Scrupulosity: Religious and Moral OCD

What Is Scrupulosity OCD?

Scrupulosity is an Obsessive Compulsive Disorder (OCD) subtype focused on religious or moral issues. This subtype often impacts people of deep religious conviction and high moral aspirations. Naturally, to those who care deeply about these issues, repetitive thoughts and recurrent doubts about one’s moral character, true intentions, religious devotion, and state of salvation are highly distressing.

Scrupulosity is often considered the first identified form of OCD. Priests observed parishioners repeatedly coming to confess the same sin over and over despite previous absolution. Moreover, people with this religious anxiety would also confess to thoughts or acts that were not sins, confess to things they had not done, or engaging in prayer and ritual well beyond the average person.

Just like all other manifestations of OCD, Scrupulosity exists as a self-reinforcing cycle in which the sufferer has an unwanted, intrusive thought that takes the form of a feared story about their character, actions, intentions, and their potential consequences. The story’s resulting anxiety can feel overwhelming. What is worse is that the content of the feared story describes  a complete disqualification of their spirituality or moral character. Consequently, compulsions are attempts to get rid of the feeling, ensure that they are morally or spiritually safe, or prove that the feared story is wrong.

Moral Obsession and Religious Doubt

Unfortunately, religion and morality inherently lack 100% objective evidence. This statement will be unsettling to many readers. Faith, by definition, includes uncertainty because we are unable to fully prove or disprove the existence of God or gods. Simply put, it is faith, not proof. Just think of the innumerable denominations, manifestations, styles, and expressions of any one religious belief system! If God were provable and objective, there would be one understanding and one religious system.

Morality is also without certainty. Usually, morals are not codified laws that one can refer back to for clarity. Instead, they are suggestions, guidelines, or “common knowledge” for best human practices. Morality varies widely from country to county, culture to culture, family to family, and even between people within the same family. While the vast majority of society are trying to be “good” people, society has a tough time agreeing on what it means to be a completely good person.

Common obsessions and compulsions:

Religious Scrupulosity

• Fearing that one has committed blasphemy
• Repeated and excessive prayers
• Attempts to pray perfectly
• Re-reading religious texts to feel certain about a religious doctrine
• Seeking reassurance by asking pastors or religious friends
• Attempting to suppress unwanted sexual or blasphemous thoughts in religious services
• Endless attempts to ensure a “spiritual feeling” or connection with God
• Acting more dogmatically than the vast majority of others in one’s religious congregation
• Repetitive thoughts of selling one’s soul to the devil or giving up on God
• Avoiding religious services because of past, present, real, or imagined sin

Moral Scrupulosity

• Repeatedly questioning whether one has cheated on a test years earlier
• Asking others feedback about the “right” action
• Giving to charity beyond one’s means
• Fearing that deep down one’s intentions are truly bad
• Rigidly adhering to laws despite adverse social, personal, or occupational consequences
• Avoiding morally ambiguous situations
• Mentally reviewing conversations to ensure nothing offensive was said
• Suppressing unwanted racist or sexist thoughts, and compulsively seeking self-punishment and forgiveness

Scrupulosity Treatment

Scrupulosity treatment includes Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness based treatments such as Acceptance and Commitment Therapy (ACT).

CBT starts with challenging a client’s distorted thoughts about their character, intention, or sins, and then works to develop a more grounded and rational understanding of their thoughts, actions, intentions, and relationship with God. This effort is to provide a rational foundation in the client’s understanding of morality or their religious beliefs, not to ensure 100% certainty. Softening the rigidity of OCD’s requirement for assurance, and embracing a reasonable level of doubt helps free clients from the repetitive and legalistic thoughts from which they suffer.

ERP helps clients progressively face their fears through mutually developed and executed exercises. The intention is not to ensure that the client will sin or commit immoral acts, but to help the client live in a reasonable and personally congruent way while resisting compulsive behavior. Repetitive exposure to one’s fear while resisting compulsions will lead to a slow reduction in the subjective anxious experience. Ultimately, the Scrupulous person comes to recognize their compulsions are excessive, unnecessary, and ultimately are strengthening the moral and religious obsession. Therefore, the goal is to reduce unnecessary compulsive behavior and ritual as much as possible.

Mindfulness is the practice of nonjudgmentally connecting with all that is happening right now. This present moment awareness includes the unwanted intrusive thought. Mindfulness training is an invaluable addition to CBT and ERP treatment, but can also be used independently for those who are unwilling to actively engage their fears for legitimate religious reasons.

For more information about Scrupulosity, or to schedule an assessment to begin treatment, please contact me.

FearCast Podcast episodes about Scrupulosity:

• Episode 20- Religious Scrupulosity Overview
• Episode 21- Religious Scrupulosity With Guest Mike Erre
• Episode 23- Religious Scrupulosity With Guest Fr. Thomas Santa