Have I done enough to avoid blame? Fear of guilt evokes OCD-like indecisiveness
Introduction
Obsessive-compulsive disorder (OCD) is a leading cause of disability and is difficult to treat (Olatunji, Cisler, & Deacon, 2010). Although OCD is recognized as a disorder of doubt and indecisiveness (Esquirol, 1838), a disorder of decision-making (Sachdev & Malhi, 2005), and a state of pathological indecisiveness (Beech, 1974), these are not diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), nor are they particularly well-emphasized in leading models of the development and persistence of OCD. Yet, a better understanding of the factors that influence indecisiveness and doubt may enable us to better understand and treat individuals with OCD. A growing body of research suggests that fear of guilt is characteristic of OCD, and that it may influence decision-making (Mancini & Gangemi, 2006) by raising the perceived stakes of minor decisions (e.g., whether one has washed one's hands sufficiently). However, to the best of our knowledge, no studies have directly examined the effect of fear of guilt on the decision-making process in vivo. The purpose of this study was therefore to determine whether fear of guilt might provoke indecisiveness (objectively and/or subjectively) and influence parameters of decision-making, such as latency for decisions and need for information, as well as the subjective experience of decision-making, such as perceived difficulty of the decision-making process and confidence in and satisfaction with decisions.
Individuals with OCD do not tend to exhibit a general deficit in decision-making (e.g., Lawrence et al., 2006; Nielen, Veltman, De Jong, Mulder, & Den Boer, 2002), but even in nonclinical samples there is a very close relationship between indecisiveness and severity of checking (but not washing) behaviour (Frost and Shows, 1993, Gayton et al., 1994, Rassin and Muris, 2005), suggesting that doubt and indecisiveness characterize the obsessive-compulsive cycle. Furthermore, people with OCD have been found to take longer to make decisions than control participants when presented with problems that have multiple solutions (Goodwin & Sher, 1992), with OCD-relevant hypothetical scenarios (Foa et al., 2003), in probability-based gambling tasks presented as possible losses rather than gains (Sip, Muratore, & Stern, 2016), and in tasks with high uncertainty (Banca et al., 2015). People with OCD have also been found to require more information before making decisions about hypothetical scenarios (Foa et al., 2003), to request more trials on a signal detection task despite performing on par with people without OCD (Milner, Beech, & Walker, 1971), and to need more evidence to make determinations about the direction of moving dots under high uncertainty conditions (Banca et al., 2015).
These laboratory findings are consistent with clinical presentation. For example, individuals with OCD require more information when making decisions about terminating compulsive behaviours, rely on subjective criteria more heavily when making that decision, and use more criteria than do people without OCD (Wahl, Salkovskis, & Cotter, 2008). Likewise, Simpson, Cove, Fineberg, Msetfi, and Ball (2007) found that individuals with OCD performed similarly to controls in reasoning tasks but relied more heavily on emotionally-driven heuristics than logic-based analytic processes. Wahl et al. (2008) suggested that people with OCD may bring complex decision-making processes to bear on decisions that people without OCD would find straightforward. Neuroimaging studies support this, demonstrating that people with OCD exhibit hyperactivation in limbic and paralimbic brain regions during decision-making tasks; these areas coincide with nodes of the default mode network and are thought to reflect an over-engagement of self-focused internal thought processes, such as recalling autobiographical memories and simulating negative future scenarios, which stall the decision-making process (Stern et al., 2013). Such repeated attempts to construct, predict, and revise simulations of the future may explain the greater demands for information and longer time taken for decisions observed in OCD groups.
This begs the question as to why there is such substantial processing in decision-making. Anecdotally, we know that people with OCD view decisions relevant to obsessional themes as having high stakes. People with OCD uniquely rate their moral self-concept as highly important but low in competence (Doron, Moulding, Kyrios, & Nedeljkovic, 2008). They also endorse greater uncertainty, ambivalence, and dichotomy in their self-view compared to healthy and anxious controls (Bhar & Kyrios, 2007). As such, the issue of whether or not one is a “good” person is not well-resolved, and schema may be routinely over-accommodated in response to experience (e.g., “I made the wrong decision and some harm came of it, therefore I am a bad person”), rather than appropriately accommodated (“Even a good person, like I am, can err sometimes”), resulting in guilt.
Decision-making may thus involve high motivation to maximize outcomes for proximal issues (e.g., buying the best lock) in addition to distal concerns (e.g., ensuring nothing can go wrong for which they could be held accountable, avoiding ensuing guilt). However, it is very difficult to resolve the problem of whether or not one has prevented all possible harm. Thus, fear of responsibility for harm, and the ensuing guilt may not only prolong decision-making for scenarios involving harm and safety but also result in doubt about decisions already made (fuelled by ever new ideas about possible inadequate behaviour), consequently evoking the urge to repeat the compulsion. This is consistent with a theory of indecisiveness put forth by Rassin (2007), which proposes that predisposing factors (e.g., perfectionism) contribute to specific perceptions that lead to indecisive behaviours. It may therefore be that heightened fear of guilt is one such predisposing factor for indecisiveness.
