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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 38  |  Issue : 3  |  Page : 243-250

Guilt, regret, and coping in individuals with obsessive–Compulsive disorder and individuals in conflict with law: A comparative study


1 Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Psychiatric Social Work, Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India
3 Department of Psychiatry, Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India

Date of Submission21-Jul-2020
Date of Decision24-Aug-2020
Date of Acceptance23-Sep-2020
Date of Web Publication08-Sep-2021

Correspondence Address:
Ms. Pooja Audhya
Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi - 834 006, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_224_20

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  Abstract 


Background: Persons with Obsessive Compulsive Disorder and individuals in conflict with law are prone to experience guilt and regret which can have significant implications on their lives. Guilt and regret are two very prominent emotions found in individuals with Obsessive Compulsive Disorder A question then arises whether the individuals who are in Conflict with Law experiences the same kind of guilt and regret, which is experienced by the persons suffering from obsessive compulsive disorder; another aspect that too seeks attention is how related is the coping strategy of the two distinguished population. Methods: The objective of this study was to aim assess and compare the guilt, regret and coping in individuals with obsessive compulsive disorder and individuals in conflict with law. The sample size consists 60 individuals (18-55years of age), of whom 30 individuals were with OCD taking treatment in the Institute of Psychiatry and 30 individuals in conflict with law, who were taken from the Presidency Correctional Home and Alipore Women Correctional Home. Participants were selected purposively. The Revised Mosher Guilt Inventory, Regret Scale and Brief Cope were administered of the participants of either group for the assessment guilt, regret and coping respectively. Data analysis was done by the SPSS-25 (Windows version). Descriptive statistics, independent samples t test and chi-square test were used. Results: In OCD group, majority of the participants were found to have higher educational qualifications, e.g. intermediate, graduation or more, whereas, in persons in conflict with law group, most of them were either illiterate or minimally educated, nearly equal participation of males and females was observed in either group, mean ages were 32.93±9.21 and 40.00±8.38 in OCD and persons in conflict with law groups respectively. No significant differences were noted between these two groups in coping and regret. In case of guilt, significant difference was noted in 'guilty conscience', where OCD patients reported significantly higher scores than that of persons in conflict with law. In other two forms of guilt, i.e., sexual guilt and hostility guilt no significant differences were noted. Conclusion: Difference in guilt between OCD patients' and the persons' in conflict with might be due to several reasons, ranging from core illness related factors to larger socio-cultural factors. Roles of personality might as well have some association with it. Giving conclusive remark about guilt, regret and coping about these two divergent populations might not be possible with this small size. In future, studies should be carried out on larger samples which should be selected through stratified sampling method for securing more accurate information about those issues. Factors like, family structure and functions, marital relationship, family support and personality disposition should also be studied.

Keywords: Conflict, Guilt, law and coping, OCD, persons


How to cite this article:
Audhya P, Barik-Sil I, Saha PK, Bhattacharjee D, Kannekanti P. Guilt, regret, and coping in individuals with obsessive–Compulsive disorder and individuals in conflict with law: A comparative study. Indian J Soc Psychiatry 2022;38:243-50

How to cite this URL:
Audhya P, Barik-Sil I, Saha PK, Bhattacharjee D, Kannekanti P. Guilt, regret, and coping in individuals with obsessive–Compulsive disorder and individuals in conflict with law: A comparative study. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Oct 3];38:243-50. Available from: https://www.indjsp.org/text.asp?2022/38/3/243/325754




