As a therapist who treats OCD—and who happens to be a Christian myself—one of the questions I’ve been asked is whether faith-based therapy can help with Religious Scrupulosity OCD.
The answer to that is complex, and there is a specific type of therapy that has been proven to be effective in treating OCD. But before we delve into that a little more, let me start with an example from a woman I’ve helped.
Let’s call her Candace. As a child raised in an Episcopalian home, she started to experience intrusive images of the devil at a young age. She was tortured by her fears of going to hell, but “grew out of it” as a teenager. Fast forward to her twenties. Engaged to a Catholic man, she decided to convert to Catholicism. During her RCIA (Rite of Christian Initiation for Adults), a process through which non-baptized people enter the Catholic Church, her religious fears started to come back.
When she prepared for her first confession that she would make to the priest, Candace spent hours listing out all the sins she could remember. She went to her first confession, but she did not feel absolved. Worried that she had forgotten something, she went back to confession again, and then again, trying to “get it right.” The priest observed that Candace might be struggling with a mental health concern, and suggested she seek out therapy.
Searching for answers, Candace heard about how obsessive-compulsive disorder (OCD) can focus on religious themes, despite the way it’s usually portrayed in media. But when she read about how recovery is achieved, she felt fearful—in exposure and response prevention (ERP) therapy, the gold-standard treatment for OCD, a therapist such as myself coaches the patient as they confront various triggering situations, then works with them to resist doing compulsive behaviors that reinforce their fears.
Candace worried that by confronting her fears, she might actually be sinning during the therapy, and wondered if she would be “punished” for treatment. Sound familiar? Keep reading.
Why OCD can feel extra challenging for religious people
When OCD interacts with a person’s religion, a lot of questions can come up. Trust me—as an OCD therapist, a Christian, and as a person who struggles with OCD myself, I know this firsthand.
Sometimes people worry that getting any kind of therapy outside of faith-based counseling is “risky” for their faith and will interfere with their devotional life. This is often due to misconceptions about how OCD works, and what treatment for OCD actually entails.
We’ll explore both parts—first, let’s explain what Religious Scrupulosity OCD actually is.
What is Scrupulosity?
Scrupulosity, sometimes referred to as Religious OCD, is a form of OCD involving religious or moral obsessions. A person with religious or moral scrupulosity might have fears that they are a bad or evil person. They might have concerns that they will do something to offend God or commit an “unpardonable” sin, or that they may have done so in the past.
In OCD, an obsession is a recurrent intrusive thought, feeling, impulse, sensation, or image that is distressing, while a compulsion is a repetitive behavior or mental action done in response to an obsessional fear or worry. Compulsions are performed to prevent something bad from happening or to immediately reduce the distress triggered by obsessions.
Common Obsessions related to Religious OCD:
- What if I accidentally use God’s name in vain?
- What if I commit a sin that won’t be forgiven?
- What if I go to hell because I had sex before marriage, looked at pornography as a teenager, or masturbated?
- What if I think evil things in my head about my friends?
- What if I harm someone, or harmed someone in the past?
- What if another religion is the “right” one?
Common Compulsions related to Religious OCD:
- Praying excessively
- Excessive confession to a priest, family or loved ones
- Bargaining with God to not go to hell
- Seeking reassurance from friends or loved ones about sinning or not being forgiven
- Avoidance of anything associated with immorality
- Excessive research about religious topics
- Excessive attendance of religious ceremonies or services
It is important to note that not all repetitive religious rituals are driven by obsessive fears. One person may attend Mass every day of the week, go to confession twice a week, volunteer in the church soup kitchen, and direct the children’s Christmas pageant because of their devotion to their faith. They feel good about this, and are driven by devotion, not fear. Another person suffering from OCD may do all of these things because they feel like if they don’t, they will be somehow offending God, not living up to their standards, or may be punished.
It’s important to differentiate acts of devotion from scrupulosity, and this can be done with the help of an OCD therapist who is also trained to keep faith considerations in mind.
How is Scrupulosity treated most effectively?
As mentioned earlier, ERP—which stands for exposure and response prevention—is the gold standard of treatment for OCD. ERP therapy has decades of clinical research backing it up, and has been found to be effective for the majority of people with OCD. Through ERP, people who struggle with Religious OCD will work with their therapist to be gradually exposed to their worries and fears, while learning to stop engaging in compulsions to feel better.
Over time, people build more tolerance for uncertainty and anxiety when they are exposed to their triggers, and don’t feel such a strong urge to engage in compulsions out of fear and anxiety. Let’s take a look at some specific examples of things someone with Scrupulosity or Religious OCD might do in ERP therapy:
- Reading about the beliefs of another religion
- Reducing prayer to once a day
- Writing the word “Satan” on a piece of paper over and over
- Watching a movie clip about demonic possession
- Saying “I am not a perfect practitioner of my faith”
Don’t worry if you’re flinching about the idea of any of these things. At NOCD, we understand how important one’s faith can be to them. We know that some exposures may be “off the table” for some people—and that’s completely okay. Therapy is never “one size fits all.” We will work to help you face your fears while upholding the importance of your faith by creating a completely customized treatment plan.
Can faith-based counseling work in tandem with ERP?
This is a great question, and one I get asked often. First, it’s necessary to note that faith-based counseling isn’t a replacement for ERP.
Additionally, it’s important to make some considerations when seeking out faith-based therapy as a form of treatment used in conjunction with ERP. For one thing, there is a need for more education about OCD in the world at large. This includes the world of faith, and sadly the world of mental healthcare as well. In seeking faith-based counseling in addition to ERP, whoever is doing the counseling needs to have an understanding of OCD and how it manifests. Someone (a minister, for example) who is providing counseling to someone struggling with OCD may become concerned or fearful themselves when presented with someone’s obsessions if they don’t adequately understand OCD. And when someone doesn’t understand OCD, all kinds of misconceptions and misperceptions can be made that could cause treatment to inadvertently make OCD worse.
In my early days as an ERP therapist, I heard about a mother with perinatal OCD who had thoughts about harming her infant being turned into Child Protective Services (CPS) by her pediatrician. CPS quickly realized that she was suffering from OCD and would not actually harm her child, but this does not change the fact that this mother endured a traumatic experience. That doctor caused all kinds of unneeded grief for her, and reinforced fears even more.
A faith-based counselor who does not understand or take into consideration how OCD can manifest may sometimes cause more harm than good. On the other hand, when a faith-based counselor is educated about OCD, they can help a patient to figure out where their faith ends and their OCD begins.
As an OCD therapist, I am always willing to work with another professional to deliver the best treatment possible for a patient. Sometimes, this means collaborating with a faith-based counselor. Healing from OCD and growing in spirituality can occur at the same time when both areas are addressed appropriately. That was the outcome for Candace, who was dealing with scrupulosity and was lucky to embrace ERP therapy while also having the support of her priest.
Where to get help for OCD
You can get help for your OCD from anywhere on a confidential, professional, and highly effective program with NOCD. NOCD has brought ERP therapy to thousands who suffer from OCD. Being able to offer telehealth allows your ERP therapist to be with you via video chat, right from the comfort of your home, and NOCD Therapists are able to coordinate care with others in your journey.
If you think you may be struggling with Religious OCD or religious anxiety, I strongly encourage you to learn more about NOCD’s holistic, expert approach to treating OCD and anxiety. We can get you on the road to feeling better sooner than you may think.