Obsessive-compulsive disorder--A question of conscience? An fMRI study of behavioural and neurofunctional correlates of shame and guilt

The self in depression and anxiety as a transdiagnostic and differential-diagnostic neural marker: A systematic review

Accurate and early diagnosis of Depression and Anxiety is met with the challenge of comorbid presentations and the neglect of the basic disturbances of self in current diagnostic criteria. Here, we review studies employing functional magnetic resonance imaging (fMRI) with self-based tasks in major depressive disorder (MDD) and anxiety disorders (AD) to determine the transdiagnostic and differential-diagnostic applicability of neural markers related to the self. This systematic review identified three main findings: (I) Large-scale brain-wide changes related to self-dysfunction overlap significantly between MDD and AD. (II) Regional changes are unspecific to tasks and stimuli confirming their specificity to the self as distinguished from other cognitive functions. (III) MDD affects regions related to emotional-cognitive processing like the anterior cingulate cortex, while AD involves prefrontal and insular regions associated with interoceptive and emotional-cognitive regulation. Our systematic review shows the utility of the self as a transdiagnostic marker that exhibits neural topographic similarities across the diagnostic boundaries of MDD and AD. More fine-grained regional differences between MDD and AD can be found within their underlying large scale neural similarities, allowing for their differential-diagnostic specification. In conclusion, we demonstrate the relevance of the self as both a transdiagnostic and differential diagnostic neural marker in MDD and AD.

Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates

OBJECTIVE

Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD.

METHODS

Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews.

RESULTS

BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions.

CONCLUSIONS

Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.

Guilt and Shame in Patients with Obsessive-Compulsive Disorders

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a tremendous psychiatric illness with a variety of severe symptoms. Feelings of shame and guilt are universal social emotions that fundamentally shape the way people interact with each other. Mental illness is therefore often related to pronounced feelings of shame and guilt in a maladaptive form.

METHODS

A total of 62 participants (38 women and 24 men) were clinically and psychometrically investigated.

RESULTS

The OCD patients (n = 31) showed a maladaptive guilt and shame profile, characterized by increased interpersonal feelings of guilt accompanied by a stronger tendency to self-criticism and increased punitive sense of guilt with a simultaneous prevailing tendency to perfectionism, as well as an increased concern for the suffering of others. The proneness to profuse shame in OCD patients seems to be in the context of the violation of inner values and a negative self-image with persistent self-criticism.

CONCLUSION

Although there are limitations with a small sample size in this monocentric approach, our study underlines the importance of an individual consideration of the leading obsessive-compulsive symptomatology, especially in the context of very personal feelings of guilt and shame. Further multidimensional studies on guilt and shame could contribute to their implementation more strongly in individualized psychotherapy.

Neurobiological outcomes of cognitive behavioral therapy for obsessive-compulsive disorder: A systematic review

Introduction

Obsessive-compulsive disorder (OCD) is characterized by recurrent distressing thoughts and repetitive behaviors, or mental rituals performed to reduce anxiety. Recent neurobiological techniques have been particularly convincing in suggesting that cortico-striatal-thalamic-cortico (CSTC) circuits, including orbitofrontal cortex (OFC) and striatum regions (caudate nucleus and putamen), are responsible for mediation of OCD symptoms. However, it is still unclear how these regions are affected by OCD treatments in adult patients. To address this yet open question, we conducted a systematic review of all studies examining neurobiological changes before and after first-line psychological OCD treatment, i.e., cognitive-behavioral therapy (CBT).

Methods

Studies were included if they were conducted in adults with OCD and they assessed the neurobiological effects of CBT before and after treatment. Two databases were searched: PsycINFO and PubMed for the time frame up to May 2022.

Results

We obtained 26 pre-post CBT treatment studies performed using different neurobiological techniques, namely functional magnetic resonance imaging (fMRI), Positron emission tomography (PET), regional cerebral blood flow (rCBF), 5-HT concentration, magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), Electroencephalography (EEG). Neurobiological data show the following after CBT intervention: (i) reduced activations in OFC across fMRI, EEG, and rCBF; (ii) decreased activity in striatum regions across fMRI, rCBF, PET, and MRI; (iii) increased activations in cerebellum (CER) across fMRI and MRI; (iv) enhanced neurochemical concentrations in MRS studies in OFC, anterior cingulate cortex (ACC) and striatum regions. Most of these neurobiological changes are also accompanied by an improvement in symptom severity as assessed by a reduction in the Y-BOCS scores.

Conclusion

Cognitive-behavioral therapy seems to be able to restructure, modify, and transform the neurobiological component of OCD, in addition to the clinical symptoms. Nevertheless, further studies are necessary to frame the OCD spectrum in a dimensional way.

