New Research Explores The Link Between OCD And Anger Suppression

Researcher Celina Müller explains the connection between OCD symptoms and their impact on individuals' sense of responsibility and anger suppression.

By Mark Travers, Ph.D. | October 30, 2024

A new study published in the Journal of Clinical Psychology found that higher OCD symptoms predict greater anger suppression over time—independent of depressive symptoms and medication intake.

I recently spoke to lead author Celina Müller—PhD candidate at the Ludwig Maximilian University of Munich, and research associate at the Julius Maximilians University of Würzburg—to discuss the emotional impact of suppressing anger and how individuals with OCD can learn to express emotions more effectively. Here is a summary of our conversation.

Can you explain what OCD is, its key symptoms and how it connects to an inflated sense of responsibility, anger and anger suppression?

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions are defined as intrusive, involuntary thoughts, images or urges that are experienced as distressing and cause intense emotions—such as anxiety, disgust or shame.

Compulsions, on the other hand, are repetitive behaviors or mental acts that individuals with OCD feel compelled to perform, often in response to their obsessions.

The goal of compulsions is usually to reduce the distress caused by the obsessions or to neutralize the content of the obsessions, even though individuals often recognize that these actions are excessive or unwarranted.

Obsessions and compulsions can vary widely in content and form. For example, one person with OCD may have an intense fear of germs and contamination, leading to repeated and excessive hand washing—while another may experience intrusive thoughts about forgetting to turn off the stove, resulting in repeatedly checking the stove knobs before leaving the house.

Several cognitive processes are proposed to contribute to the development and maintenance of OCD. One key cognitive factor is an inflated sense of responsibility, where individuals perceive themselves as excessively responsible for provoking or preventing harm or negative outcomes.

This also includes the sense of responsibility for their own thoughts, which, especially in the case of obsessions, are largely beyond voluntary control. Returning to the example given before, the individual who fears forgetting to turn off the stove may experience an intrusive thought that this could lead to a fire.

Paired with the exaggerated sense of responsibility for ensuring the safety of others, he feels compelled to check the stove knobs repeatedly—believing it is his duty to prevent such a potential disaster.

In this context, anger is a frequently experienced emotion in OCD. It may arise from a perceived failure to prevent obsessive thoughts or the constant feeling of being unable to fully prevent harm—an endeavor that is, in fact, impossible as no one can ensure with 100% certainty that nothing bad will happen.

Furthermore, anger can also arise from the ongoing distress caused by OCD symptoms themselves. However, since individuals feel entirely responsible for preventing harm as well as the occurrence of intrusive thoughts related to harm or violations of moral standards, they often assign blame to themselves rather than to external factors.

This also frequently hinders them from expressing anger in the form of aggression and rather leads to an internal attribution of blame and associated anger, which ultimately results in anger suppression.

What motivated you to explore the relationship between OCD symptoms, responsibility, and anger suppression in this study?

While previous research has investigated cognitive factors contributing to OCD, such as an inflated sense of responsibility, research on the regulation of anger in OCD remains scarce.

For me, anger is a particularly interesting emotion because it also directly threatens the excessive moral standards that individuals with OCD often experience. This makes the experience of anger even more distressing.

Nevertheless, anger is frequently overlooked in clinical settings. Considering that previous studies have demonstrated both heightened levels of anger and anger suppression in individuals with OCD, I was motivated to examine the relationship between cognitive factors—such as an inflated sense of responsibility, OCD symptoms and the regulation (or suppression) of anger.

Through our research, we shed light on the temporal relations between these symptoms, which may not only encourage further investigations into anger and anger suppression in OCD but also highlights the relevance of considering anger and anger regulation in psychotherapeutic settings.

What are the emotional and psychological consequences of suppressing anger for individuals with OCD?

Regulating emotions by suppression has previously been considered an unhelpful strategy when used habitually and is suggested to lead to a paradoxical increase in the experienced emotion over time.

While suppressing anger may provide short-term relief, the habitual use of anger suppression may be ineffective in the long run. In a clinical setting, anger and its suppression can influence several aspects of psychotherapy.

Anger is thought to affect the therapeutic alliance (i.e., the collaborative relationship between a therapist and a client) and is likely to be experienced during exposure and response prevention (a form of treatment for OCD).

Additionally, research on other psychological disorders has shown that anger is associated with poorer treatment outcomes. Although this link has not been thoroughly explored in OCD, it highlights the need to address anger and anger suppression in future research and clinical practice.

Specifically, it could be beneficial in psychotherapeutic settings to actively engage with patients about their experiences of anger and how they usually manage or regulate it.

How can individuals with OCD, especially those with a heightened sense of responsibility, learn to express their emotions more effectively?

Since anger suppression has been shown to be associated with the non-acceptance of negative emotions, emotional awareness training may be helpful as a first step. For individuals with OCD and a heightened sense of responsibility, it can be particularly challenging to accept unpleasant emotions, as these emotions may themselves induce distress.

In the therapeutic setting, approaches such as Emotion-Focused Therapy or Acceptance and Commitment Therapy can help individuals with OCD to identify and accept aversive emotions, such as anger, rather than avoiding them.

Accepting the occurrence of emotions such as anger allows individuals to use the emotional information to better identify their needs and subsequently allows them to adapt their thoughts and behavior accordingly.

In contrast, suppressing unpleasant emotions can hinder adaptive processing over time, as it prevents individuals from fully understanding the reasons behind their emotions and the needs they convey.

Beyond accepting emotions, approaches that help individuals develop a self-compassionate way of dealing with emotional difficulties, such as Compassion-Focused Therapy, may also be beneficial.

By developing a mindset of kindness and understanding (i.e., compassion for oneself and others) this therapy aims to reduce self-criticism and fear of failure—patterns frequently observed in individuals with OCD.

What advice would you offer to people outside of clinical settings who suppress emotions?

In general, identifying and acknowledging one's feelings can help to effectively regulate one's emotions and support psychological well-being. As discussed before, when emotions are suppressed, they remain largely unprocessed—which reduces the potential to learn from the situations that elicited these feelings.

Since people often encounter similar situations throughout their lives, developing alternatives to suppressing emotions and instead fostering the identification and acceptance of emotions can be beneficial for individuals in general—not only those currently suffering from a mental disorder.

One exemplary method for increasing emotional awareness in daily life is journaling. This practice enables individuals to gain insights into their emotional states and understand the context in which these emotions arise.

Additionally, sharing emotional experiences with others—known as a form of interpersonal emotion regulation—can further enhance emotional processing. Seeking social support not only helps to regulate emotions but also reinforces the understanding that peers often experience similar feelings, thus promoting a sense of connection and reducing feelings of isolation.