  Introduction Top


The approximate worldwide prevalence of obsessive–compulsive disorder (OCD) is 2%.[1] OCD is characterized by recurrent, intrusive unwanted thoughts, ideas, impulses, or sensations (obsessions) which are coupled with specific repetitive behavior. Those repetitive behaviors are meant for reducing the distress and anxiety caused by the obsessions (compulsions).[2],[3],[4] Obsessions are perceived as distressing and ego-dystonic.[5] Sense of guilt is a common phenomenon of OCD and it can aggravate, maintain and worsen the course of illness.[6],[7],[8] There are primarily two types of guilt, for example, (a) guilt due to transgression of a moral rule (Deontological Guilt) and (b) guilt due to subjective feeling of compromise of a personal altruistic goal (Altruistic Guilt). In OCD, deontological guilt is more prominently present and it can stimulate the checking and cleaning compulsions.[9],[10] In OCD, feelings of guilt compel the affected individuals to activate and increase compulsive behaviors, because they feel that those actions (Compulsions) are the forms of prevention of more complicated problems.[10] Psychoanalytical view suggests that “super ego” plays pivotal role in checking the wrongful acts by generating the sense of guilt and shame and pathological anxiety as the consequence of morally transgressing drives and impulses.[11],[12] Guilt evokes negative emotional state containing sadness, anxiety, remorse, and distress and in order to avoid these negative emotions individuals take up remedial measures as compulsive acts and behavior.[12],[13],[14] In OCD, higher guilt proneness can hamper several important social, personal, and cognitive functions.[15],[16],[17],[18],[19],[20],[21],[22],[23] In terms coping with the distressing obsessional thoughts pasts studies observed that OCD patients use means such as “cognitive rituals,”[24],[26] “neutralization,”[24],[25],[27] “distraction,”[28] “reassurance,”[28] “performing a mental or concrete action for removal of the thought,”[28],[29] “engagement in observable physical actions (e.g., watching television, getting involved in sports, reading, and walking),”[28],[29],[30] and “talking to others.”[28],[29],[30]

For those people who have had the history of crime, emotions like shame and guilt can have positive consequences, i.e., refraining from offensive acts and decrease in recidivism. These emotions are often held as “moral” emotions because of their ability to promote altruistic behavior in those people. The primary component of guilt is the feeling of remorse for actions and deeds done in past. Acceptance of criminal responsibility and feeling of guilt would influence him to approve and adopt reparative behaviors, this way his character is improved and he becomes a better individual.[12],[31],[32],[33],[34] Guilt is an emotion of self-blame that can appear as a consequence of wrongful and socially condemnable act.[7],[12],[22],[31],[32],[33],[34],[35],[36],[37],[38] According to Baumeister, Stillwell and Heatherton[38] guilt is not just limited to individuals' self; rather it should be seen in larger perspective. Guilt has an interpersonal dimension that has the potentiality to influence and moderate communal relationships between people. Guilt can strengthen social bonds among people by eliciting the symbolic affirmation of caring and commitment; and guilt can propagate a mechanism of dissolving imbalances or inequities in emotional distress within the relationship and creating influence over others.[31],[32],[33],[34],[35],[36],[37],[38]

In OCD, guilt has been identified to be one of the most important factors in the course and outcome of this disorder. Guilt is the intensive emotional state which acts as the harbinger of anxiety and depression among the people who have it.[8],[9],[10],[15],[22],[39],[40] However, the interrelatedness among guilt, regret and the coping mechanisms in clinical context like OCD is not explained succinctly. The other population the present study intends to focus on is the individuals in Conflict with Law, that is, the persons who are convicted for a crime and are incarcerated thus. Several researches too are carried out on this population, but a study which examines their coping with guilt and regret feeling is not done in Indian context. The most important aspect is that, a study which tries to compare the experience of guilt and regret and their analogs coping strategies between the two highly varied populations, i.e., individuals with OCD and individuals in conflict with law, was not engineered previously. The key rationale for undertaking the present study was to find out whether the amount of guilt and regret experienced by the individuals with OCD are similar to those who are convicted and do they practice similar kind of coping techniques to handle the emotions; or do they differ completely. The hypotheses of the study were:

Ha: There will be significant difference in guilt between individuals with OCD and individuals in conflict with law.

Ha: There will be significant difference in regret between individuals with OCD and individuals in conflict with law.

Ha: There will be significant difference in coping between individuals with OCD and individuals in conflict with law.


  Methodology Top


Universe, samples, and sampling

The study was carried out on 60 individuals, of which, 30° OCD patients and the other 30 were individuals in conflict with law. People with the diagnosis of OCD were selected from the Outpatient Department of the Institute of Psychiatry (IOP), Centre of Excellence, Kolkata. Persons with conflict with law were taken from two Correctional Institutions located in the city of Kolkata, namely, Presidency Correctional Home and Alipore Women Correctional Home. The subjects of these two groups were selected purposively in accordance with the criteria of the study. The age range of the either group was kept as 18–55 years and individuals from either sex were selected in the study. Persons who had the knowledge and ability to interact in Bengali, Hindi, and English were selected in the study. Following measures were used for data collection:

Semi-structured sociodemographic and clinical data sheet

A semi-structured questionnaire containing necessary social-demographic variables and duration of illness (in case of individuals with OCD), and year of last attempted crime, age of first attempted crime and duration of imprisonment (in case of individuals in conflict with law) was developed for recording the socio-demographic and clinical information.