Interpersonal Guilt and Problematic Online Behaviors: The Mediating Role of Emotion Dysregulation

OBJECTIVE

The positive association between problematic Internet use (PIU) and emotion dysregulation (ED) is well documented. Research has also found that interpersonal guilt is positively associated with ED. Nevertheless, the influence of interpersonal guilt on PIU has been scarcely examined. In the current study, we investigated the relationships among the three constructs, and tested if emotion dysregulation mediates the association between interpersonal guilt and different types of PIU, namely problematic online gaming, problematic social media use, and problematic online pornography use.

METHOD

A sample of 434 adult participants (210 males, 48.4%) aged between 18 and 69 years old completed self-reported measures on interpersonal guilt, ED, and PIU. A structural equation modeling (SEM) framework was used to test the mediation models.

RESULTS

SEM analyses showed that ED mediates the relationship between interpersonal guilt as antecedent, and problematic online gaming, problematic social media use, and problematic online pornography use as outcomes.

CONCLUSIONS

Our findings suggest that emotion dysregulation deriving from experiences of interpersonal guilt can amplify the risk of using gaming, social media, and online pornography in a problematic way. Implications for prevention and treatment of PIU are discussed.

Self-Conscious Emotions and the Right Fronto-Temporal and Right Temporal Parietal Junction

For more than two decades, research focusing on both clinical and non-clinical populations has suggested a key role for specific regions in the regulation of self-conscious emotions. It is speculated that both the expression and the interpretation of self-conscious emotions are critical in humans for action planning and response, communication, learning, parenting, and most social encounters. Empathy, Guilt, Jealousy, Shame, and Pride are all categorized as self-conscious emotions, all of which are crucial components to one’s sense of self. There has been an abundance of evidence pointing to the right Fronto-Temporal involvement in the integration of cognitive processes underlying the expression of these emotions. Numerous regions within the right hemisphere have been identified including the right temporal parietal junction (rTPJ), the orbitofrontal cortex (OFC), and the inferior parietal lobule (IPL). In this review, we aim to investigate patient cases, in addition to clinical and non-clinical studies. We also aim to highlight these specific brain regions pivotal to the right hemispheric dominance observed in the neural correlates of such self-conscious emotions and provide the potential role that self-conscious emotions play in evolution.

Shame in patients with psychogenic nonepileptic seizure: A narrative review

Psychogenic Nonepileptic Seizures (PNES) have been linked to dysregulated emotions and arousal. However, the question which emotions may be most relevant has received much less attention. In this multidisciplinary narrative review, we argue that the self-conscious emotion of shame is likely to be of particular importance for PNES. We summarize current concepts of the development of shame processing and its relationship with other emotional states. We demonstrate the potential of acute shame to cause a sudden disruption of normal cognitive function and trigger powerful behavioral, cognitive, physiological and secondary emotional responses which closely resemble key components of PNES. These responses may lead to the development of shame avoidance strategies which can become disabling in themselves. We discuss how excessive shame proneness and shame dysregulation are linked to several psychopathologies often associated with PNES (including depression and PTSD) and how they may predispose to, precipitate and perpetuate PNES disorders, not least by interacting with stigma. We consider current knowledge of the neurobiological underpinnings of shame and PNES. We explore how shame could be the link between PNES and a heterogeneous range of possible etiological factors, and how it may link historical aversive experiences with individual PNES events occurring much later and without apparent external trigger. We argue that, in view of the potential direct links between shame and PNES, the well-documented associations of shame with common comorbidities of this seizure disorder and the well-characterized relationship between chronic shame and stigma, there is a compelling case to pay greater attention to shame in relation to PNES. Its role in the treatment of patients with PNES is discussed in a separate, linked review incorporating case vignettes to highlight the complex interactions of different but interlinked shame-related issues in individual patients.

The correlates of social phobia in OCD: Findings from a large clinical sample

OBJECTIVES

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients.

METHODS

We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses.

RESULTS

Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients.

CONCLUSION

Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD.

PRACTITIONER POINTS

Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.

