Religious or scrupulosity obsessive-compulsive disorder (OCD) is an OCD subtype characterized by ongoing intrusive thoughts, images or urges, as well as compulsive behaviors or mental actions around violating a religious, moral or ethical belief. 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
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 in a secular context.
OCD tends to fixate on what is most important to the individual, and when being moral or religiously devout is central to a person’s identity, OCD will latch on and cause a person to have obsessions and compulsions centered around their core values, which makes the doubting thoughts all the more anxiety-provoking (e.g., Am I a “true believer” in my faith?).
Many religious people may be concerned they have sinned and want reassurance. However, with religious or scrupulosity OCD, the concern is never-ending, and these doubting thoughts can feel impossible to let go of despite extensive reassurance. Someone with this condition may have a thought come into their mind about eating a meal on a day when they are fasting. They might begin thinking: “Is it okay I thought about food right now? Am I fasting correctly? Have I sinned? Will I not have access to the afterlife?”
This unrelenting anxiety and fear about committing a sin may cause a person to confess to their religious leader. But confirmation they haven’t sinned may only ease the anxiety temporarily. It’s a matter of time before the thoughts kick back in, and they begin to think: “I didn’t share how I wished I could break the fast when I saw a family barbecue at the beach. Maybe I should go back and confess this as well.” Regardless of the confirmation, the person’s OCD will come up with more and more fuel for their doubting thoughts.
Examples of religious or scrupulosity obsessions
People with religious or scrupulosity OCD experience obsessive thoughts focused around their adherence to religious or moral beliefs. Here are some examples of common themes:
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?
Moral/secular-focused OCD thoughts:
- 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?
- Avoiding: 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.
Religious or scrupulosity OCD ERP therapy
The best course of treatment for religious or scrupulosity OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been found 80% effective. The majority of patients experience results within 12-25 sessions. As part of ERP therapy, you will track your obsessions and compulsions, and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.
The idea behind ERP therapy is that exposure to these thoughts is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety.
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.
Example of religious or scrupulosity OCD exposures
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
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.
If you’re interested in learning about religious or scrupulosity OCD and how it’s treated with ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment. You can also join our Religious & Spirituality OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.