Answering a Question on Shame. Unmasking the Link: OCD, Shame, and the Power of Compassion by Linda Sunderland

Obsessive-Compulsive Disorder (OCD) is often misunderstood, viewed merely as an anxiety disorder focused on excessive checking or cleaning. However, at its core, it frequently involves a deeply rooted struggle with shame. For therapists working with OCD, understanding this connection and approaching it with compassion is critical for healing.

This post was written following a presentation to Trauma Aid UK and it is based on the thoughtful questions asked by two attending clinicians. It is hoped that sharing the answers to these two essential questions will be helpful for both clinicians and those living with OCD. We explore the possible fundamental link between OCD and shame, and how to navigate the very common fear of disclosing obsessions.

1. Can you explain the link between OCD and Shame? 

The relationship between OCD and shame is complex, operating in both the past formative experiences and the present experiences.

Shame as a Foundational Experience

For a child experiencing overwhelming or intolerable feelings—perhaps stemming from shaming practices in their family, educational, religious, peer groups, or cultural environment—the young mind creates adaptive strategies to survive.

• The Protective Distraction: The patterns of OCD (the obsessions and compulsions) can be seen as a defense mechanism or a protective part designed to distract, block, or divert the client away from these overwhelming feelings and memories of shame. This shame often translates into a deep fear of rejection.

• The Internalised Safety: For a young, helpless child, it is paradoxically safer to internalise the shame and belief "I'm bad" "there's something wrong with me", than to externalise it to the attachment figures, environment, or others, needed for survival. The belief "I'm bad" is less terrifying than the reality that my essential caregiver, environment, group, are bad or unsafe. For children we can observe the importance of attachment and this system will operate to maintain attachment for safety, even if it means internalising a sense of being fundamentally flawed or bad.

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  There's something wrong with me can be seen as an adaptive way to create a false sense of control. If I am the problem, I might be able to compensate or make it right (through compulsions, perhaps). This provides a sense of agency where none exists over the external experience of needs not being, neglect, what should have happened but didn't, developmental trauma, adverse life experiences, and any overwhelming formative experiences.

Present-Day Shame about OCD

The connection also works in the other direction. Once OCD is established, the client frequently experiences intense shame attached to the actual intrusive thoughts and compulsions and how this creates difficulties in everyday functioning. This will lead to delaying seeking treatment or not feeling able to fully engage with treatment. 

It’s incredibly common to feel ashamed of having OCD—especially given the ego-dystonic and taboo nature of intrusive thoughts (e.g., harm, sexual, religious). This present-day shame can sometimes be seen as the protective part redirecting shame back to a "safe" place which in turn distracts away from perceptions of the original childhood experiences that the system will work so hard to suppress and avoid. The OCD itself becomes the source of shame, which is perceived to be within their control and provides a necessary distraction from early experiences - rather than the original, unmanageable shame source of childhood memories and formative experiences, the shame becomes attached to the OCD.

The Antidote: Compassion 

The powerful antidote to shame is COMPASSION. If you are a Therapist, this must be woven into every interaction:

• Attuned Interaction: Respond to any disclosure of intrusions or compulsions with immediate, non-judgmental, compassionate understanding and attunement.

• Safety and Normalisation: Create a compassionate, safe space with no judgement. Share general, normalising information about the universal nature of intrusive thoughts to reduce the client's self-blame and shame about the thought content or compulsions..

• Self-Compassion Practices: Connect the client to self-compassionate resources and practices, such as "Loving Eyes", Compassion Focused Therapy resources, compassionate visualisations or bringing in resource figures.

• Pace and Patience: It can take a long time for a client to reveal the nature of their most distressing intrusive thoughts and compulsions. Hold compassionate space for this reluctance. Reinforce: "I’m aware of the possible themes that OCD part can hook into, and this is a completely safe, non-judgmental place."

• Parts work: As a therapist, if you are trained in parts work, this can be a great place to integrate and support your client compassionately get to know the part.

When there's a fear of talking about the problem 

It is understandable that it's incredibly difficult to talk about the highly distressing content of obsessions and compulsions. This fear often stems from feelings of shame, fear of being misunderstood and negatively judged or that the misunderstanding could lead to devastating consequences following disclosure of thoughts such as harm or sexual OCD.

Building Foundational Safety

Trust and safety are paramount, particularly in the initial phases of therapy (e.g., Phase 1 and 2 in ai-EMDR).

• Attachment as Strength: Use the early phases to develop safety in the therapeutic attachment. This relationship itself is one of the main strengths that allows for later, deeper work.

• Small Disclosures: A client might talk about the problem piece by piece to "test the waters" and sense your reaction. Your consistent, calm, compassionate response is their key to safety and the signal from your nervous system, to theirs, that this is a safe connection and space. Apply principles from Polyvagal Theory by remaining in your ventral vagal state—a state of safe connection—from nervous system to nervous system.

The Clinician’s Role: Centered and Calm

It is really important for all therapists working with OCD, to become deeply familiar with the ego-dystonic nature and common themes. A non-judgmental stance will be welcomes when a client discloses content that feels taboo or horrifying to them, the clinician's task is to communicate through all channels that there is no judgment and an abundance of compassionate understanding. 

Strategies for Disclosure

There are several ways to gently approach the disclosure of obsessions:

• Compassion! Compassion! Compassion! It's the anti-dote to shame!

• Patience and Generalisation: Discuss with your client that you understand if they don’t feel ready, and also that you are aware of the general, difficult themes that often show up with OCD.

• The ai-EMDR Approach: It is possible to begin processing if your client is prepared and you collaboratively agree, without knowing the exact thoughts or compulsions. You can ask the client to simply have this knowledge and provide the associated Emotion, Body Sensation, and Negative Belief and "bridge back" from there.

• Supportive Tools: Completing a standardised measure like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) together can sometimes be supportive. Seeing the list of example themes can validate the client's experience, normalize their symptoms, and provide a clinical, shared language to discuss the difficult content.

Attune, build trust, bring compassionate understanding, be patient, and remember that your client has probably judged and shamed themselves enough so they absolutely need a non-judgmental presence to accompany them on the healing journey.