Boyfriend Troubled by Obsessive Guilt

Reader’s Question

Is it possible to be diagnosed with obsessive-compulsive disorder if there are only obsessions and no compulsions? My boyfriend has suffered since childhood with obsessive thoughts of guilt, such as ‘I am responsible for the upcoming death of my classmate’, ‘I robbed the priest’s car’, ‘I have killed certain people’ etc. — which have no logical basis at all. Those obsessions occur every time with a different theme. The first ‘episode’ ocurred when he was 6 years old and lasted for several months. Another one ocurred when he was 12 and it lasted for years. He believed that he had caused injury to one of his classmates (just by pushing him once and causing no visible injury) which would then be fatal. He changed schools and was avoiding to find out anything about that person for years because he was afraid he’d find out that the person had died. He couldn’t sleep at night due to his guilt and fear, kept crying etc. After all he met that old classmate by luck and realised nothing had happened.

So now there’s a new obsession which he won’t even reveal to me. He has also told me that I’m the only person to whom he has ever talked about these things. I’m not really sure if those thoughts are accompanied by compulsive acts because it’s very hard to get him to talk about this problem. It causes him major terror and discomfort and he just wants to stop the conversation and leave.

As far as I know there have been some problems between his parents (they were thinking about getting a divorce since several years ago but never got one after all). I know nothing else about his family so this is the only reason which I might assume as being responsible for those obsessive guilty thoughts since childhood. Is it right to pressure him to talk to me about it? I study psychology so at least I can try to persuade him to visit a psychotherapist in order to solve his issue. If it’s not OCD, could it be part of another specific disorder?

Our Consulting Clinical Psychologist’s Reply

Your boyfriend may be suffering from Obsessive-Compulsive Disorder (OCD). This may also be a combination of OCD and Depression as both are considered to be related to low levels of the brain neurotransmitter Serotonin. Low levels of Serotonin create a clinical depression, often in response to a high level of stress in the environment (parents in the process of divorce). In all of us, low Serotonin may produce different symptoms. For some, like your boyfriend, OCD symptoms surface and they develop rituals (counting, handwashing, etc.) and obsessive thoughts. Other people develop anorexia and eating disorders. Others experience auditory hallucinations. Some people experience delusional guilt. In short, your boyfriend probably experiences OCD features any time his stress level increases and this is one of those times. There are treatments available for this condition.

I’d recommend reading and researching about OCD. I would look at other symptoms he may be experiencing, especially those known to be related to depression. I would then encourage him to seek treatment, perhaps first through a family physician. He would also find a psychologist, counselor, social worker, or psychiatrist very helpful. Offer to go with him to the appointments.

You can find additional articles on this topic on this website and on my website at www.drjoecarver.com.

His situation and symptoms are very treatable.