Revised Mosher guilt inventory

The Mosher guilt inventory[41],[42],[43] assesses three forms of guilt: sexguilt, hostilityguilt, and moralityconsciences. The Revised Mosher Guilt Inventory consists of 114 items, arranged in pairs of responses to the same sentence completion stem, in 7point Likert-type format to measure (a) sexguilt - 50 items, (b) hostilityguilt - 42 items, and (c) guiltyconscience - 22 items.

Regret scale

This scale consists of two measuring instruments - one designed to assess the tendency to satisfy or maximize and one designed to assess the tendency to experience regret. The regret scale consists of five items and makes use of the same seven-point rating scale. It assesses how individuals feel after having made a decision and whether they experiencing lingering doubt about their choice or regret over what they have missed out.[44]

Brief cope

This scale[45] is the abridged form of the larger COPE inventory.[46] The original COPE inventory was meant for making broader assessment of coping responses. The inventory includes some responses that are presumed to be dysfunctional, as well as some that are expected to be functional. This scale includes at least 2 pairs of mutually opposite tendencies. The COPE includes 15 scales each composed of 4 items. The abbreviated version, the Brief-COPE has 14 subscales composed of 2 items each, thus: (a) acceptance - suggesting the acceptance of reality and preparing oneself; (b) emotional support - seeking emotional support; (c) humor - trying to make fun on the situation; (d) positive reframing - trying to see the situation from a different perspective or searching for something positive in it; (e) religion - seeking comfort through religious or spiritual practices and beliefs; (f) active coping - actively using of strategies or plans to make the situation better; (g) instrumental support - seeking help and advice from other people; (h) planning - developing specific strategy; (i) behavioral disengagement - not attempting to cope; (j) denial - refusing to accept the reality; (k) self-distraction - involving in work or other activities to get off problematic situation; (l) self-blaming - being self-critical for the occurrence of the problem or stressor; (m) substance use - taking the help of alcohol or other drugs to get off the feeling of stress; and (n) venting - expressing negative feelings. Carver[50] had categorized the strategies of acceptance, emotional social support, humor, positive reframing, and religion as emotion focused. On the contrary, active coping, instrumental support, and planning are put under the rubric of problem-focused strategies. Behavioral disengagement, denial, self-distraction, self-blaming, substance use, and venting are recognized as dysfunctional coping strategies.

Procedure

After getting due approval from the Ethical Committee, OCD patients fulfilling the inclusion and exclusion criterions were included in the study and they were selected from the OPD of the Institute of Psychiatry, Kolkata, India. The diagnosis of OCD was made by the consultant psychiatrists of the institute. OCD patients who were being rated by the consultant psychiatrists of the institute as remitted were considered in the study. Individuals in Conflict with Law were the inmates of Presidency Correctional Home, Kolkata and Alipore Women Correctional Home, Kolkata. They were also selected as per the inclusion and exclusion criterions of the study. Participants of the either groups were matched as per the “age” and “sex.” The socio-demographic data sheet was applied on either group. The Revised Mosher Guilt Inventory, Brief Cope, and Regret Scale were administered on the participants belonging to either group.

Statistical analysis

The Statistical Package for Social Sciences (Version 23 for Windows) (IBM-SPSS Inc. Corporate Headquarters Armonk, New York, United States of America) was applied to analyze the data in the current study. Descriptive statistics such as mean, standard deviation, and percentage were used in the study. Inferential statistics such as t-test and Chi-square were used for continuous and discrete variables, respectively.


  Results Top


[Table 1] shows the comparability of the OCD patients and inmates of correctional homes in various sociodemographic parameters. Mean ages of the OCD patients and correctional home inmates were 32.93 and 40.00 years, respectively. No significant difference was noted between them in age. However, significant differences were noted between them in “marital status,” “education,” “occupational status (retrospective),” and “family type.”
Table 1: Sociodemographic profile of individuals with obsessive- compulsive disorder and individuals in conflict with law

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It was seen that 76.7% of the individuals had been suffering from OCD between the span of 1–10 years, 16.7% of them falls in the group of 11–20 years and only 6.7% of the individuals had been suffering for a span between 21 and 30 years [Table 2].
Table 2: Duration of illness of individuals with obsessivecompulsive disorder (n=30)

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[Table 3] shows the age of the respondents when he/she first attempted crime. In the current study, the lowest age was found to be 14 years and the highest age was 50 years.
Table 3: Crime related information of individuals in conflict with law (n=30)

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In the current study, significant difference was noted between the selected OCD patients and inmates of correctional homes in one area of the guilt measuring instrument, i.e., Revised Mosher Guilt Inventory. In the “guilty conscience” domain of the inventory, significant difference was noted. OCD patients had reported significantly higher score in this domain than that of inmates of correctional homes; however, in remaining two domains of the inventory (sexual guilt and hostility guilt), no significant differences were noted between them. No significant difference was noted between them in regret also.

