Why people with Moral Scrupulosity OCD are more prone to chronic guilt and anxiety

Quick Summary:

According to the evidence presented, OCD may have a neural basis that makes the sufferer more susceptible to intense feelings of chronic guilt and anxiety.

What the research says about guilt, anxiety and OCD

Medical imaging shows that in OCD sufferers, the brain areas that generate guilt and anxiety (vmPFC and left amygdala) are abnormally hyperconnected. [1] [2] More specifically, the vmPFC has been shown to generate guilt. [3] [4]

diagram showing vmpfc responsible for guilt
The area of the brain that generates guilt is hyperconnected in OCD.

Hyperconnectivity in these areas of the brain results in OCD sufferers having higher levels of guilt and anxiety, especially in response to triggers such as real-life events, false memories, moral uncertainty or intrusive thoughts.

For scrupulosity OCD in particular, sufferers find it difficult to accept moral uncertainty – because the core fear or worst-case scenario feels so real and threatening. Many people with false memory and real-event OCD find it difficult to recover by using only cognitive diffusion (as the only recovery tool).

My own first-hand experience as a former sufferer of scrupulosity OCD has taught me that dampening down the exaggerated fear towards the worst-case scenario via unconditional acceptance is essential for recovery.

Lowering your fear levels in the long term requires you to identify and make peace with all of the scenarios that frighten you. To learn about the most common worst-case scenarios that are often overlooked in relation to scrupulosity OCD please read this informative article.

Unconditional life and other acceptance as well as flexible thinking usually occur as a result of a gradual change in beliefs via CBT.

People with OCD also usually have lower levels of serotonin (mood chemical) compared to “healthy” individuals and medications like Sertraline are often prescribed to stabilise serotonin levels.

Key takeaway message for evidence-based recovery from Moral Scrupulosity OCD

People with OCD are generally more prone to guilt and anxiety in response to negative stimuli and real-life events. This may be due to hyperactivity in the neural circuit that regulates emotional responses.

Because they have a heightened threat, danger and guilt response, they can’t afford to adopt conventional beliefs and thinking patterns that are based on unhealthy beliefs such as people’s deservingness and conditional life acceptance. In contrast, healthy beliefs (eg unconditional acceptance) are more flexible and do not provoke these negative emotions.

It is essential that OCD sufferers work on recovery strategies such as exposure therapy and unconditional life acceptance in order to gradually dampen down their fear levels.

Breaking down core fears and learning to accept worst-case scenarios will help sufferers of OCD avoid mental breakdowns and crisises in the future.

If you’re interested in putting this into practice and lowering your guilt and anxiety levels, please read our article which goes into depth about how to recover from moral scrupulosity OCD using 5 effective strategies.


  1. Hyperconnectivity of the ventromedial prefrontal cortex in obsessive-compulsive disorder: https://journals.sagepub.com/doi/10.1177/2398212818808710
  2. Functional and structural connectivity of the amygdala in obsessive-compulsive disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167243/
  3. Economic Games Quantify Diminished Sense of Guilt in Patients with Damage to the Prefrontal Cortex: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646169/
  4. Acquired personality disturbances associated with bilateral damage to the ventromedial prefrontal region: https://pubmed.ncbi.nlm.nih.gov/11385830/

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