Fear of guilt from behaving irresponsibly in obsessive-compulsive disorder.

Previous cognitive models of obsessive-compulsive disorder (OCD) propose that inflated responsibility plays a key role in the maintenance of symptoms (Behav.Res.Ther. 28 (1985) 571). In this manuscript, we propose that this thesis may be improved by emphasizing that instead, OCD may be characterized by a fear of guilt that would result from behaving irresponsibly and/or from not behaving responsibly. We believe that this concept provides a better explanation for the anxious and fearful nature of OCD than do more traditional conceptualizations of inflated responsibility. We support this idea with empirical evidence and propose that OCD symptoms are consistent with patients acting in a prudential mode because of their fears of guilt.