associated with sex guilt are initially learned through the early punitive reactions of parents to their children’s expressions of sexuality. Though parents intend to introduce a moral training about appropriate sexual behaviors, their punitive reactions often lead children to experience intense guilt which may later get generalized to other sex-related situations throughout their lives. This cognitive predisposition is highly manifested in OCD where they suffer intense levels of guilt and regrets following violations of internalized sexual standards. It makes them resist sexual temptation, feel intense tension, remorse, preoccupation with the wrongdoing and a strong wish to undo the wrong deed. Sexual guilt in OCD is more of a known phenomenon than it is for Depression, where past researchers have studiedmasturbatory guilt in depression (Chakrabarti et.al., 2011; Aneja et. al.,2011 & Albobali and Madi; 2021). There can be various factors like hormonal change, body image, negative past sexual experience or trauma which can be linked with sexual guilt in people with Depression. The resistance in sexual temptations caused by sexual guilt can possibly discourage depressed individuals from engaging in sexual activity, often manifested as lack of sexual interest and lack of libido.

A common observation in OCD is their overactive conscience, which is consistent with psychoanalytic assumptions of the presence of an overly strict superego. With a higher guilty conscience, one tends to psychologically magnify scenes involving moral temptations and may feel guilty about themselves. While people brought up in India (who do not have OCD) may experience moral dilemmas and associated emotional distress, the affliction experienced in OCD is way more damaging and serious. Along with hypersensitivity towards transgression of rules and principles, people with OCD also tend to have an overvalued sense of responsibility (Cougle, Lee & Salkovskis, 2007) especially for harm. It is to an extent that any responsibility for a negative outcome is equated to taking full responsibility for the outcome and failing to prevent harm is akin to actually causing harm. Coupled with that, Moral- Thought Action Fusion (TAF) which prompts people with OCD to assume that thinking about an action is equivalent to actually carrying out that action.

Correlation between Severity of OCD and Guilt &Depression & Guilt:

It was found from this study that the more severe the OCD, the more guilt one experiences. Certain specific symptoms may trigger the feeling of sexual guilt like, having sexual thoughts that transgresses their own moral standard, immoral or sacrilegious thoughts and images about God and blasphemy that make oneself feel guilty to the core. Being extremely particular or having excessively strict moral rules of right and wrong can lead the sufferer to become so self-critical that they may even punish themselves as they feel the act is ‘unacceptable’. People with OCD may feel that the “guilt feeling” is so unbearable that they try to do everything in their capacity to prevent committing the slightest actions that might lead them to feel guilty. Similar to our finding, Audhya et al. (2022) in a recent study utilized the Revised Mosher Guilt Inventory and found that individuals with OCD reported significantly higher guilty conscience than the group in conflict with the lawand they did not differ in terms of hostility guilt. However, unlike our study, no evident differences were observed in terms of sexual guilt between the two groups.

Feelings, thoughts or utterances conveying experiences of self-blame, remorse and guilt are common in Depression. A clear correlation was found between guilt and BDI scores in a study by Berrios et. al. (1992) on persons with Depressive Disorder. Sexual guilt brings a sense of judgement of being morally wrong and the urge to fight or suppress any form of temptation related to sex and failing to do so gives rise to various negative emotions and punitive reactions. As the Depression increases, the sense of failure magnifies and sexual guilt acts as one of the possible catalysts. Hostility-guilt is conceived of as an affective-cognitive structure that regulates aggressive behavior. It consists of beliefs that aggressive behaviors are immoral and one should expect to be punished for the same. The psychoanalytic conception was that Oedipal guilt was transformed into a need for punishment. A prominent feature of Depression is directing aggression toward themselves, possibly because of their guilt-proneness. When hostility- guilt arises, they tend to psychologically magnify not just anger and rage but also the cognition about the immorality of their aggressive thought or behavior. Hence, it tends to make them more irritable and intolerant towards themselves. During depressive episodes, individuals with depression tend to engage in self-blaming, where they excessively criticize themselves for minor faults or shortcomings. This selfcriticism often leads to heightened feelings of guilt, which can exacerbate the symptoms of Depression.

Corroborating this observation, a study by Li et al. (2018) revealed a strong association between guilt and Depression. Using the same tool Mukherjee & Ganguly (2020) examined different types of guilt, and obtained contrasting results compared to our study, i.e., those with severe Depression exhibited elevated levels of guilty conscience in comparison to those with mild or moderate levels of Depression.

Funding:

None

Conflict Of Interest:

None