In the current study, no significant differences were noted between the selected OCD patients and Inmates of Correctional Home in three forms of coping, i.e., “emotion-focused coping,” “problem focused coping,” and “dysfunctional coping.” The Brief COPE scale was applied on either group to assess their coping strategies.


  Discussion Top


Methodological consideration

The current study was conducted on individuals with OCD and individuals in conflict with law to find the difference in their guilt, regret, and coping strategies. The subjects were selected as per criteria of the study. Written consent was taken from each one of the participants before their formal inclusion in the study. The Revised Mosher Guilt Inventory, Regret Scale,[44] and Brief Cope[45] were administered on the selected patients of either group. The participants belonging to either group were adequately matched with regards to “age,” “sex,” and “socioeconomic status.” These two groups were found to be adequately comparable to each other on important socio-demographic parameters [Table 1].

Findings related to hypotheses of the study

This study compared the guilt, regret and coping of OCD patients and persons with the conflict of law. In the context of OCD some researches were carried out in past to assess issues such as shame, guilt, and regret.[7],[8],[9],[10],[15],[22],[39],[40] Individuals with OCD are seen to have more trait guilt, state guilt, and higher moral standards than normal individuals.[8] Guilt has been found to have significant importance in the in the rehabilitation process of the offenders.[49],[50],[51] These two populations have commonalities in the forms of guilt and regret. Guilt has been depicted as the adaptive complex social emotion that has potential role in dissuade people in indulging wrongful acts.[34],[35],[36],[37],[38] In both OCD and criminality, guilt has significant implication; in OCD, it may influence the course of illness[8],[9],[10],[22],[39],[40] and in the life of persons with the history of criminality guilt and regret have important implications.[49],[50],[51]

