Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a “victim”, supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Cognitive–behavioral therapy is a well-established treatment for obsessive–compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y–BOCS (Yale–Brown obsessive–compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y–BOCS in terms of the interference, severity, and impairment of obsessive–compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η² = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.

Background: Patients with Complex Trauma (CT) may have an impaired ability to trust others and build intimate relationships due to non-integrated representations of self and others. This sometimes leads to an oscillation between needing and fearing intimacy in their adult relationships. This dynamic can occur in the therapeutic relationship, undermining the effectiveness of therapy and affecting the mental health of both the patient and the therapist. To date, no study has analyzed interpersonal patient–therapist dynamics in cases of CT. The present case aims to fill this gap by exploring relational cycles between the therapist and the patient during the therapeutic process in terms of goals and self–other beliefs. Methods: The methodology consisted of a shared and integrated reconstruction by the patient and therapist, both with clinical expertise in psychology, of the impasse in their therapeutic relationship. The reading was done through the lens of the cognitive model of Pathological Affective Dependence, a theory of traumatic relationships, by describing the primary interpersonal cycles occurring in the therapeutic relationship (altruistic, deontological, and vulnerable). Results: The condition of CT leads to several alliance breakdowns and specific interpersonal cycles, leading to new healing meanings for the patient and the relationship itself. Limitations: The study’s main limitation is that it consists of a qualitative analysis of the therapeutic relationship without data that can quantify the clinically observed changes. Conclusions: This case report demonstrates how CT, PAD and the fear of intimacy can be risk factors for the therapeutic alliance and how the therapeutic relationship constitutes a fundamental tool for intervention effectiveness in patients who experience unmet primary needs.

Specific relational risk conditions may increase vulnerability to dysfunctional, coercive, or unsafe intimate relationships in adulthood. Pathological Affective Dependence (PAD) and Fear of Intimacy (FoI) represent two clinically relevant relational conditions associated with difficulties in adult intimacy. PAD is characterized by the perceived need to preserve the relational bond at all costs, even when the relationship is harmful or highly costly. FoI is characterized by avoidance of emotional closeness and defensive distancing from intimacy. Although recent research has linked these patterns to relational dysfunction and intimate partner violence risk, little is known about the attachment profiles, early relational experiences, and affective–cognitive mechanisms that differentiate PAD and FoI. The present study addressed this gap by examining, for the first time, PAD and FoI within a shared framework of attachment, recalled parental styles, and self‐ versus other‐focused threat processes. Specifically, we aimed to (a) characterize adult attachment profiles and early relational experiences associated with PAD and FoI and (b) test whether shame and paranoia function as distinct mechanisms indexing negative views of the self versus others. A community sample of 245 adults ( M = 31.9) completed measures of PAD, FoI, adult attachment, recalled parental styles (indifference, overcontrol, abuse), external shame, and paranoid ideation. PAD was uniquely associated with fearful attachment, whereas FoI was positively related to dismissing and negatively to secure attachment. Parental overcontrol and indifference predicted both outcomes; paternal overcontrol was especially relevant for PAD, and parental indifference for FoI. Mediation analyses supported distinct pathways: overcontrol was associated with higher shame, which in turn was associated with higher PAD, whereas indifference was associated with higher paranoia, which in turn was associated with higher FoI. Findings clarify PAD and FoI as distinct but related relational risk configurations and suggest tailored intervention targets to promote healthier intimacy and affect regulation.