The association between OCD and shame : A systematic review and meta-analysis

Journal article

Laving, Michelle, Foroni, Francesco, Ferrari, Madeleine, Turner, Cynthia and Yap, Ann Keong. (2023). The association between OCD and shame : A systematic review and meta-analysis. British Journal of Clinical Psychology. 62(1), pp. 28-52. https://doi.org/10.1111/bjc.12392
AuthorsLaving, Michelle, Foroni, Francesco, Ferrari, Madeleine, Turner, Cynthia and Yap, Ann Keong
Abstract

Background
Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive–compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.

Objectives
Our review systematically examines the association of shame with OCD and unacceptable thoughts.

Methods
The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.

Results
The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [−0.467, 0.9708], harm obsessions r = .224, CI [−0.190, 0.638] and symmetry concerns r = .200, CI [−0.108, 0.509].

Limitations
Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.

Conclusions
Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.

Keywordsmeta-analysis; obsessive–compulsive disorder; OCD; shame; unacceptable thoughts
Year2023
JournalBritish Journal of Clinical Psychology
Journal citation62 (1), pp. 28-52
PublisherJohn Wiley & Sons Ltd
ISSN0144-6657
Digital Object Identifier (DOI)https://doi.org/10.1111/bjc.12392
PubMed ID36300990
Scopus EID2-s2.0-85141347086
Open accessPublished as ‘gold’ (paid) open access
Page range28-52
FunderResearch Training Program Scholarship (RTP), Australian Government
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online27 Oct 2022
Publication process dates
Accepted13 Sep 2022
Deposited27 Mar 2023
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Albarello, Flavia, Foroni, Francesco, Hewstone, Miles and Rubini, Monica. (2017). Generalisation of Roma onto Romanians Evidence of the Outgroup Projection Effect. Psicologia Sociale. 2/2017, pp. 239 - 249. https://doi.org/10.1482/87249
The effectiveness of an outpatient Acceptance and Commitment Therapy Group programme for a transdiagnostic population
Pinto, Richelle Anne, Kienhuis, Mandy, Slevison, Monique, Chester, Andrea, Sloss, Annie and Yap, Keong. (2017). The effectiveness of an outpatient Acceptance and Commitment Therapy Group programme for a transdiagnostic population. Clinical Psychologist. 21(1), pp. 33 - 43. https://doi.org/10.1111/cp.12057
A neural signature of food semantics is associated with body-mass index
Pergola, Giulio, Foroni, Francesco, Mengotti, Paola, Argiris, Georgette and Rumiati, Raffaella I.. (2017). A neural signature of food semantics is associated with body-mass index. Biological Psychology. 129, pp. 282 - 292. https://doi.org/10.1016/j.biopsycho.2017.09.001
Self-compassion is associated with optimum self-care behaviour, medical outcomes and psychological wellbeing in a cross-sectional sample of adults with diabetes
Ferrari, Madeleine, Cin, Michelle D. and Steele, Mike. (2017). Self-compassion is associated with optimum self-care behaviour, medical outcomes and psychological wellbeing in a cross-sectional sample of adults with diabetes. Diabetic Medicine. 34(11), pp. 1546 - 1553. https://doi.org/10.1111/dme.13451
The smell of terroir! Olfactory discrimination between wines of different grape variety and different terroir
Foroni, Francesco, Vignando, Miriam, Aiello, Marilena, Parma, Valentina, Paoletti, Maurizio Guido, Squartini, Andrea and Rumiati, Raffaella I.. (2017). The smell of terroir! Olfactory discrimination between wines of different grape variety and different terroir. Food Quality and Preference. 58, pp. 18 - 23. https://doi.org/10.1016/j.foodqual.2016.12.012
A qualitative comparison of needles and insulin pump use in children with type 1 diabetes