Functional Brain Imaging and OCD

In the last 20 years, functional magnetic resonance imaging (fMRI) has been extensively used to investigate system-level abnormalities in the brain of patients with obsessive-compulsive disorder (OCD). In this chapter, we start by reviewing the studies assessing regional brain differences between patients with OCD and healthy controls in task-based fMRI. Specifically, we review studies on executive functioning and emotional processing, protocols in which these patients have been described to show alterations at the behavioral level, as well as research using symptom provocation protocols. Next, we review studies on brain connectivity alterations, focusing on resting-state studies evaluating disruptions in fronto-subcortical functional connectivity and in cortical networks. Likewise, we also review research on effective connectivity, which, different from functional connectivity, allows for ascertaining the directionality of inter-regional connectivity alterations. We conclude by reviewing the most significant findings on a topic of translational impact, such as the use of different fMRI measurements to predict response across a variety of treatment approaches. Overall, results suggest that there exists a pattern of regions, involving, but not limited to, different nodes of the cortico-striatal-thalamo-cortical circuits, showing robust evidence of functional alteration across studies, although the nature of the alterations critically depends on the specific tasks and their particular demands. Moreover, such findings have been, to date, poorly translated into clinical practice. It is suggested that this may be partially accounted for by the difficulty to integrate into a common framework results obtained under a wide variety of analysis approaches.

Obsessive-compulsive symptoms, intrusive thoughts and depressive symptoms: a longitudinal study examining relation to maternal responsiveness

BACKGROUND

The postpartum period is a vulnerable time for the development of depression. While perinatal depression has been well studied, intrusive thoughts related to the infant and classic obsessive-compulsive (OC) symptoms (e.g. chequering, ordering and cleaning) are also common in the postpartum and less well understood.

OBJECTIVE

The present study investigated the associations among depressive symptoms, intrusive thoughts, and OC symptoms and their relation to the quality of the mother-infant relationship, particularly in the realm of maternal responsiveness.

METHODS

Participants (N = 228) were recruited after delivery from a large Midwestern academic medical centre. At 2 and 12-week postpartum, participants completed self-report questionnaires that assessed demographics, depressive and OC symptoms, postpartum-specific intrusive thoughts and accompanying neutralising strategies, and maternal responsiveness.

RESULTS

At 12-week postpartum, maternal responsiveness was significantly lower for participants that endorsed intrusive thoughts, neutralising strategies or OC symptoms of clinical significance. More severe intrusive thoughts and neutralising strategies were associated with maternal responsiveness but not predictive after accounting for depressive symptoms; depressive symptoms were associated with lower levels of maternal responsiveness across the postpartum.

CONCLUSIONS

A sizable number of postpartum women experience clinically significant postpartum-specific intrusive thoughts and utilise neutralising strategies, especially in the context of postpartum depressive symptoms. Depressive symptoms have the most influence on maternal responsiveness but it is also important to target intrusive thoughts and OC symptoms in the context of postpartum depression to promote the welfare of new mothers and their offspring.

Shame in Anxiety and Obsessive-Compulsive Disorders

PURPOSE OF REVIEW

Studies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work.

RECENT FINDINGS

Medium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional. The consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.

Modality-specific overlaps in brain structure and function in obsessive-compulsive disorder: Multimodal meta-analysis of case-control MRI studies

Neuroimaging research has shown that patients with obsessive-compulsive disorder (OCD) may present brain structural and functional alterations, but the results across imaging modalities and task paradigms are difficult to reconcile. Are the same brain systems that are structurally different in OCD patients also involved in executive function and emotional processing? To answer this, we conducted separate meta-analyses of voxel-based morphometry studies, executive function functional magnetic resonance imaging (fMRI) studies, and emotional processing fMRI studies. Next, with a multimodal approach (conjunction analysis), we identified the common alterations across meta-analyses. Patients presented increased gray matter volume and hyperactivation in the putamen, but the putamen subregions affected differed depending on the psychological process. Left posterior/dorsal putamen showed hyperactivation during executive processing tasks, while predominantly right anterior/ventral putamen showed hyperactivation during emotional processing tasks. Interestingly, age was significantly associated with increased right putamen volume. Finally, the left dorsolateral prefrontal cortex was hyperactive in both functional domains. Our findings highlight task-specific correlates of brain structure and function in OCD and help integrate a growing literature.

Social Cognition and Obsessive-Compulsive Disorder: A Review of Subdomains of Social Functioning

Disturbances in social cognitive processes such as the ability to infer others' mental states importantly contribute to social and functional impairments in psychiatric disorders. Yet, despite established social, emotional, and cognitive problems, the role of social cognition in obsessive-compulsive disorder is largely overlooked. The current review provides a first comprehensive overview of social (neuro)cognitive disturbances in adult patients with obsessive-compulsive disorder. Results of our review indicate various social cognitive alterations. Patients with obsessive-compulsive disorder show deficits in the recognition of affective social cues, specifically facial expressions of disgust, and more general deficits in theory of mind/mentalizing. Additionally, patients show heightened affective reactions and altered neural responding to emotions of self and others, as well as poor emotion regulation skills, which may contribute to poor social functioning of patients. However, the discrepancies in findings and scarcity of studies make it difficult to draw firm conclusions with regard to the specificity of social cognitive disturbances. The review offers directions for future research and highlights the need to investigate obsessive-compulsive disorder from an interactive social neurocognitive perspective in addition to the prevalent passive spectator perspective to advance our understanding of this intricate and burdensome disorder.