Although anecdotally we recognize that people with OCD report significant guilt, there is no consistent evidence that people with OCD exhibit higher trait guilt than other groups (e.g., Steketee, Quay, & White, 1991). Chiang, Purdon, and Radomsky (2016) proposed instead that people with OCD may fear the experience of guilt more because it signals that one has failed to uphold one's own standards of moral conduct. They developed a measure of fear of guilt, finding that it was indeed highly correlated with OCD symptomatology in nonclinical samples and that it predicted severity of OCD symptoms after controlling for responsibility, trait and state guilt, anxiety, depression, neuroticism, and stress. Meanwhile, D’Olimpio and Mancini (2014) found that, in nonclinical individuals, induction of guilt about violating personal moral values resulted in greater discomfort and doubt, more repetitive checking and washing behaviours, and greater hesitation. Furthermore, the addition of a fear of guilt induction in an experimental task resulted in greater checking behaviour and hesitation, than the high responsibility induction alone (Mancini, d’Olimpio, & Cieri, 2004).
It may be the case that higher fear of guilt motivates people to search for the “right” decision and to delay decision-making until they are certain of the outcome of each course of action. When faced with a problem for which there is no certain answer (e.g., which lock to buy when many types are on offer), high fear of guilt may lead people to choose a course of action that would help absolve them of responsibility and concomitant guilt should any harm result from that decision (e.g., following the advice of a trusted authoritative figure).
The current study was designed to: i) examine whether fear of guilt evokes indecisiveness, as indicated by objectively longer decision latencies and elevated evidence requirements; ii) determine whether individuals higher in fear of guilt experience greater subjective feelings of indecisiveness and doubt about decisions already made; and, iii) determine if individuals with elevated fear of guilt prefer information from sources that may better absolve them of guilt (e.g., opinion of trusted authoritative other vs. large-scale surveys) in case of a wrong decision. We used a decision-making paradigm based on Foa et al. (2003), which allowed for assessment of decision-making parameters (latency, amount of information required before deciding) and comfort with the decision once made. We also wanted to examine whether an induction of state fear of guilt would moderate these relationships. Prior to the decision-making task, participants underwent a challenging stove-checking task and were either told that the researcher would get into a lot of trouble if the stove was left on (state guilt induction) or were given no induction.
We hypothesized that: (1) higher fear of guilt will be associated with slower decision-making and requests for more information, particularly those with high state fear of guilt; (2) higher fear of guilt will be associated with greater doubt about decisions, difficulty making decisions, less satisfaction with decisions made, and less confidence in having made the right decision, particularly in those high in state fear of guilt; and (3) higher fear of guilt individuals will prefer to base decisions on information from an authoritative person who could share culpability should harm arise from the decision, particularly those high in state fear of guilt.
Section snippets
Participants
Participants were 63 undergraduate students enrolled in an introductory psychology course at University of Waterloo who completed the study for course credit. The sample was 63.5% female and 20 years of age on average (SD = 3.0, range = 17–34). In an attempt to obtain a wider range of trait fear of guilt scores, participants were invited to complete the study if their scores on a screener version of the Fear of Guilt Scale (FOGS) in an unrelated recruitment participant pool fell on either end
Data analytic strategy
Data analyses were performed using SPSS 22 (IBM). To assess whether the manipulation was successful for those randomised to the fear of guilt induction, the two groups were compared on state fear of guilt (VAS) ratings and guilt ratings completed before and after the induction (i.e., pre-stove task and after the induction/no comment) using repeated measures ANOVAs.
Hierarchical multiple regression analyses were performed to determine the impact of fear of guilt on objective and subjective
Discussion
The purpose of this study was to determine whether fear of guilt might provoke indecisiveness (objectively and/or subjectively) and whether higher fear of guilt would be associated with a greater reliance on information from sources that could potentially share responsibility if harm were to occur as a result of the decision. This pathway might help us to understand perseveration and indecisiveness in OCD. Results suggested that, in general, fear of guilt did not clearly influence the amount of
Conclusions
In conclusion, fear of guilt was associated with indecisiveness when faced with safety/harm concerns, and was particularly associated with doubting of decisions that had already been made. Fear of guilt may raise the perceived stakes of decision-making, elevating the decisional threshold, fuelling indecisiveness, and evoking perseveration with information gathering during the decision-making process (e.g., “have I checked enough to know it is safe?”). The fear of guilt construct therefore
Acknowledgements
This research was supported by a CIHR CGS Master's Award Scholarship and a SSHRC CGS Doctoral Scholarship awarded to the first author and a SSHRC Insight Grant (118049) awarded to the second author. The authors are grateful to Martyn Gabel and Anchal Bhatia for their invaluable help with data collection and to the anonymous reviewers of earlier versions of this manuscript for their helpful comments and suggestions.
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