Ferrari, Madeleine, McIlwain, Doris J. F. and Ambler, Geoffrey. (2017). A qualitative comparison of needles and insulin pump use in children with type 1 diabetes. Journal of Health Psychology. 23(10), pp. 1332 - 1342. https://doi.org/10.1177/1359105316653999
Embodiment and emotional memory in first vs. Second language
Baumeister, Jenny C., Foroni, Francesco, Conrad, Markus, Rumiati, Raffaella I. and Winkielman, Piotr. (2017). Embodiment and emotional memory in first vs. Second language. Frontiers in Psychology. 8, pp. 1 - 11. https://doi.org/10.3389/fpsyg.2017.00394
Preliminary evaluation of a brief mindfulness-based stress reduction intervention for mental health professionals
Dobie, Alana, Tucker, Alison, Ferrari, Madeleine and Rogers, Jeffrey Michael. (2016). Preliminary evaluation of a brief mindfulness-based stress reduction intervention for mental health professionals. Australasian Psychiatry. 24(1), pp. 42 - 45. https://doi.org/10.1177/1039856215618524
Lexical-semantic deficits in processing food and non-food items
Rumiati, Raffaella I., Foroni, Francesco, Pergola, Giulio, Rossi, Paola and Silveri, Maria Caterina. (2016). Lexical-semantic deficits in processing food and non-food items. Brain and Cognition. 110, pp. 120 - 130. https://doi.org/10.1016/j.bandc.2016.08.007
Testing the bivalent fear of evaluation model of social anxiety: The relationship between fear of positive evaluation, social anxiety, and perfectionism
Yap, Keong, Gibbs, Amy L., Francis, Andrew J. P. and Schuster, Sharynn E.. (2016). Testing the bivalent fear of evaluation model of social anxiety: The relationship between fear of positive evaluation, social anxiety, and perfectionism. Cognitive Behaviour Therapy. 45(2), pp. 136 - 149. https://doi.org/10.1080/16506073.2015.1125941
Registered replication report: Strack, Martin, & Stepper (1988)
Wagenmakers, E.-J., Beek, Titia, Dijkhoff, Laura, Gronau, Quentin F., Acosta, A., Adams, R. B., Albohn, D. N., Allard, E. S., Benning, S. D., Blouin-Hudon, E.-M., Bulnes, L. C., Caldwell, T. L., Calin-Jageman, R. J., Capaldi, C. A., Carfagno, N. S., Chasten, K. T., Cleeremans, A., Connell, L., DeCicco, J. M., ... Zwaan, R. A.. (2016). Registered replication report: Strack, Martin, & Stepper (1988). Perspectives on Psychological Science. 11(6), pp. 917 - 928. https://doi.org/10.1177/1745691616674458s
Deeper than skin deep - The effect of botulinum toxin-A on emotion processing
Baumeister, Jenny C., Papa, G. and Foroni, Francesco. (2016). Deeper than skin deep - The effect of botulinum toxin-A on emotion processing. Toxicon. 118, pp. 86 - 90. https://doi.org/10.1016/j.toxicon.2016.04.044
We are what we eat: How food is represented in our mind/brain
Rumiati, Raffaella I. and Foroni, Francesco. (2016). We are what we eat: How food is represented in our mind/brain. Psychonomic Bulletin and Review. 23(4), pp. 1043 - 1054. https://doi.org/10.3758/s13423-015-0908-2
Mindfulness-based stress reduction for restless legs syndrome: A proof of concept trial
Bablas, Vicky, Yap, Keong, Cunnington, David, Swieca, John and Greenwood, Kenneth Mark. (2016). Mindfulness-based stress reduction for restless legs syndrome: A proof of concept trial. Mindfulness. 7(2), pp. 396 - 408. https://doi.org/10.1007/s12671-015-0457-9
Automatic female dehumanization across the menstrual cycle
Piccoli, Valentina, Fantoni, Carlo, Foroni, Francesco, Bianchi, Mauro and Carnaghi, Andrea. (2016). Automatic female dehumanization across the menstrual cycle. British Journal of Social Psychology. 56(2), pp. 270 - 280. https://doi.org/10.1111/bjso.12178
A bait we cannot avoid: Food-induced motor distractibility
