Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Is Scrupulosity (Religious) OCD? Diagnosis, Symptoms, and Treatment

Oct 24, 20238 minute read

You’re probably somewhat familiar with obsessive compulsive disorder (OCD), a mental health disorder in which a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that lead to discomfort. Compulsions are repetitive or ritualistic behaviors or mental acts that someone with OCD then engages in to relieve the anxiety caused by the obsessions or to prevent something “bad” from happening. 

As a specialist in the field of OCD, I know that some subtypes of OCD are less familiar to most people. For example, many people aren’t aware that there’s a subtype of OCD called Scrupulosity. (You may see it referred to as scrupulosity, Religious OCD, or scrupulosity OCD.)

What is Scrupulosity or Religious OCD?

The term “scrupulosity” was first used by the Roman Catholic church to describe obsessive concern with sin and compulsive acts for the purpose of atonement. Today, mental health professionals also use the term to describe OCD thoughts related to ethics and morality.

Scrupulosity is a subtype of OCD that involves a religious, moral, or ethical obsession. Scrupulous individuals experience intrusive thoughts that something they thought or did might be a sin or go against their faith or moral doctrine. People with religious or scrupulosity OCD experience frequent worry and guilt about violating a religious or ethical code and what it means about them as a person (e.g., “Did I allow myself to have an “impure” thought in church? Does it mean that I’m a sinner and must repent?”). The guilt and anxiety drive these people to engage in various compulsions aimed to alleviate their distress (e.g., confessing to a religious figure). 

Religious or Scrupulosity OCD Symptoms

Many religious people may be concerned they have sinned and want reassurance. However, with religious or scrupulosity OCD, the concern is never-ending. This unrelenting anxiety and fear about committing a sin may cause a person to engage in behavioral or mental compulsions.

Here’s a list of common obsessions and compulsions in scrupulosity:

Examples of religious or scrupulosity obsessions

Religious-focused OCD thoughts: 

  • Have I prayed correctly? Have I prayed for the correct amount of time? I was a bit distracted. Maybe I should do it again. 
  • Today I thought my religious leader is ugly. Does that make me a bad person? 
  • During religious services, I found it hard to concentrate and thought about my to-do list for a few minutes. Is that a sin?
  • At the supermarket, I accidentally picked up the pork and immediately put it down. Am I contaminated from having touched it? Should I confess?
  • I wanted to laugh today during services. Does this mean I don’t take my religion seriously? 
  • Did I do something that offended or angered God?
  • I’m striving for purity and I fear I’ve done something wrong.

Moral/secular OCD obsessions: 

  • I told someone I’ll call them at 5 p.m., but I called them at 5:01 p.m. Have I lied? Am I a bad person?
  • Did I offend my friend without knowing during our conversation yesterday?
  • Was the question I asked in class rude? Have I accidentally offended the teacher?
  • Is it OK that my friend edited my essay? Does that count as cheating?
  • I didn’t say ‘thank you’ to the person who held the door for me. I am a bad person. 
  • I told my spouse that I am great when they asked how I am. But the truth is I’m upset. Am I deceiving my partner? Do I deserve to be in this relationship?
  • I told a prospective tenant that I ended up choosing someone else, but the truth is I let my cousin stay in the apartment. Am I a horrible person for “telling a white lie?”

Examples of religious or scrupulosity OCD compulsions

In response to their obsessive thoughts, a person with religious or scrupulosity OCD will engage in compulsive actions as an attempt to alleviate their anxiety. Here are some examples of what that might look like:

