Scrupulosity & OCD: Religious/Moral Symptoms

Scrupulosity Religious Moral OCD

Treatment of scrupulosity (religious/moral OCD) is based on exposure and response prevention (ERP), but pre-treatment goals often focus on belief clarification.

Question: I have scrupulosity (religious/moral obsessive-compulsive disorder), and I am triggered by religious posts on Facebook.

When I see a religious post, I feel like I have to repost it or God will be mad at me. I also worry about what other people think about these reposts, which then leads me to fear that God will judge me for worrying.

Any suggestions for treating scrupulosity (religious OCD)?

Religious Scrupulosity/OCD

For many people with OCD/scrupulosity, treatment can be especially confusing at first. Every action or inaction can feel potentially dangerous, which is why scrupulosity often goes untreated for so long. The very fact that you recognize that this is related to obsessive-compulsive disorder is excellent. It also sounds like you have insight about your OCD symptoms and the OCD positive feedback loop. Many people with religious obsessions don’t realize that obsessions can target religious/moral topics. Their OCD tells them that it’s impossible to engage in religious practices “too much” or “too frequently.”

Scrupulosity/OCD Belief Clarification

The first step in your recovery is to clarify your religious beliefs. If you don’t do this, exposure and response prevention for your scrupulosity will likely be unhelpful. The types of questions you should ask yourself are:

  • Does God expect me to be perfect?
  • If I make a mistake or commit a sin, does my religion have procedures for obtaining forgiveness?
  • Would God want my behaviors to be largely driven by obsessive-compulsive disorder?
  • Would God want my relationship to my religion to be OCD-based or faith-based?
  • Would God understand what’s going on in my head and want me to fight my OCD?
  • If my treatment involves doing things that might be considered potentially sinful, would God understand?

Although you cannot have complete confidence when answering many of these questions, your answers to these questions will help frame your treatment efforts. For those whose symptoms distort their view of God, these questions can be especially tricky. These individuals sometimes base their answers on how they would like to think about God. When I treat people who have religious scrupulosity in my South Florida (Palm Beach County) psychological practice, my intention is not to change their religion or create more guilt for them…but rather to help them determine if there are aspects of their current relationship to God/religion that are dysfunctional. If this is the case, it’s not the person’s fault; this simply reflects a common symptom of scrupulosity.

Treatment is then designed to help them develop a more functional and healthy relationship with God.

Once you’ve clarified your beliefs, the next step is to define appropriate treatment goals.

Moral/Religious OCD Treatment Goals

For anyone with scrupulosity/OCD, it’s unhelpful to define your goals in terms of impossibilities. You must set achievable treatment goals. For example, it would be unwise to select the goal of knowing for sure that you did the right thing or handled the situation the right way. Moreover, it would also be unhelpful to adopt the goal of trying to be 100% sure that God isn’t mad at you. For other people with scrupulosity, there may be the fear of hell/damnation and the unattainable goal of wanting to know 100% that you are saved. These types of goals just feed obsessive-compulsive symptoms.

No matter what we do, we can never know these things in the ways that OCD tells us we should know them. Perfect certainty about faith and morality just isn’t possible.

If you think about it, you’ll realize that these types of OCD-driven goals take faith completely out of religion.

Obsessive-compulsive disorder (OCD) often tells us that the only acceptable way to practice religion is to practice it with a perfect sense of knowing. This is actually incompatible with the idea that faith involves believing in something that can’t be seen or verified.

Appropriate treatment goals involve learning to live more comfortably in a world that is often gray, muddied, and confusing…to better tolerate OCD doubt, uncertainty, and ambiguity regarding our actions and intentions. This involves accepting yourself as an imperfect person who will inevitably mess up and learning to rely more on faith and less on certainty.

Exposure and Response Prevention (ERP) for Scrupulosity/OCD

Once you’ve set your goals, you then practice exposure and response prevention (ERP) for scrupulosity. You intentionally enter situations that trigger your doubt and uncertainty and resist the urge to escape or perform your rituals. For you, with the symptoms you’ve described, this would involve resisting the urge to cross-post religious topics on Facebook. Although this will feel dangerous at first, the more practice you get, the easier it will become.

There are also a variety of other exposures that might be helpful to you, such as thinking a bad thought on purpose. Again, this likely sounds dangerous if you’ve never done it before. However, after you’ve clarified your beliefs and defined appropriate treatment goals, you might determine that this territory is an important step in your recovery.

Would God understand and support your efforts to fight OCD?

Only you can answer this question.

Scrupulosity & Mental Rituals

It’s also important to note that when people have symptoms like yours, they often have a variety of mental rituals that accompany their obsessions. These include:

  • Reviewing/re-analyzing/replaying scenes from the day to figure out if you did the “right” thing.
  • Trying to figure out (i.e., questioning) your own motives in various situations.
  • Compulsive praying (which often includes repeating/restarting prayers multiple times)
    • Repeating prayers or restarting prayers if you get distracted or lose focus.
    • Repeating prayers or restarting prayers if you are not concentrating 100% on the words of your prayer.
    • Repeating prayers or restarting prayers if you had a bad thought during them.
    • Repeating prayers or restarting prayers if you felt they weren’t 100% genuine.
  • Reassurance-seeking behaviors.
    • Asking others if you did the “right” thing.
    • Excessively reading/studying religious texts (e.g., Bible/Torah/Koran) in order to inform current behavior.
    • Asking for forgiveness excessively.

It’s important that you resist these rituals, as they will interfere with your progress in treatment. If you have a hard time determining if a certain behavior is problematic (e.g., praying, studying the Bible/Torah/Koran), it can be helpful to consult with a religious professional (e.g., pastor, priest, rabbi) in order to get feedback. Because not all clergy are familiar with OCD/scrupulosity, I would recommend that you have your therapist join you at this meeting.

After this consultation, it may be helpful to set parameters for your prayer. For example, you may decide to pray at specific times, limit the amount of time you spend praying, and resist urges to repeat/restart prayers. If these behaviors reflect symptoms of scrupulosity, they can actually interfere with being able to establish a healthy relationship with your religion.

Just like any form of OCD, scrupulosity can be effectively treated through exposure and response prevention (ERP). Given the complexity of these symptoms, I would recommend getting the assistance of a therapist who specializes in treating OCD. If you live in a remote area and there are no local providers, there are probably providers in your state who would be willing to do therapy by phone or over Skype. If you use a screen-sharing program, you could even do some of the Facebook exposures “together.”

Wishing you the best in your recovery from religious scrupulosity!

Questions? Comments? Experience with recovering from religious obsessive-compulsive disorder? Sound off below.

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