In the current study, no significant differences were noted between the OCD patients and the persons in conflict with law in two areas of the Revised Mosher Guilt Inventory, i.e., “Sexual guilt” and “Hostility guilt.” However, significant difference was seen in the third domain of the Revised Mosher Guilt Inventory, “Guilty Conscience.” In this domain, OCD patients reported significantly higher scores than that of “persons in conflict with law” [[Table 2]: 74.73 ± 9.60 vs. 69.10 ± 9.57: P = 0.027*]. Guilt has been conceptualized as the dysphoric feeling that is being experienced by the individual who has made violation of the relevant moral or social standard. In the present study, since only remitted OCD patients were included in the study, they might not have the guilt in impactful manner or their condition was improved with the treatment they had undergone before the onset of the current study. Another reason could be, a significant number of OCD patients do have significant dissatisfaction associated with sexuality and avoidant in their sexual relationships or even discussion about this issue. However, significant difference was noted between these two groups in the domain of “guilty conscience,” here OCD patients reported significantly higher score than that of persons in conflict with law. Guilt is known as a disagreeable emotional condition related to transgression of personal rules, morals, or mores. Guilt is a negative emotion that makes people aware about the responsibility for an event or an act.[12],[14],[34],[48] OCD patients are prone to harbor guilt and they tend to devoid of doing those acts which could further ignite their guilty conscience and bring about negative emotions for them.[12],[49],[50] Therefore, it could be assumed that in present study too, selected OCD patients showed importance to guilty conscience, because of the fear of experiencing negative emotions like anxiety, remorse, and reproach. Persons in conflict with law scored significantly lesser score in the “guilty conscience.” However, the size of the population of inmates of the correctional institution is not conducive to discern any conclusion related to difference in “guilty conscience.” Here, some variables might have played mediating role. In this study, issues such as “justification of criminal act,” “attribution of the criminal act,” “personal meaning and definition of morality of the selected inmates,” and “personality characteristics of the inmates” were not assessed and those factors had been identified to have significant linkage with the development of guilt among offenders.[51],[54] Another important issue is “individual difference” in proneness to guilt in this population.,[54] this particular issue should also be kept in mind while discussing about the guilt of these individuals. Guilt emits from the self's negative evaluation of specific behaviors or transgressions[38],[48],[52],[54] and in the present study, no such attempt was made to assess this particular area of the selected individuals of either group. Studies showed that guilt appears as adaptive emotion and it yields benefits in the forms of “motivating individuals for reparative action” and “taking responsibility for transgressions and errors.” The current study was conducted on one clinical and another nonclinical special population. Ideally, there should have been stratifications or subgroups among the persons in conflict with law; there may be several mediating variables that can play significant implication on the guilt and reproach, for example, “type of offence,” “habitual offenders,” “personality dispositions of the offenders,” “degree of offence,” “duration of confinement,” “quality of environment prevailing in the correctional institution - whether it is rehabilitative and constructive in true sense, skills and abilities of the professionals and administrators in reinstating these people in mainstream of the society, motivational level of the professionals and administrators and accessibility given to convicts to interact with common people, etc., This can be held as a major limitation of present study. There might be a qualitative or characteristic difference between the perceptions of guilt between a clinical group and nonclinical group. In case of OCD, guilt is related to the core of their psychopathology and individuals with OCD feel distress when they have guilt [Table 4].[12],[14],[15],[39],[47] Guilt has a strong interpersonal interface because it aims to increase relationship-enhancing actions and reduce relationship-damaging actions.[38],[47],[52] Despite significant reformatory changes inside the prisons, prisoners are yet to have a normal interpersonal interface within the prisons. Situation inside the correctional institutions is yet to be a good replacement of normal social-interpersonal situation that can be found in one's own interpersonal repertory. Probably because of this reason selected inmates of the correctional institute scored significantly lesser than OCD patients in “guilty conscience” domain. Perhaps, they do not find the custodial environment conducive for having enduring and meaningful interpersonal relationship nor do they can motivate themselves to work on interpersonal relationship with other prisoners. Overly formal and regulated environment might have been preventing the development of informal and affectionate relationships among these people.[38],[50],[51],[52] In the current study, no significant difference was noted between the OCD patients and persons in conflict with law with regards to regret [Table 4]. Regret is associated with decision making or selection of a particular option or avenue from a set of options or avenues. This decision-making is related to one's life aspects, needs, or requirements. The modern complex society provides countless options or possibilities to its members ranging from essential needs to life's important junctures, phases such as marriage, career, and lifestyle choices. In fact people are now supposed to take endless decisions daily. This combination of freedom and abundance makes the life of people enjoyable and at the same time confusing. These daily choices can be distressing for individuals suffering from OCD. Because, the core of OCD is “doubt,” and they may have problems in sticking to a particular decision due to the fear, decisions they are taking are the right ones or not.[53],[54] Similarly, persons in conflict with the law are confined in custodial institution and they have very limited options available now to decide things by their own, since they are in a formal governmental setting and whatever things are being provided to them or the institute made available for them they have to take. With regards to coping no significant differences were noted between these two groups. The brief COPE scale was applied on the both OCD patients and the persons in conflict with law and this scale assesses coping in three domains, namely, emotion focused coping, problem focused coping, and dysfunctional coping. However, OCD patients reported higher score in problem focused coping than the persons in conflict with law, suggesting their inclination to deal with the situation in positive manner. The difference between these two was nearing to the level of significance [[Table 5]: P = 0.075]. In other two domains of the coping measuring instrument differences were more insignificant. It might be due to inclusion of remitted patients who are found to be doing fairly well in treatment. Conversely, in 2nd group, most of the inmates might have accepted the situation or it can be attributed to small sample size and not stratifying the samples as per their duration of stay in correctional centers, quality and nature of their offences and most importantly not seeing the impact of important variables such as “family structure and functions,” “marital relationship,” “social support,” “personality disposition.” Another important limitation of the current study is not studying the “shame,” which has very significant implication on either condition.
Table 4: Comparison of guilt and regret between obsessive- compulsive disorder patients and inmates of correctional homes (individuals in conflict with law)

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Table 5: Comparison coping strategies between obsessive- compulsive disorder patients and inmates of correctional homes

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Acknowledgment

Authors of the current study are deeply indebted to the Administrations of the Institute of Psychiatry, Kolkata, for bestowing their sincere support and cooperation in different phases of the study, especially in the data collection process.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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