Shame in the obsessive compulsive related disorders: a conceptual review

Abstract

Background: Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame׳s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work.

Methods: We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs.

Results: General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors.

Limitations: Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct.

Conclusions: Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.

Keywords: Body dysmorphic disorder (BDD); Obsessive compulsive disorder (OCD); Obsessive-compulsive related disorders; Shame; Skin picking (SP); Trichotillomania (TTM).