  • Excessive prayer: People with religious OCD may pray extensively — longer than the standard for their particular faith, sometimes hundreds of times a day, in order to make sure their prayers have been performed perfectly. If there’s a mistake or hesitation, the person may repeat themselves until they believe the prayer is flawless.
  • Excessive confession: People with religious OCD may repeatedly go to their religious leader/authority to ask about or confess sins they are worried about having committed. It could be minor questions, like, was it a sin when I found a woman attractive, even though I’m married? The person may return multiple times to confess about the same event, for fear that they haven’t communicated the sin properly and may still be guilty. 
  • Excessive rituals: People with religious OCD may develop excessive rituals to calm their obsessive thoughts. This may look like coming up with a number of minutes to pray, asking for God’s forgiveness a certain number of times, or performing established religious rituals a certain number of times. 
  • Reassurance seeking: People with religious and scrupulosity OCD may repeatedly turn to the people in their life for reassurance. They may ask family or friends if they’ve ever experienced the same thoughts they have, to affirm whether or not they are sinful. They may also spend hours in online forums asking strangers whether something they’ve done would be considered a sin. Someone with scrupulosity OCD may ask their teacher if it’s okay that a friend helped them with their homework, even if the teacher already clarified it is. They may ask a friend if they would consider this cheating. 
  • Mental checking: People may mentally review past experiences and try to evaluate whether they behaved in an immoral or sinful way. Someone who is concerned about having offended their friend might replay the face he made over and over, and think back to other times their friend has made this face. Is this the face he makes when he’s offended? 
  • Avoidance: Someone with religious OCD may avoid their place of worship for fear of behaving in a sinful way. They may avoid certain people who cause them to have thoughts they’ve determined are immoral or sinful.

Is Scrupulosity OCD more common for people of a certain religion?

You may have heard that OCD affects people of all walks of life—it doesn’t discriminate. And that’s certainly true for Scrupulosity OCD as well. To date, there’s no evidence that shows people of a particular religion are more likely to experience this form of OCD. And keep in mind, as previously mentioned, that it’s certainly possible to suffer from Scrupulosity OCD and not have any religious affiliation. 

Can Scrupulosity OCD be treated?

Yes! As with all other forms of OCD, the gold standard treatment is called exposure and response prevention (ERP) therapy. ERP was developed specifically for treating OCD, and it’s supported by decades of rigorous clinical research proving its effectiveness.

As part of ERP therapy, you’ll work with a specially-trained ERP therapist to slowly put yourself into situations that bring on your moral or ethical obsessions. This gives you a chance to respond differently to the obsessions and eventually you no longer have to respond with a compulsion. (This has to be carefully planned to ensure  you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.)

People with religious OCD may face particular challenges during ERP therapy because they may be convinced certain exposures will make them unfaithful to their religion. Working with a trained therapist who understands your faith and how important it is in your life will help you feel confident to begin the process of separating your faith from your OCD thoughts about it. As the nature of these OCD thoughts is to convince you that you aren’t devout, a therapist who’s familiar with religious OCD will be able to help you work through these thoughts in a way that isn’t overwhelming. 

How, exactly, does OCD therapy work for Scrupulosity OCD?

ERP therapy works to get you acquainted and comfortable with the unknown, since it’s the fear of the unknown and the need for certainty driving the obsessions and compulsions.

Let’s say you’re someone with scrupulosity OCD and excessively concerned about telling the truth. You’ve just told your spouse you’ll be home at 3 p.m., but you actually arrived at 3:30 pm. Each time this happens, you spiral into obsessive thoughts about being a liar, and the need to know if you’ve done something wrong, and sometimes ask your spouse for confirmation that this isn’t a serious lie and that you are still a good person. 

In ERP therapy, the goal is to prevent yourself from acting on your compulsions. Instead of asking your spouse for reassurance, a therapist may have you think to yourself, “Maybe I am a liar. Maybe I’m not. It’s impossible to know for sure.” This teaches your brain a new response to your anxiety and begins to get you comfortable with the uncertainty fueling your obsessions and compulsions. In order to avoid becoming overwhelmed, you’ll work with a therapist to come up with a hierarchy of anxieties and related exposures and gradually work your way through them. 

How to Get Help Today

Religious or scrupulosity OCD can be a tricky diagnosis to make because many of the behaviors can appear as concern about being faithful or ethical. A religious leader may tell you you’re simply overly concerned and have nothing to worry about, without knowing they are actually helping fill your need for reassurance. However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. 

Please know that effective and faith-affirming mental healthcare is out there for you. You don’t have to suffer from scrupulosity OCD forever, and you can get on the path to recovery—just as thousands of others with religious themes of OCD have before you.

We specialize in treating Scrupulosity OCD

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