Dopamine Plays a Vital Role in Modulating Anxiety
Guilt feels like a painful counterpart of OCD, but that’s the paradox of the disorder. What it wants you to believe is the opposite of your authentic self, but it lets you carry the guilt anyway. But what makes this happen?
First, and 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.
So could the same happen when people with OCD confuse wanting to do what they logically wouldn’t? For instance, suppose someone has an obsessive urge to harm underage persons sexually. They might feel a rise in dopamine as though the urge is a genuine desire. So, naturally, they would be burdened with guilt as though they have a real problem. But can the problem really be defined as an urge?
First, it’s not unusual for people with OCD to ruminate and analyse harmful intrusive thoughts. For example, “What if it’s something I want to do?” “If it isn’t, why do I get urges that make 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 you will act on it. In other words, you would call the urge an intrusive sensation or feeling obsession, not a sudden impulsive desire. But back to mental review, 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 Feeling Obsessions
As we’ve seen, it’s difficult to express a meaning for an intrusive thought associated with a bodily sensation suggesting harm could happen instantly. It’s why people relate to their intrusive thoughts as having urges or wanting to act on the thoughts but fear them. 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.
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, you can see the emotional impact of nucleus accumbens dopamine. Even though there is an adverse reaction, Mr X perceives it as genuine arousal to cause harm. Still, it is a false sensation in OCD, so an urge to act on it is misperceived. Therefore, his misinterpretation 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. That being so, he might think of it as wanting sex with his friend. 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 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.
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 who question whether they have a genuine desire to do sexually immoral or other harmful behaviours suffer terrible guilt. Consequently, they battle with it, wondering how to tolerate it on the one hand and, on the other hand, trying to avoid it 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, which could result in them feeling more guilt.
The solution, therefore, is for people to 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. Evidently, since the obsession is invalid, subsequent guilt cannot be legitimised despite how real it feels. But that’s the paradox of OCD. What it wants you to believe is the opposite of your authentic self, remember. Therefore, developing a tolerance for the guilt sensation (not actual guilt) is crucial to your recovery, as it is with anxiety and building tolerance to it and becoming habituated to the obsessional fear.
Exposure Response Prevention
Therefore, exposure-response prevention (ERP), an evidence-based treatment for OCD, can help you resist the rituals that keep obsessive content going in a circle and see that feared consequences are part of the problem. For example, suffering from guilt for perceived wrongdoing and not coping with it is hard to bear. It is the same with anxiety; it feels too intolerable to endure.
But as we’ve seen, ERP helps you build a tolerance for both. In addition, cognitive therapy alongside ERP can help you change faulty beliefs about accountability and guilt, seeing that it is associated with OCD and treating it that way. In other words, obsessions are irrelevant to what happens in life. Therefore, if a disaster occurs, it is relevant to the here and now, not an obsession. Understanding this can help to manage uncertainty.
In conclusion, the sensation that makes you feel you have the urge to do harmful things is a feeling obsession. It is not a genuine desire to harm. 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 amygdala has emotional memory, it signals danger in relevant situations, but in OCD, again, it is a false alarm. Still, subsequent guilt and feared consequences are part of the obsession, not genuine arousal in the here and now. Therefore, exposing yourself to your obsessive fear and resisting reinforcing behaviours is crucial to freeing yourself from anxiety and guilt sensitivity, thus leading to recovery.
More about pure-intrusive thoughts is covered in my book “3 Effective Ways To Treat OCD and Reclaim Your Life”.