Decoding moral emotions in obsessive-compulsive disorder

Background

Patients with obsessive-compulsive disorder (OCD) exhibit abnormal neural responses when they experience particular emotions or when they evaluate stimuli with emotional value. Whether these brain responses are sufficiently distinctive to discriminate between OCD patients and healthy controls is unknown. The present study is the first to investigate the discriminative power of multivariate pattern analysis of regional fMRI responses to moral and non-moral emotions.

Method

To accomplish this goal, we performed a searchlight-based multivariate pattern analysis to unveil brain regions that could discriminate 18 OCD patients from 18 matched healthy controls during provoked guilt, disgust, compassion, and anger. We also investigated the existence of distinctive neural patterns while combining those four emotions (herein termed multiemotion analysis).

Results

We found that different frontostriatal regions discriminated OCD patients from controls based on individual emotional experiences. Most notably, the left nucleus accumbens (NAcc) discriminated OCD patients from controls during both disgust and the multiemotion analysis. Among other regions, the angular gyrus responses to anger and the lingual and the middle temporal gyri in the multi-emotion analysis were highly discriminant between samples. Additional BOLD analyses supported the directionality of these findings.

Conclusions

In line with previous studies, differential activity in regions beyond the frontostriatal circuitry differentiates OCD from healthy volunteers. The finding that the response of the left NAcc to different basic and moral emotions is highly discriminative for a diagnosis of OCD confirms current pathophysiological models and points to new venues of research.

Emotional Processing in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis of 25 Functional Neuroimaging Studies

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) experience aversive emotions in response to obsessions, motivating avoidance and compulsive behaviors. However, there is considerable ambiguity regarding the brain circuitry involved in emotional processing in OCD, especially whether activation is altered in the amygdala.

METHODS

We conducted a systematic literature review and performed a meta-analysis-seed-based d mapping-of 25 whole-brain neuroimaging studies (including 571 patients and 564 healthy control subjects) using functional magnetic resonance imaging or positron emission tomography, comparing brain activation of patients with OCD and healthy control subjects during presentation of emotionally valenced versus neutral stimuli. Meta-regressions were employed to investigate possible moderators.

RESULTS

Patients with OCD, compared with healthy control subjects, showed increased activation in the bilateral amygdala, right putamen, orbitofrontal cortex extending into the anterior cingulate and ventromedial prefrontal cortex, and middle temporal and left inferior occipital cortices during emotional processing. Right amygdala hyperactivation was most pronounced in unmedicated patients. Symptom severity was related to increased activation in the orbitofrontal and anterior cingulate cortices and precuneus. Greater comorbidity with mood and anxiety disorders was associated with higher activation in the right amygdala, putamen, and insula as well as with lower activation in the left amygdala and right ventromedial prefrontal cortex.

CONCLUSIONS

Patients with OCD show increased emotional processing-related activation in limbic, frontal, and temporal regions. Previous mixed evidence regarding the role of the amygdala in OCD has likely been influenced by patient characteristics (such as medication status) and low statistical power.

White Matter Features Associated With Autistic Traits in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders. Comorbid autism spectrum disorder (ASD) or autistic traits may impair treatment response in OCD. To identify possible neurostructural deficits underlying autistic traits, we performed white matter tractography on diffusion tensor images (DTI) and assessed autistic trait severity using the Autism-Spectrum Quotient (AQ) in 33 OCD patients. Correlations between AQ and the DTI parameters, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were examined in major white matter tracts that were suggested to be altered in previous OCD studies. We found a negative correlation between AQ and FA and positive correlations between AQ and MD, AD and RD in the left uncinate fasciculus using age, Beck Depression Inventory, Yale-Brown Obsessive-Compulsive Scale, intelligence quotient and medication as covariates. However, we could not detect the significant results between AQ and all DTI parameters when adding gender as a covariate. In addition, in the ASD comorbid group, FA in the left uncinate fasciculus was significantly lower than in the non-ASD comorbid group and MD and RD were significantly higher than in the non-ASD group. These results did not survive correction for multiple comparisons. In ASD, the socio-emotional dysfunction is suggested to be related to the alteration of white matter microstructure in uncinate fasciculus. Our results suggest that variations in white matter features of the left uncinate fasciculus might be partly explained by autistic traits encountered in OCD patients.

