Combating Shame Around Intrusive Thoughts

When I work with clients who struggle with intrusive thoughts, one of the most difficult parts is often not just the thought itself, but the shame that attaches to it.

The thought often feel disturbing and anxiety provoking, but there is often a range of other emotions that the person may feel that can be quite overwhelming for most patients. I find that some OCD-related themes bring on far more tremendous shame for patients than other themes do. Shame is a self conscious emotion involving self devaluation, social withdrawal, and elevated sensitivity to external judgment. Increasingly, researchers are focusing on shame because of its influence on emotional regulation and relationships. Shame is a self-conscious emotion that comes up when a person perceives a gap between their own traits, behaviours, or actions and their standards (social and internalized) (Jiang 2026). Of the different forms that shame can take, trait shame shapes how people approach and respond to interpersonal situations over time (Jiang 2026). Gilbert (2007) describes trait shame as having two main dimensions: external shame, which is the sense of being judged negatively by others and feeling inferior, defective, or unattractive; and internal shame, which comes from negative self-evaluations that focus on personal flaws, limitations, or imperfections (Gilbert 2007). These self judgments can relate to many different themes, including appearance, independence versus dependence, competitiveness, and broader issues around intimacy and how others view us (Jiang 2026). I find this quite a facinating, since people with OCD do want to find help, but at the same time the shame may push them away from accessing care. I think as a profession we need to do a better job at creating more awarness around shame based OCD themes. A story for another day.

When I talk about intrusive thoughts, I am not referring to just any random thought that comes into the mind. I am talking about thoughts, images, impulses, or urges that feel unwanted, distressing, and deeply inconsistent with a person’s values. These are often called ego-dystonic thoughts, meaning they go against who the person is, what they care about, and what they believe. In other words, these are not thoughts people want to have. They are thoughts that feel invasive, alarming, and deeply upsetting precisely because they clash so strongly with the person’s identity. In my work with clients, I often explain that intrusive thoughts tend to “go for the jugular.” They latch onto the things a person cares about most deeply and then twist those things into a source of terror. That is why these thoughts can feel so compelling and so difficult to dismiss.  

Many of the intrusive thoughts that generate the most shame tend to fall into taboo categories. These can include violent thoughts, sexual thoughts, blasphemous thoughts, religious fears, or thoughts that attack a person’s morals and values. A person may have a thought about harming someone they love, about acting sexually in a way that horrifies them, or about violating a deeply held moral or spiritual belief.  Shame has also been found to inhibit individuals’ willingness to disclose their symptoms and premature therapy termination in individuals with OCD (Visvalingam et al., 2022). What I try to help patients understand is that the presence of the thought is not evidence of desire, intent, or character. In fact, the very reason the thought feels so distressing is often that it is so opposite to what they value. The mind has the ability to generate material that feels shocking. OCD then takes that material and treats it as a threat that must be solved, prevented, controlled, or neutralized.  

Intrusive thoughts are actually very common in the general population. That can be frustrating to hear when someone is suffering, because it may lead to the question, if these thoughts are common, why do they feel so different for me? I understand that reaction, and I never say this to minimize the pain. I say it because it matters. What often distinguishes OCD is not simply the presence of intrusive thoughts, but the way the person becomes entangled with them. The thought gets flagged as dangerous. It feels significant. It sticks. The person begins monitoring for it, trying to suppress it, arguing with it, seeking certainty about it, or avoiding anything that might trigger it. Patients come to understand  that the problem is not that they had the thought. The problem is the relationship that OCD creates with the thought.  Thoughts do not just stay in the mind as passing experiences. They often lead to avoidance. Sometimes that avoidance is physical. A person may avoid children, knives, driving, religious settings, partners, or pets because the thought has attached itself to those situations. Sometimes the avoidance is emotional. The person becomes afraid not just of the thought, but of the shame, disgust, or anxiety the thought brings up. Sometimes the avoidance is cognitive. The person tries to force the thought away, replace it with a “good” thought, mentally review whether it means anything, or search for reassurance that they would never act on it.  I often explain that all of these efforts make sense in the short term because they are attempts to get relief. But over time, they strengthen the OCD cycle. The more we avoid, the more the brain learns that the thought must be dangerous. The more we try to suppress a thought, the more it tends to rebound and return.  