Foroni, Francesco, Rumiati, Raffaella I., Coricelli, Carol and Ambron, Elisabetta. (2016). A bait we cannot avoid: Food-induced motor distractibility. Brain and Cognition. 110, pp. 74 - 84. https://doi.org/10.1016/j.bandc.2015.12.003
Food color is in the eye of the beholder: The role of human trichromatic vision in food evaluation
Foroni, Francesco, Pergola, Giulio and Rumiati, Raffaella Ida. (2016). Food color is in the eye of the beholder: The role of human trichromatic vision in food evaluation. Scientific Reports. 6, pp. 1 - 6. https://doi.org/10.1038/srep37034
Do emotions or gender drive our actions? A study of motor distractibility
Ambron, Elisabetta, Rumiati, Raffaella I. and Foroni, Francesco. (2016). Do emotions or gender drive our actions? A study of motor distractibility. Cognitive Neuroscience. 7(1-4), pp. 160 - 169. https://doi.org/10.1080/17588928.2015.1085373
When the mask `falls': The role of facial muscle resonance in memory for emotional language
Baumeister, Jenny C., Rumiati, Raffaella I. and Foroni, Francesco. (2015). When the mask `falls': The role of facial muscle resonance in memory for emotional language. Acta Psychologica. 155, pp. 29 - 36. https://doi.org/10.1016/j.actpsy.2014.11.012
Do we embody second language? Evidence for 'partial' simulation during processing of a second language
Foroni, Francesco. (2015). Do we embody second language? Evidence for 'partial' simulation during processing of a second language. Brain and Cognition. 99, pp. 8 - 16. https://doi.org/10.1016/j.bandc.2015.06.006
Self-compassion mediates the relationship between parental criticism and social anxiety
Potter, Rob F., Yap, Ann Keong, Francis, Andrew James Peter and Schuster, Sharynn. (2014). Self-compassion mediates the relationship between parental criticism and social anxiety. International Journal of Psychology and Psychological Therapy. 14(1), pp. 33 - 43.
The attraction of emotions: Irrelevant emotional information modulates motor actions
Ambron, Elisabetta and Foroni, Francesco. (2014). The attraction of emotions: Irrelevant emotional information modulates motor actions. Psychonomic Bulletin and Review. 22(4), pp. 1117 - 1123. https://doi.org/10.3758/s13423-014-0779-y
Perfectionism and its relationship with anticipatory processing in social anxiety
Scott, Jessica H., Yap, Ann, Francis, Andrew James Peter and Schuster, Sharynn. (2014). Perfectionism and its relationship with anticipatory processing in social anxiety. Australian Journal of Psychology. 66(3), pp. 187 - 196. https://doi.org/10.1111/ajpy.12045
The FoodCast Research Image Database (FRIDa)
Foroni, Francesco, Pergola, Giulio, Argiris, Georgette and Rumiati, Raffaella I.. (2013). The FoodCast Research Image Database (FRIDa). Frontiers in Human Neuroscience. 7(51), pp. 1 - 19. https://doi.org/10.3389/fnhum.2013.00051
Abandoning a label doesn't make it disappear: The perseverance of labeling effects
Foroni, Francesco and Rothbart, Myron. (2013). Abandoning a label doesn't make it disappear: The perseverance of labeling effects. Journal of Experimental Social Psychology. https://doi.org/10.1016/j.jesp.2012.08.002
Does Chinese medicine consultation share features and effects of cognitive-behavioural therapy? Using traditional acupuncture as an example
Zheng, Zhen, Paterson, Charlotte and Yap, Ann Keong. (2013). Does Chinese medicine consultation share features and effects of cognitive-behavioural therapy? Using traditional acupuncture as an example. Australian Journal of Acupuncture and Chinese Medicine. 8(2), pp. 6 - 15.
Comprehension of action negation involves inhibitory simulation
Foroni, Francesco and Semin, Gun R.. (2013). Comprehension of action negation involves inhibitory simulation. Frontiers in Human Neuroscience. 7(209), pp. 1 - 7. https://doi.org/10.3389/fnhum.2013.00209
