Feeling ashamed of having OCD: a double problem

Shame often grows in secret. Others may see the compulsions, avoidance or repeated questions, but not the danger the person feels. From the inside, the responses make sense: they are attempts to protect themselves or others and to quieten the anxiety and doubt. When others do not see this connection, the person may begin to judge themselves as harshly as they fear others will.

Shame about the content of thoughts: direct shame

Many people with OCD feel ashamed of the content of their thoughts. This is especially true of unwanted thoughts, images and impulses that conflict with the person’s values. A thought about stabbing someone while holding a knife can trigger intense doubt: What if the thought means I might actually do it?

The doubt is not only about what she fears she might do, but also about who she fears she might be. One example is a woman who has OCD thoughts about sexually abusing children. She fears that the thoughts reveal a hidden desire or that she might act on them. At the same time, she is ashamed of having the thoughts at all. She is now struggling both with the fear of acting on the thoughts and with shame about what the thoughts seem to say about her. The thoughts have become a threat to her self-image.

She may fear that the people she loves will distance themselves from her if she tells them about the thoughts. It therefore becomes vital to hide both the thoughts and the compulsions that follow. This is direct shame: shame about the content of the thoughts and what they seem to say about her as a person. Fear of other people’s reactions can leave someone alone with their symptoms for a long time before seeking help.

OCD thoughts often centre on what matters most to the person. Someone who is conscientious may become trapped in the fear of making a serious mistake. Someone who is caring may be plagued by the thought of harming a person they love. The thoughts become so distressing and shameful precisely because they conflict with the person’s values.

Intrusive thoughts are common

Most people experience intrusive thoughts with content similar to that of obsessions. In an international study across 13 countries, more than nine in ten participants had experienced at least one unwanted intrusive thought during the previous three months. People without OCD have described thoughts about running over an animal or a person, taking part in a sexual act they find repulsive, or infecting others with a serious illness.

It is therefore not the content of the thought alone that distinguishes OCD from ordinary intrusive thoughts. The difference lies in the meaning the thought is given, how intrusive it becomes and how the person attempts to deal with it. Many people notice a strange or unpleasant thought and carry on with what they were doing. In OCD, by contrast, the thought feels like a question that demands an answer that leaves no doubt.

Thinking a thought is not the same as wanting it or acting on it. Thoughts, images and impulses arise continually in the mind without expressing the person’s wishes or character.

In OCD, the doubt returns: What if the thought does mean something after all? The person therefore does everything they can to get rid of it or become completely certain. They monitor the thought, analyse it, seek reassurance or avoid whatever triggers it. The struggle to get rid of the thought makes it more prominent and gives it greater significance.

Shame about having OCD: secondary shame

Many people with OCD feel ashamed of being afraid of something others consider harmless. This is secondary shame: shame about having OCD, feeling different or being unable to do the same things as others.

Compulsions may be hidden, but they can also make the problem visible to others. One example is a man who is too afraid of serious illness to shake hands. When a person breaks with ordinary social norms, the difference becomes visible, and they may feel ashamed of standing out or appearing rude. At the same time, they face the dilemma of whether to explain their OCD or try to hide it.

It can be difficult for a person to tell others that they have a mental disorder. Without an explanation, they may fear that others will see their behaviour as rude or strange.

Whether or not OCD is visible, shame may lie just beneath the surface. The person may come to believe that something is wrong with them and that they ought to pull themselves together and move on.

Many people are criticised for not simply pulling themselves together and gradually begin to turn the same criticism on themselves. They often know that, seen from the outside, the fear seems excessive, but that does not make the anxiety, doubt or disgust disappear. When they cannot explain their own reaction either, shame gains an even stronger hold.

Direct and secondary shame can occur separately, but they often go hand in hand. A person feels ashamed both of the thoughts and of being unable to let them go. The two forms of shame reinforce one another and make it even harder to speak openly about what they are experiencing.

Shame does not define who you are

Anxiety, doubt, guilt and disgust are not feelings a person chooses. When something feels dangerous, the body and emotions both respond, even if the person can also see that the fear seems excessive. That is why “pull yourself together” is not an answer to OCD.

Shame makes thoughts and actions look like evidence that a person is dangerous, immoral, weak or somehow wrong. But they are not evidence of any of these things. An unwanted thought is not a desire, and a compulsion does not reflect a lack of willpower. Both form part of an OCD pattern that has gained power over the person’s attention and everyday life.

When a person understands the connection between the thought, the fear and the attempt to become completely certain, their harsh self-judgement loses some of its power. OCD does not tell the truth about who the person is. Neither does shame.