Differences in clinical intrusive thoughts between obsessive-compulsive disorder, generalized anxiety disorder, and hypochondria

Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.

The role of guilt sensitivity in OCD symptom dimensions

Although some studies have found that guilt may precede, motivate, or be a consequence of obsessive-compulsive disorder (OCD), the relationship between guilt and OCD has been under investigated. The studies that explored the role of trait guilt (guilt propensity) in OCD reported inconsistent findings and failed to support its predictive role. Since it has been suggested that OCD patients perceive guilt in a more threatening manner, it might also be relevant to test to what extent they negatively evaluate the experience of guilt (i.e., guilt sensitivity; GS). Study 1 investigated the psychometric properties of a new 10-item Italian measure developed to assess GS-named Guilt Sensitivity Questionnaire-in a nonclinical sample (N = 473). Results from exploratory factor analyses supported the unidimensionality of the scale. It also showed excellent internal consistency and good discriminant validity. Study 2 investigated the role of GS in OCD symptoms, in particular with regard to responsibility for harm obsessions and checking compulsions, using a heterogeneous OCD sample (N = 61) and a control group of patients with anxiety disorders (N = 47). GS was the unique significant predictor of checking related OCD symptoms independent of negative mood states and obsessive beliefs. Guilt Sensitivity Questionnaire scores of patients with responsibility for harm concerns were significantly higher than those of patients with other kinds of obsessive concerns and with anxiety disorders. Findings supported the hypothesis that GS plays a relevant role in OCD symptoms when checking rituals are primarily involved. Implications for current cognitive behavioral models are discussed.

KEY PRACTITIONER MESSAGE

Guilt sensitivity may play a role in checking-related OCD symptoms. We developed a psychometrically sound unidimensional 10-item scale to assess guilt sensitivity. Guilt sensitivity was a unique predictor of checking-related OCD symptoms. Targeting beliefs about the intolerability/dangerousness of experiencing guilt may be useful. Acceptance-based approaches may be helpful as they promote the acceptance of guilt.

Seeking a perfect body look: feeding the pathogenic impact of shame?

Shame feelings often lead individuals to adopt compensatory mechanisms, such as the minimization of the public display or disclosure of mistakes and the active promotion of perfect qualities, conceptualized as perfectionistic self-presentation. Although perfectionism is considered a central characteristic of disordered eating, the investigation on the specific domain of body image-related perfectionistic self-presentation and on its relationship with psychopathology is still scarce. The main aim of the present study was exploring the moderator effect of body image-related perfectionistic self-presentation on the associations of shame with depressive symptomatology, and with eating psychopathology, in a sample of 487 women. Results revealed that body image-related perfectionistic self-presentation showed a significant moderator effect on the relationships of external shame with depressive symptomatology, and with eating psychopathology severity, exacerbating shame's impact on these psychopathological indices. These findings appear to offer important clinical and investigational implications, highlighting the maladaptive character of such body image-focused strategies.

Cognitive and emotional impairments in obsessive-compulsive disorder: Evidence from functional brain alterations

There is a common agreement on the existence of dysfunctional cortico-striatal-thalamus-cortical pathways in OCD. Despite this consensus, recent studies showed that brain regions other than the CSTC loops are needed to understand the complexity and diversity of cognitive and emotional deficits in OCD. This review presents examples of research using functional neuroimaging, reporting abnormal brain processes in OCD that may underlie specific cognitive/executive (inhibitory control, cognitive flexibility, working memory), and emotional impairments (fear/defensive, disgust, guilt, shame). Studies during resting state conditions show that OCD patients have alterations in connectivity not only within the CSTC pathways but also in more extended resting state networks, particularly the default mode network and the fronto-parietal network. Additionally, abnormalities in brain functioning have been found in several cognitive and emotionally task conditions, namely: inhibitory control (e.g., CSTC loops, fronto-parietal networks, anterior cingulate); cognitive flexibility (e.g., CSTC loops, extended temporal, parietal, and occipital regions); working memory (e.g., CSTC loops, frontal parietal networks, dorsal anterior cingulate); fear/defensive (e.g., amygdala, additional brain regions associated with perceptual - parietal, occipital - and higher level cognitive processing - prefrontal, temporal); disgust (e.g., insula); shame (e.g., decrease activity in middle frontal gyrus and increase in frontal, limbic, temporal regions); and guilt (e.g., decrease activity anterior cingulate and increase in frontal, limbic, temporal regions). These findings may contribute to the understanding of OCD as both an emotional (i.e., anxiety) and cognitive (i.e., executive control) disorder.