Scrupulosity and OCD

Scrupulosity is a form of religious OCD that often involves having blasphemous or unacceptable thoughts about God.

What is Scrupulosity?

Scrupulosity is a form of obsessive-compulsive disorder (OCD) characterized by religious and/or moral obsessions. Scrupulosity can sometimes be difficult to recognize because even within a single faith community, religious beliefs and practices vary widely. There is no singular belief or behavior that is diagnostic for scrupulosity.

Instead, scrupulosity is best regarded as a pattern of beliefs and behaviors associated with excessive worry about having committed a sin or engaging in immoral acts. Concern may focus either on thoughts or actions already taken or the possibility of committing sins in the future. This results in significant emotional distress, guilt, and despair.

Scrupulous individuals also worry about the sinfulness of having bad thoughts. This experience is very similar to individuals with OCD who experience harm-related obsessions (e.g., the fear of harming a child or loved one). People with scrupulosity often wonder why they’re having bad thoughts and worry that these thoughts have special meaning. They also mistakenly assume that they wouldn’t be having these thoughts if the thoughts weren’t true.

Because the sinfulness of thoughts is discussed in the Bible and other religious texts, many scrupulous individuals take this as “proof” that they should be able to control their thoughts at all times. For individuals who hold this belief, it is especially important that treatment includes steps related to belief clarification. Treatment of scrupulosity may also include consultations with religious professionals. When I treat individuals in South Florida (Palm Beach Gardens, West Palm Beach, Jupiter) with scrupulosity, I typically incorporate these elements in my treatment plan.

Feared consequences associated with scrupulosity often focus on damnation, estrangement from God, making God angry, or living an empty existence. There may also be the fear that one may “corrupt” others or experience uncontrollable feelings of guilt forever.

In order to prevent these outcomes from occurring, individuals with religious scrupulosity engage in a variety of rituals. These compulsions typically involve taking preventative action to keep a sin from occurring or engaging in some type of restoration ritual to repair their relationship with God. People with scrupulosity also commonly engage in a variety of mental rituals.

How is Scrupulosity Diagnosed?

Diagnosis of scrupulosity is complicated because symptoms of scrupulosity exist at the intersection of spirituality and mental health.  This results in symptoms of scrupulosity frequently going undetected. Psychologists may not sufficiently inquire about one’s faith tradition and overlook scrupulous symptoms.  Similarly, religious professionals may have less experience in recognizing signs of obsessive-compulsive disorder (OCD).  Parents of scrupulous children often take pride in their children’s seemingly strong faith and fail to recognize that their “faith” is predominantly fear-based. Because of these challenges, it is especially important to foster better public awareness about scrupulosity and how it relates to OCD.

Here are some common obsessions and compulsions associated with scrupulosity.  Because many of these behaviors are normal within certain faith traditions, it can be useful to consult with an OCD specialist if you’re concerned about these (or other) symptoms.

Symptoms of Scrupulosity (OCD)

  • Fear of committing blasphemy or having blasphemous thoughts.
  • Excessive fear of hell and/or damnation.
  • Fear of committing (or having committed) an “unpardonable sin.”
  • Excessive worry that one’s life is on the “wrong path.”
  • Excessive concern about doing the “right thing.”
  • Applying different moral standards to one’s own behavior than to the behavior of others.
  • Excessive concern about clothing choices (i.e., not wanting to dress provocatively).
  • Excessive concern about child-rearing practices.
  • Afraid that one will (or has) sold one’s soul to the Devil.
  • Afraid that one is secretly a Satanist.
  • Intrusive images of sex or violence related to religious figures (God, Jesus, Mary, saints, etc.)
  • Repetitive thoughts about being sexually attracted to God, Jesus, Mary, saints, or other religious figures.
  • Intrusive images of inverted crosses, pentagrams, or other sacrilegious icons.
  • Fear that one may secretly be possessed by demons.
  • Fear that one’s children may be possessed by demons.
  • Fear of future actions (e.g., worry that one will have to murder their children if they are possessed).
  • Fear of being (or becoming) the Antichrist.
  • Fear that one’s kids may be the Antichrist.
  • Worry about whether one is fundamentally good or evil.
  • Afraid of repeating prayers backwards.
  • Fear of secretly wanting to go to hell.
  • Fear of impulsively or intentionally praying to the Devil.
  • Intrusive thoughts related to loving the Devil (e.g., Satan is Lord).
  • Fear of secretly being controlled by the Devil and carrying out his wishes.
  • Intrusive thoughts about rejecting the Holy Spirit.
  • Intrusive thoughts about impulsively committing suicide and going to hell.

Compulsions Related to Scrupulosity (OCD)

  • Repeating or restarting prayers.
  • Praying excessively.
  • Compulsively seeking out information online about the sinfulness of certain activities.
  • Excessively attending confession.
  • Compulsive reassurance-seeking from family members or members of one’s faith community.
    • Did I do the right thing?
    • Do you think it’s okay if I…?
  • Compulsive self-reassurance
    • Repeatedly saying: “I’m a good Christian person” after experiencing an unwanted thought.
    • Repeatedly saying: “God loves me” after having an unwanted thought.
    • Compulsive writing (e.g., Jesus loves me).
    • Mentally reviewing or analyzing events to determine if a sin was committed.
  • Taking religious practices to extremes.
    • “Observing the Sabbath” in a way that’s not typical for others in one’s faith tradition.
    • Fasting in a way that’s not typical for other members of one’s religious community.
    • Engaging in self-punishing atonement practices that are not characteristic of one’s faith.
  • Making deals with God.
  • Planning and preparing for future religious problems (e.g., researching exorcisms).
  • Replacing unwanted thoughts or images with safer or holier images.
    • Thinking of images of the cross, doves, Jesus’s face, Mary’s face.
    • Mentally inverting unwanted images.
  • Inspecting one’s body for “signs” from God or the Devil.
    • Examining birthmarks or looking for moles that indicate whether one is good or evil.
  • Restarting or cleansing rituals.
    • Getting out of bed again.
    • Taking showers.
    • “Renewing” oneself through mini-Baptisms.
  • Asking for forgiveness excessively.
  • Excessive study of religious texts (i.e., Bible, Torah, or Koran).

Avoidance Behaviors Related to Scrupulosity (OCD)

  • Avoiding religious services (if one is afraid of God’s judgment for having bad thoughts while attending a service).
  • Avoiding communion (if afraid of dropping a communion wafer).
  • Avoiding triggers related to other spiritual or secular belief systems.
    • Avoiding books, movies, or magazines that mention evolution.
    • Avoiding yoga or other practices that developed out of a different faith tradition.
  • Avoiding numbers that are unlucky or have religious significance (e.g., 13, 666).
  • Avoiding reading the Bible, Torah, or Koran.
  • Postponing decisions until they “feel right” or until God gives a clear sign about what to do.
  • Avoiding prayer (if afraid of having a bad thought while praying).
  • Deferring decisions to other people.
  • Avoiding eye contact with members of the opposite sex (if afraid of committing adultery).

Remember, effective treatment for scrupulosity is based on exposure and ritual prevention, a type of behavioral therapy that was designed to treat obsessive-compulsive disorder (OCD). However, ERP will typically be augmented with steps related to belief clarification.

Questions? Comments? Do you experience scrupulous symptoms that were not mentioned above? Sound off below.

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