Scrupulosity OCD: Symptoms, Examples, & Treatment Options

Published – April 29, 2021 Updated – April 30, 2021

Scrupulosity OCD is a form or subtype of obsessive-compulsive disorder (OCD) in which the affected person finds themself experiencing religious or moral obsessions as well as intrusive, unwanted thoughts, images, or urges. Those suffering from this kind of OCD will often find themselves obsessing over whether their thoughts or actions may be immoral, unethical, or sinful.

What Is Scrupulosity OCD?

Scrupulosity OCD is a form of OCD in which the person finds themselves experiencing obsessions related to morality or religion. They may be overly concerned with whether they commit blasphemy or sin, act according to their morals, and maintain their purity, as well as whether they are going to hell and when they will die.

Generally, if a person is suffering from this form of OCD, they will suffer from a lack of impulse control.¹ These impulses may include both behavioral compulsions (like excessive trips to confessional) and mental compulsions (like excessive praying) that relate to their religion and morals.

According to Kevin Foss, MFT, Founder of CalOCD, “On the surface, Scrupulosity can present as excessive interest in one’s religious or spiritual life, in the case of Religious Scrupulosity, or a never ending effort to be the best possible person or do all the right things. However, these perceptions are motivated by fear, anxiety, and uncertainty about their religious standing, moral quality, or intrinsic character. Scrupulous individuals may exhibit outward compulsions of repetitive prayer, ritualistic washing or routines, checking with others that they did the right thing or did not do the wrong thing, or repeating activities until done “right.” The Scrupulous can also have covert, or internal, compulsions of evaluating the quality and quantity of their feelings, intention, or physical sensations, or mentally reviewing previous events or interactions to ensure their ‘purity’ or ‘rightness.’”

Normal Religious Practice vs. Religious OCD

Scrupulosity OCD causes someone to obsess over a particular area of religion or morality rather than on faith or morals as a whole. Oftentimes, the best way to tell whether someone is simply practicing their religion or suffering from religious OCD is to note how much the practices affect everyday life. People with religious OCD will likely hone in on a very specific part of the religion.

Common scrupulosity obsessions include:

• Angering God
• Committing a sin
• Committing blasphemy
• Maintaining your purity
• Not practicing a religion perfectly (i.e., misunderstanding religious teachings, attending the wrong place of worship, or practicing your religion incorrectly)

These worries may result in the practice of obsessive rituals, including:

• Excessive praying and/or trips to confessions
• A need for reassurance from religious leaders
• Repeated rituals to cleanse and purify yourself
• Obsessively avoiding situations in which sinful or immoral acts may happen
• Self-sacrifice
• Repeating passages from scriptures in your head
• Making pacts with God

Common Obsessions for Those With Scrupulosity OCD

While many religious people worry or think about certain things related to their faith or belief system, they eventually get over it. People with  scrupulous OCD take these worries to a point of obsession, and they begin to take over other aspects of life.

Four common obsessions associated with scrupulosity OCD include:

• Angering God: Excessively worrying that they will say the wrong thing, think the wrong thing, or do the wrong thing and end up angering God. This can show up as worries of committing sin or blasphemy, maintaining purity, or whether or not you’re going to hell.³
• Going to Hell: Living in constant fear of going to hell for committing any sin or immoral act.
• Not practicing a religion perfectly: Whether it is prayer or religious activities, excessive worry over the perfection of religious practice is common.
• Committing sins or acting immorally: Scrupulous OCD may lead to being afraid of committing a sin or immoral act, causing crippling fear and anxiety.

Common Compulsions Among Those With Scrupulosity OCD

One characteristic of any form of OCD is compulsions or irresistible urges. Scrupulosity OCD is no exception to this rule. Sufferers struggle with compulsions related to religion or morals.

Common compulsions of scrupulosity OCD include:

• Excessive praying:  Praying for hours a day while it is normal for religious people to pray a few times a day.
• Frequent confessions: Making frequent confessions due to fear of angering God, doing something wrong, or committing a sin.
• Avoiding situations that may lead to immoral or sinful acts: Avoiding any and all situations that could conceivably lead to committing a sin or an immoral act. Some  may refuse to leave the house out of fear of committing sinful acts.
• Seeking reassurance from religious leaders: Continuously seeking reassurance from leaders of the religion to avoid imperfect religious practice.
• Repeated cleansing or purifying rituals: Due to fear of not being pure enough, people may participate in excessive cleansing or purifying rituals.
• Mentally repeating passages from scriptures: An excessive repeating of scriptures could be a compulsion in scrupulosity OCD.

Examples of What Scrupulosity OCD Looks Like

Scrupulosity OCD does not show up in the same way for everybody. The symptoms will show up depending on a number of factors, including personality, religion, morals, and whether or not OCD shows up as a moral or religious subtype.

