Shame and OCD: what the research shows

One of the quietest features of obsessive-compulsive disorder (OCD) is shame. The intrusive thoughts that sit at the centre of OCD are often the kind a person would never say aloud — thoughts about harm, taboo themes, or things that feel at odds with everything they value. The rituals can look strange from the outside, and the person living with them usually knows that. The result is that many people carry OCD privately for years, convinced that what they are experiencing says something shameful about who they are.

What the research looked at

This review brought together twenty studies to ask a specific question: how closely is shame linked to OCD, and to particular kinds of obsessions? Eighteen of those studies were pooled in a meta-analysis — a way of combining results across studies to get a more reliable estimate than any single one provides.

What it found

Across the studies, there was a significant, moderate positive relationship between shame and OCD: in general, higher levels of shame went with greater OCD severity. When the authors looked at specific symptom types, the links with so-called unacceptable thoughts (intrusive harm-related or taboo thoughts), harm obsessions and symmetry concerns were positive but weaker, and varied a fair amount between studies.

The authors were careful about the limits. The shame measures used were general, not designed for OCD specifically, and there was meaningful variation between studies. They suggested that a shame measure built for OCD would sharpen future research. But the core finding held: shame and OCD travel together.

Why this matters

The practical point the authors draw is the important one. Because shame can be a barrier to seeking help and can wear down quality of life, it is something to address directly — through psychoeducation, careful assessment, and treatment — rather than something to work around.

In practice, this shapes how the early part of treatment goes. A person needs to be able to describe their actual obsessions, including the ones that feel most unspeakable, before those obsessions can be worked with. Part of the clinician's job is making the room safe enough for that to happen. Naming OCD for what it is — a condition, not a verdict on someone's character — is often where the shame starts to loosen.

If intrusive thoughts or rituals have been something you have carried alone, this is worth knowing: the thoughts themselves are a recognised feature of OCD, and treatment is built to work with them, not to judge them.

Reference Laving, M., Foroni, F., Ferrari, M., Turner, C., & Yap, K. (2023). The association between OCD and shame: A systematic review and meta-analysis. British Journal of Clinical Psychology, 62(1), 28–52. https://doi.org/10.1111/bjc.12392

Co-authored by Dr Cynthia Turner, Clinical Psychologist, The Moore Centre.

This article touches on a sensitive topic. It is general information, not a substitute for individual assessment. If OCD or distressing intrusive thoughts are affecting day-to-day life, get in touch — we see children, adolescents and adults in person at the Annerley rooms, by telephone, or by Zoom.