This is one of the great paradoxes in OCD treatment: the harder a person tries not to think a thought, the more present that thought can become. I often use this idea to help normalize why someone feels so trapped. They are not failing because they cannot suppress the thought. Human minds are simply not built to control thought in the way OCD demands. In fact, shame can make this even worse. When a person feels ashamed of a thought, they often keep it secret, hide from it, and avoid speaking it aloud. That secrecy gives the thought even more emotional charge. It becomes something hidden, forbidden, and dangerous, which can make it intrude even more forcefully.  Repugnant obsessions (i.e., intrusive violent and sexual thoughts) are associated with greater distress, anxiety, and increased efforts to control thoughts compared to contamination and symmetry obsessions (Visvalingam et al., 2022). In my work, I often see that shame and secrecy are two of the biggest amplifiers of intrusive thoughts. That is why I think it is necessary to distinguish shame from guilt. Guilt sounds like, I did something bad, whereas shame sounds like, I am bad. Guilt is about behavior. Shame is about identity. Shame feels global, painful, and totalizing. It tells people that they are defective, broken, disgusting, dangerous, or unworthy. Shame makes people want to hide, shrink, withdraw, and isolate. It creates the urge to become smaller and less visible. When a person with OCD is already terrified by what their mind is producing, shame makes the entire experience far more painful by turning a feared thought into a feared self. That is one of the reasons shame can be such a powerful maintaining factor in OCD.  

Shame and isolation tend to reinforce each other. A person feels ashamed, so they withdraw. Then, because they are alone with the thought, the thought feels even more shameful and even more dangerous. They begin to believe that nobody else could possibly understand what they are going through. They may start to think that if anyone really knew what went through their mind, they would be judged and rejected.  It convinces people that they are uniquely horrifying, when in reality many of the themes they carry are much more common than they realize. Shame says, This means something terrible about you. Treatment helps people learn to say, This is a painful symptom, not a confession of character.  

I have also seen how shame can become a barrier to treatment itself. Clients may come into therapy wanting help, but still hold back the very material that causes them the most distress. Sometimes it takes weeks or months before they feel safe enough to name the thought they are most afraid to say out loud. When that happens, I always feel deeply honored. In my view, it takes tremendous courage to tell the truth about a thought that has been bringing on the feeling of shame. I believe many clients need to hear this clearly: therapists who understand OCD are not shocked by intrusive thoughts. We are not sitting there judging the person for the content of their mind. We recognize that these thoughts are often the opposite of the person’s values. Most of us OCD therapists try to create a space where they do not have to perform wellness before they are worthy of help. They do not have to clean up the thought before bringing it into the room. They can say the hard thing, and we can work with it together.  

Another important part of this conversation is recognizing that there is a connection between OCD and shame. Research has found an association between OCD symptoms and shame, including shame proneness, which refers to the tendency to respond to experiences by turning inward and blaming the self (Jiang 2026). It also describes different kinds of shame that can show up, including shame related to the stigma of having a mental health condition and shame related to the specific content of the symptoms themselves. I think both are clinically important. Sometimes clients feel ashamed that they have OCD at all. Other times they feel ashamed because of the exact theme of their obsessions. In practice, I often see both at once: shame about struggling and shame about what they are struggling with.  

What I find especially important is helping clients understand that shame does not prove the thought is meaningful. In fact, shame often emerges because the thought attacks what matters most. If a person cares deeply about protecting others, a harm thought can feel devastating.  I  reframe this by saying: the thought is not pointing to your darkness; it is often pointing to your values. OCD tends to target the tender spots. It attacks the places where conscience, care, love, responsibility, and morality are strongest. That does not make the experience any less painful, but it can begin to loosen shame.  

One of the ways I help clients work with shame is through self-compassion.  Mindful self compassion is broken down into three parts: common humanity, self-kindness, and mindfulness. Common humanity means remembering that suffering is part of being human and that a person is not alone in having a mind that produces painful material. Self-kindness means responding to pain with gentleness rather than attack. Mindfulness means noticing the thought and the emotion without  making them into a story about identity. A patient may practice saying, ‘this hurts’, instead of immediately saying, ‘this means something is wrong with me’. That shift matters.  

