Case Report: Addressing Stigma and Shame in the Treatment of OCD

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When I first met 15-year-old Tina*, she was timid and guarded, only responding to yes-or-no questions. She had been admitted to the partial hospitalization program, where I am the attending psychiatrist, for recent suicidal ideation. On admit, her diagnoses were generalized anxiety disorder and major depressive disorder. After a few sessions of developing a rapport with Tina, she began to open up about her intrusive thoughts.

She was still hesitant to elaborate much, so I had her complete the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Her responses revealed her daily obsessions and compulsions, which she believed made her a “…terrible person not deserving of happiness.”

One of her most prominent obsessions was concern that she harmed her younger brother. She would often compulsively ask him if he was okay, reassuring herself that her thoughts had not become a reality. The result, of course, was that she created a self-imposed distance between them (for fear of actually harming him), furthering her feelings of isolation and wedging a familial gap in their relationship. Her parents could not understand why she had become a “…cold older sister,” and Tina became more and more ashamed of her thoughts, actions, and behaviors.

After I explained Tina’s diagnosis of obsessive-compulsive disorder (OCD) and an effective treatment for it, her demeanor changed. Tina became more hopeful. She started to see that her shame, which once resulted in feelings of worthlessness, could be managed, and the shame she was experiencing is not at all uncommon for individuals with OCD.

A 2022 study published in the British Journal of Clinical Psychology revealed a significant association between severity of OCD and feelings of shame.¹ I encouraged both Tina and her therapist to work on the association between her illness and feelings of shame.

The term obsessive compulsive disorder has become synonymous with being overly neat, organized, or particular. As a psychiatrist who treats OCD, I cringe when the illness is described as a quirky personality trait. The casual manner of “I’m so OCD” perpetuates the stigmatization and shame experienced by individuals suffering from OCD, which is a chronic and disabling illness with a high impairment in quality of life.² As a society, we need to stop such casual usage of language, and as health care professionals, we need to address the shame associated with OCD.

The aforementioned 2022 study emphasizes that the feelings of shame can be brought upon by the “odd and nonsensical” interpretation of the excessive and repetitive nature of a patient’s OCD behavior, and that a higher level of shame is experienced by patients with more severe cases of OCD. So, it becomes imperative for clinicians to recognize the signs of OCD and to address them through therapy and education.

Shame can be a debilitating condition, and routinely experiencing this emotion can feed the cycle of despair—but the underlying cause can, and should, be addressed. Shame is a feeling, like sadness, and understanding why the patient is having this feeling is critical to developing the proper treatment path. It is vital that patients understand that their individual diagnosis will never define who they are and, more importantly, that they can be taught to recognize specific triggers and change their thoughts.

Shame poses significant obstacles for patients with OCD, from seeking initial care to discussing their experiences openly.³ Addressing shame in the treatment of OCD is not a mere formality but a crucial component of the therapeutic process. By promoting acceptance and support, we can empower patients to break free from the burden of shame and move toward healing and recovery.

*Name and age have been changed for HIPAA compliance.

Dr Simone is a psychiatrist in private practice in Los Angeles, California. She serves as a board director for the American Board of Adolescent Psychiatry and as a member of the Administration and Operations Committee for the American Society of Adolescent Psychiatry.

References

1. Laving M, Foroni F, Ferrari M, et al. The association between OCD and shame: a systematic review and meta-analysis. Br J Clin Psychol. 2023;62(1):28-52.

2. Fontenelle IS, Fontenelle LF, Borges MC, et al. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res. 2010;179(2):198-203.

3. García-Soriano G, Rufer M, Delsignore A, Weidt S. Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature. Psychiatry Res. 2014;220(1-2):1-10.