Guilt feels like a painful counterpart of OCD, but that’s the paradox of the disorder. But what else makes this happen?
Dopamine Plays a Vital Role in Modulating Anxiety
First, away from OCD, research shows that the brain’s nucleus accumbens (NAc) involves pleasure on one side and aversion on the other. Its divide is delicately thin. So, for example, when people fear something and are anxious, dopamine levels drop, so it plays a vital role in modulating anxiety. Similarly, when people have a desire for something, dopamine levels rise, even if that desire is harmful.
So could the same happen when people with OCD confuse wanting to do what they logically wouldn’t? It’s a theory, but for instance, suppose someone has an obsessive urge to harm their partner. They might feel a rise in dopamine as though the urge is a genuine desire. Later, they may be burdened with guilt and worry they are capable of harm. They feel fearful and anxious, and their dopamine levels drop.
Mental Compulsion
It’s not unusual for people with OCD to ruminate and analyse harmful thoughts. For example, “What if it’s something I want to do?” “If it isn’t, why do I get the urge that makes me think I do?” From this perspective, it’s crucial to recognise it is an automatic bodily response that makes it feel like an actual urge as though they will act on it. In other words, it is paradoxical to one’s authentic self, which makes sense because the disorder is in disagreement with the genuine self. It is also crucial to recognise that going over the doubt will continue making you question yourself when the problem is always OCD. Unfortunately, in doing so, you become more absorbed in the obsession.
More About Bodily Sensations
As we’ve seen, it’s difficult to express a meaning for a bodily sensation associated with a harm obsession. It’s similar for people who have groinal responses related to sexual obsessions. But, again, this may be down to the NAc because it involves emotions, memory and movement. Also, the release of dopamine affects motion that might be expressed as an urge. So, one might say the brain got it wrong, acting as though the obsession is real and thus releasing the dopamine.
For example, suppose Mr X has a repeated sensation where his hands want to move towards his partner’s neck. He might think of it as wanting to strangle her in that case. Therefore, he perceives it as a cue to move forward with a force that terrifies him, and he recoils. So, here, could it be possible the nucleus accumbens dopamine was at play. Even though there is an adverse reaction (suggesting a dopamine drop), Mr X interprets the entire incident as genuine arousal to cause harm. Therefore, his erroneous interpretation is the problem.
Another example is of having a groinal response. For example, imagine this time Mr X has a sensation down there. Subsequently, his private parts appear to want to move towards his same-sex friend, but he’s heterosexual. Regardless, he might think of it as wanting sex with his friend deep down. In other words, Mr X feels that it’s an internal signal to thrust himself towards his friend sexually and is horrified. Therefore, it shows he fears the urge associated with a sexual orientation obsession. So, once more, the urge is a feeling associated with the obsession, not a natural desire to do what Mr X’s authentic self doesn’t want. Again, notice the possible effect of nucleus accumbens dopamine even though it’s a false alarm.
The Problem with Obsessive Guilt
Moreover, people with OCD often suffer from guilt sensitivity, as mentioned earlier. For example, suppose someone has a hyper-responsibility obsession and does compulsive behaviours to keep themselves and others safe. If they don’t do the rituals, they fear their imagined consequences will come true and blame themselves in advance for anything that goes wrong.
In the same way, people with OCD often question whether they have a genuine desire to do sexually immoral or other harmful behaviours, and they suffer terrible guilt and shame. Consequently, they battle with these emotions, wondering how to cope on the one hand and, on the other hand, trying to avoid these feelings at whatever cost. Unfortunately, it reinforces the obsessive-compulsive pattern. They become hyper-vigilant and repeatedly check that their actions have not, or could not, lead to any harm.
Exposure-Response Prevention
The solution, therefore, is opting for an evidence-based treatment, such as exposure-response prevention. In this case, individuals must shift their focus away from obsessive content and associated guilt. Instead, they must focus on response prevention, which, when exposed to triggering situations, is resisting the rituals to avoid feared consequences and reduce distress momentarily. In addition, cognitive therapy alongside ERP can help indviduals change faulty beliefs about accountability and guilt, seeing that it is associated with OCD and treating it that way. Evidently, since the obsession is invalid, subsequent guilt cannot be legitimised despite how real it feels.
Summary
In conclusion, the sensation that makes you feel you have the urge to do harmful or sexual things is not about your authentic self. It is not a genuine desire. Since the nucleus accumbens dopamine is involved in appetitive and aversive motivation, such emotion may play a role in false arousal associated with OCD. In addition, because the brain’s amygdala has emotional memory, it signals danger in triggering situations, but in OCD, again, it is a false alarm. Therefore, subsequent guilt and feared consequences are part of the obsession, not genuine arousal in the here and now. In that case, exposing yourself to your obsessive fear and resisting reinforcing behaviours is crucial to freeing yourself from anxiety and guilt, thus leading to recovery.
More about OCD and the nucleus accumbens is covered in my book “3 Effective Ways To Treat OCD and Reclaim Your Life”.