Shame thrives on the belief that I am the only one. It tells the person that they are the only one who is disturbing, dangerous, and defective (the three D’s). What we try to do is challenge that false sense of uniqueness (all three D’s). It can be healing to realize that others with OCD have had similarly disturbing thoughts and that these thoughts do not define them either. I often find that people begin to soften toward themselves when they realize they are not the only person whose mind has produced something horrifying. Common humanity does not erase pain, but it does reduce the loneliness that shame depends on.  

Self-kindness is often much harder than clients expect. Many people with OCD have become  harsh with themselves. They believe that if they are not strict enough, vigilant enough, or disgusted enough by the thought, it means they condone it. So they respond to themselves with hostility. These patients may also  monitor their reactions, criticize themselves, and try to prove their goodness through internal punishment. I often have to help them see that attacking themselves is not the same as being ethical. Self hatred is not a treatment plan. Harshness does not purify the mind. In fact, it often deepens the cycle by increasing fear, shame, and mental preoccupation. I want clients to learn that it is possible to be deeply distressed by a thought and still meet themselves with gentleness. That is not avoidance or permission. It is courage.  

Mindfulness also plays an important role in how I approach these symptoms. By mindfulness, I mean learning to observe a thought as a thought, rather than immediately interpreting it as a fact  or a revelation. This is described as seeing things as they are without judgment.  Your OCD will attempt to make you believe:  I had a thought to therefore I am dangerous, therefore I want this, or therefore I can never trust myself. Mindfulness helps slow that process down. We want to practice noticing the thought without adding a full identity based narrative on top of it. The thought is a mental event. OCD wants to turn it into a moral emergency. Treatment helps people step back from that escalation.  

I also use ideas from Acceptance and Commitment Therapy, particularly cognitive defusion, when helping clients work with shame and intrusive thoughts. Defusion is about changing a person’s relationship to a thought rather than trying to eliminate the thought itself. Instead of fusing with the content of the thought, the person learns to notice it with some distance. For example, there is a difference between saying, I want to harm someone, and saying, I am having the thought that I want to harm someone. This  helps move the thought from identity to observation. When I use this approach, I am not trying to reassure the client or prove the thought false. I am helping them relate to it differently. OCD wants literalness, urgency, and certainty. Defusion invites observation, perspective, and flexibility.  

Every emotion has an action tendency. Anxiety tends to push people to avoid and escape. Shame tends to push people to hide and ruminate. Here is an interesting question: what would it look like to do the opposite of what shame is demanding? If shame says, ‘Hide’, opposite action may mean speaking the thought aloud in therapy. If shame says, ‘Withdraw’, opposite action may mean staying connected to safe and understanding people. If shame says, ‘Go inward and analyze yourself for hours’, opposite action may mean stepping out of rumination and returning to valued action. I find that opposite action can be a powerful bridge between insight and behavior. It helps clients not just understand shame, but respond to it differently.  

In many ways, the antidote to shame is not certainty. It is connection, compassion, and willingness. I think this is important because many people with OCD spend years trying to solve shame by proving they are good enough, safe enough, or certain enough. But shame rarely loosens through argument. It loosens through a new relationship to the thought and to the self.  I am often helping patients move from a posture of self-surveillance to a posture of self-understanding. That does not mean minimizing risk when real risk is present. It implies recognizing when OCD has taken a thought and turned it into a false indictment of character. It means helping people return to the truth that a thought, even a horrifying one, is still a thought.  

Recovery does not mean never having another disturbing thought. Recovery means learning that a thought does not get to define you. Recovery means being able to say, with increasing honesty and steadiness, my mind produced something narrative, and I do not have to react to it.

Author:

Robert Roopa, Clinical Psychologist

eJiang, X., Zhang, Y., Wu, C., Liu, D., & Zhang, J. (2026). The relationship between insecure attachment and shame: A meta-analysis. Personality and Individual Differences, 251, 113585. https://doi.org/10.1016/j.paid.2025.113585

Gilbert, P. (2007). The evolution of shame as a marker for relationship security: A biopsychosocial approach. In J. L. Tracy, R. W. Robins, & J. P. Tangney (Eds.), The self-conscious emotions: Theory and research (pp. 283–309). The Guilford Press.

Visvalingam, S., Crone, C., Street, S., Oar, E. L., Gilchrist, P., & Norberg, M. M. (2022). The causes and consequences of shame in obsessive-compulsive disorder. Behaviour Research and Therapy, 151, 104064. https://doi.org/10.1016/j.brat.2022.104064