Comparing group dehumanization and intra-sexual competition among normally ovulating women and hormonal contraceptive users
Piccoli, Valentina, Foroni, Francesco and Carnaghi, Andrea. (2013). Comparing group dehumanization and intra-sexual competition among normally ovulating women and hormonal contraceptive users. Personality and Social Psychology Bulletin. 39(12), pp. 1600 - 1609. https://doi.org/10.1177/0146167213499025
But for the bad, there would not be good: Grounding valence in brightness through shared relational structures
Lakens, Daniel, Semin, Gun R. and Foroni, Francesco. (2012). But for the bad, there would not be good: Grounding valence in brightness through shared relational structures. Journal of Experimental Psychology. 141(3), pp. 584 - 594. https://doi.org/10.1037/a0026468
Not by thoughts alone: How language supersizes the cognitive toolkit
Ijzerman, Hans and Foroni, Francesco. (2012). Not by thoughts alone: How language supersizes the cognitive toolkit. Behavioral and Brain Sciences. https://doi.org/10.1017/S0140525X11002020
Clinical psychology students' experiences of a pilot Objective Structured Clinical Examination (OSCE)
Yap, Keong, Bearman, Margaret, Thomas, Neil and Hay, Margaret. (2012). Clinical psychology students' experiences of a pilot Objective Structured Clinical Examination (OSCE). Australian Psychologist. 47(3), pp. 165 - 173. https://doi.org/10.1111/j.1742-9544.2012.00078.x
Not all implicit measures of attitudes are created equal: Evidence from an embodiment perspective
Foroni, Francesco and Semin, Gun R.. (2012). Not all implicit measures of attitudes are created equal: Evidence from an embodiment perspective. Journal of Experimental Social Psychology. 48(1), pp. 424 - 427. https://doi.org/10.1016/j.jesp.2011.08.015
The impact of financial management practices and financial attitudes on the relationship between materialism and compulsive buying
Pham, Thi H., Yap, Keong and Downling, Nicki A.. (2012). The impact of financial management practices and financial attitudes on the relationship between materialism and compulsive buying. Journal of Economic Psychology. 33(3), pp. 461 - 470. https://doi.org/10.1016/j.joep.2011.12.007
Audible smiles and frowns affect speech comprehension
Quene, Hugo, Semin, Gun R. and Foroni, Francesco. (2012). Audible smiles and frowns affect speech comprehension. Speech Communication. 54(7), pp. 917 - 922. https://doi.org/10.1016/j.specom.2012.03.004
An examination of gambling behaviour in relation to financial management behaviour, financial attitudes, and money attitudes
Chen, Effie Z., Dowling, Nicki A. and Yap, Ann Keong. (2012). An examination of gambling behaviour in relation to financial management behaviour, financial attitudes, and money attitudes. International Journal of Mental Health and Addiction. 10(2), pp. 231 - 242. https://doi.org/10.1007/s11469-011-9311-z
Category boundaries and category labels: When does a category name influence the perceived similarity of category members?
Foroni, Francesco and Rothbart, Myron. (2011). Category boundaries and category labels: When does a category name influence the perceived similarity of category members? Social cognition. 29(5), pp. 547 - 576. https://doi.org/10.1521/soco.2011.29.5.547
Why your highness needs the people: Comparing the absolute and relative representation of power in vertical space
Lakens, Daniel, Semin, Gun R. and Foroni, Francesco. (2011). Why your highness needs the people: Comparing the absolute and relative representation of power in vertical space. Social Psychology. 42(3), pp. 205 - 213. https://doi.org/10.1027/1864-9335/a000064
When does mimicry affect evaluative judgment?
Foroni, Francesco and Semin, Gun R.. (2011). When does mimicry affect evaluative judgment? Emotion. https://doi.org/10.1037/a0023163