Wendy

Wendy finds herself praying excessively throughout the day, crossing herself multiple times to ensure she has done it perfectly. She has stopped hanging out with friends out of fear that she will be tempted to sin. She is single because she fears that going on dates will lead to sinful thoughts or actions. She has begun to feel alone because her friends no longer reach out, knowing she will turn them down.

When Wendy finally decides to seek help, her treatment involves cognitive behavioral therapy (CBT). Her therapist talks to her about what she was afraid of, why she felt that she needed to cross herself perfectly, and why she feared going out with her friends. Slowly, Wendy finds herself able to resist her impulse to pray and worry. She slowly starts reaching out to friends again and getting out of the house. Wendy has a date this Friday. While she is not completely cured yet, she is on the right path to healing.

Ned

Ned believes it is morally wrong to touch things that other people may touch with dirty hands. Because of this belief, Ned washes his hands to the point that they are extremely cracked and dry. Ned’s productivity at work is impacted by his compulsions and he is on the brink of losing his job. He finally decides to seek help from his therapist, who assigns him exposure and response prevention (ERP) therapy. Ned’s therapist exposes Ned to his fear of touching things with unwashed hands slowly and teaches Ned methods to avoid his compulsion. Ned finds, over time, that his compulsion to wash his hands before touching things is beginning to fade.

Sam

Sam finds herself terrified of committing any act that may involve breaking the rules or getting into trouble. She becomes so terrified of getting into trouble that she stops leaving her house altogether out of fear. Her friends and family are becoming concerned and suggest that she seek help. Her therapist suggests CBT. As Sam talks through her reasoning behind her OCD, her therapist presents methods to manage it. She begins to see positive results the more she practices her methods.

Treatment for Scrupulosity OCD

Seeking professional mental help will help to find the best way to work through, cope with, and treat scrupulosity OCD. Sometimes medication management and lifestyle changes are also recommended.

Therapy

The first type of therapy is CBT, which typically involves the patient talking through the issues they are experiencing with their therapist. As the therapist learns more about their patient and what is causing them to suffer, they can build an action plan to help them work through their issues and learn coping mechanisms to manage their obsessions and compulsions.

The second form is ERP therapy, which involves the patient exposing themselves to obsessive thoughts while preventing themselves from engaging in their compulsive behaviors or rituals.

The third form is acceptance and commitment therapy (ACT). This includes acceptance and mindfulness techniques, and has been proven just as effective as CBT.

Medication

In some cases of moral or religious scrupulosity, a psychiatrist may prescribe medication. The medications that have been found to work in these kinds of cases are selective serotonin reuptake inhibitors (SSRIS).

Lifestyle Changes

Recognize negative thought patterns that may be fueling your OCD.

Three negative thought patterns to watch out for include:

• Thinking in extremes like, “I must not commit a single sin or I am going to hell.”
• Extreme sense of responsibility: you may find yourself worrying about upsetting God or the people around you by behaving incorrectly.
• A belief that your thoughts are able to be controlled.

Foss states, “Accept that you cannot be perfect, no matter what you do. The best we can be, both religious and morally, is good enough. And, good enough is OK.

Attempt to recognize which thoughts are consistent with you and your genuine values, and which ones are obsessive, impossible, and well beyond reasonable. Once you do this, spend as little time as possible considering them, evaluating their merit, or wondering what role they have in your life. Any amount of time thinking about them will only reinforce their presence in your life and lead you further away from your desired goals and values.

Just because you have the thought doesn’t mean you have to do it. Accept that those thoughts will show up sometimes, but that you are in control about what you do.

You don’t have to do bad or sinful things to get better, but you have to put yourself at the risk of doing bad or sinful things. In other words, the compulsive “safety” behaviors are an attempt to ensure that you are OK and that you will never do the wrong, immoral, or sinful thing. This is ultimately fruitless. Resisting the compulsion is not the same as doing a bad or sinful act, and resisting the compulsion put you in the same place as everyone else; at risk of doing something bad or sinful. Which again, is not the same as actively doing something bad and sinful.”

How to Get Help for Scrupulosity OCD

Find a therapist who knows how to work with patients who are suffering from OCD, or reach out to a trusted religious leader to seek advice. A therapist will guide treatment discussions after determining what may be causing the  symptoms. Referrals can be obtained by calling your insurance provider or speaking with your primary care provider.

Final Thoughts on Scrupulosity

Scrupulosity OCD is difficult to experience. What you’re dealing with may be unique to you, but you’re not alone. Talking to a therapist, religious leader, or a trusted friend or family member can make a big difference in how you feel. They can help you find new methods for understanding your negative thought patterns, establishing methods to help you carry on with resilience.