Deontological Guilt Differentially Affects Moral Behaviour in Participants With and Without Obsessive–Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterised by a dysfunctional sensitivity to a sense of guilt that significantly interferes with everyday functioning and is believed to be a key mechanism in symptom maintenance. Mounting evidence indicates that individuals with OCD are particularly sensitive to deontological guilt, which stems from the perception of violating an internalised rule, as opposed to altruistic guilt, which arises from the feeling of having harmed others. Here, we assess the impact of deontological vs. altruistic guilt on moral behaviour in participants with OCD. Twenty participants with OCD and 20 gender- and age-matched comparison participants took part in a social game in which they could choose to lie for a personal reward (self-gain lie) or to benefit the other player (other-gain lie). During the game, they were exposed to stimuli designed to evoke one of three emotional states: deontological guilt (DG), altruistic guilt (AG) or a neutral state. Self-report ratings of DG and AG evoked by the stimuli were also recorded. Exposure to stimuli that evoke the anticipation of AG was associated with a decrease in self-gain lies and an increase in altruistic lies in all participants. When individual emotional ratings were taken into account, we found that stronger AG elicited by the stimuli was associated with fewer lies. In contrast, higher DG ratings were associated with a decrease in self-gain lies in controls but with an increase in self-gain lies in OCD participants. Our results support the notion that DG is particularly crucial for OCD participants and reveal that it can be particularly disruptive for them, suggesting that this emotion should be a primary target of psychotherapeutic intervention.