What is Moral OCD? Signs, symptoms, and treatment

Just about everyone will find themselves wondering if they’re a good person now and then. After all, we’re human beings who are bound to make mistakes every once in a while, and our actions can often leave us questioning ourselves and our morality.  

However, a small subset of people may deal with recurring and persistent intrusive thoughts, worries, doubts, images, urges, sensations or feelings that they might be a bad person. This fear might be linked to their religious or spiritual beliefs or any other code of ethics that they follow. They might fear that they aren’t following the rules perfectly enough, or that they are otherwise doing things that are against their morals. It can leave them dealing with an intense fear that they’re a sinner or a bad person, no matter how “moral” they try to be. 

If you’re locked in a cycle of fear and feelings of inadequacy that sounds similar to this, you might be dealing with obsessive-compulsive disorder (OCD) focused on your morality. In and this article, we’ll talk about how themes of morality can cause distress for people with OCD, plus where you can turn to for help. 

How does OCD work? 

OCD is a mental health condition that is defined by the presence of two groups of symptoms: obsessions and compulsions. 

• Obsessions are intrusive thoughts, images, urges, sensations, and/or feelings. Obsessions are often repetitive and generally go against one’s usual way of thinking or belief system, which can lead to intense levels of fear, distress, and anxiety. 
• Compulsions are mental and/or physical behaviors that are done in response to obsessions as a way to soothe the anxiety and distress that they may cause. They may also be carried out as a way to prevent some feared outcome from happening. 

OCD often targets the things that we care about the most. For example, people who experience religious OCD may have fears that specifically center around their religion and their moral integrity. That’s one reason why people with OCD tend to be particularly distressed or anxious about their obsessions—while other people may be able to move past their intrusive thoughts, people with OCD will often become fixated on them instead. They might wonder what it means about them if they’re having those thoughts, and whether having these thoughts in the first place makes them a bad person.

What is moral OCD? 

If someone’s OCD includes themes surrounding their morals and their ability to adhere to them, they may be dealing with a specific kind of OCD called Scrupulosity OCD. 

Scrupulosity OCD is also sometimes referred to as Religious OCD because it is often associated with religious or spiritual beliefs. For example, people with this OCD subtype will often have recurring fears about sinning, making God angry, or otherwise going against their religion’s rules. However, scrupulosity can also be much broader, with more general doubts and fears about ethics, proper behavior, and responsibility for others.  

April Kilduff, MA, LCPC, LMHC, a licensed therapist at NOCD, sums up Scrupulosity OCD succinctly: “The core fear for people with this subtype of OCD is going to be the fear of being a bad person.” 

“Scrupulosity OCD is interesting because it used to be just about religion,” Kilduff continues. “Now, we call it scrupulosity because it still does include religion, but it also can include a general spiritual belief system or a greater ethical or moral system.” For example, people can have Scrupulosity OCD-related fears that center around moral and ethical concerns like veganism and environmentalism. 

Additionally, other people with Scrupulosity OCD may have fears that center around how they interact with the people around them. For example, someone with Scrupulosity OCD might wonder whether the interactions that they are having with their loved ones are offensive or manipulative, or that they are narcissistic and hurting others around them. 

Symptoms of Scrupulosity OCD 

For someone to have Scrupulosity or Religious OCD, they need to have obsessions and compulsions that are related to their religious, ethical, or moral codes. 

These symptoms look different from person to person. Some might fear that they are breaking the rules of their belief system, even without knowing it, while others may worry that they are fundamentally evil, without any particular reason. In general, the obsessions that people with Scrupulosity OCD center around whether or not they are truly living up to every aspect of their faith or ethics at all times. 

As a result, perfectionism is a big theme in Scrupulosity OCD. People with this kind of OCD may have repetitive and persistent fears that they are somehow breaking the rules, and that nothing they can do will ever feel right or good enough. 

For example, some common intrusive thoughts and questions that people with Scrupulosity OCD may focus on include:

• Am I doing things the right way? 
• Am I committing a sin? 
• Will God still forgive me if I make a mistake in my prayer? 
• Did I say something offensive during class?
• Why is my partner upset? Did I do something wrong?
• Am I making God mad by doing this? Have I disappointed God somehow? 
• Will I be accepted by my community if I make a mistake? 
• If I’m a vegan, am I a bad person for accidentally eating honey? 
• Am I a bad person if I throw a recyclable in the regular trash? 

These thoughts can then generate intense fear, anxiety, and discomfort since it brings into question whether or not they’re really following their religious/moral code completely. As a result, they may then engage in common compulsions that are meant to temporarily relieve that distress or prevent something bad from happening:  

• Excessive prayer and asking for forgiveness 
• Excessive confession, both to religious leaders and others 
• Asking partners or others for reassurance that you didn’t do anything wrong
• Mental compulsions like self-reassurance or self-punishment 

When people are worried about their goodness as people, and/or whether or not they’re going to be going to heaven or hell in the afterlife, it can make the fears that come from Scrupulosity OCD feel that much more serious and all-consuming. “Scrupulosity themes can make people fear such dire consequences. There’s anxiety in everybody with OCD, but it can be especially hyperactive with moral fears, which makes sense because there’s often an element of hypervigilance involved in scrupulosity,” Kilduff explains. 

Some people with Scrupulosity OCD may even be concerned about the morality of the people around them, further adding to their distress, Kilduff shares. Their fears might involve whether their loved ones are good people themselves, especially if they are religious and are concerned about whether they will see their friends and family in the afterlife. 

All in all, dealing with Scrupulosity OCD can be extremely distressing. However, the good news is that you are not alone, and that there is hope for breaking out of the cycle. 

How is Moral OCD treated? 

As intense and scary as it may be to deal with it, it’s important to remember that OCD is a highly treatable condition. If you believe that you are struggling with Scrupulosity OCD, exposure and response prevention therapy (ERP) can help. 

ERP is considered the gold standard treatment for all subtypes of OCD. In ERP, you carefully., intentionally confront the situations and worries that cause you anxiety and fear, starting at a low level and slowly working your way up. As you are exposed to uncomfortable feelings related to your OCD, you learn to better manage anxiety and distress without engaging in compulsions.

But how would this work for Scrupulosity ERP? Would you need to do things against your moral code? Thankfully, the answer is no: you don’t need to actually break the rules of your beliefs in order to get better. However, you will need to work with your therapist to better define what those rules are and how you can better live with confidence in your values, rather than being ruled by fear.

“One of the rules of ERP is that we won’t ask people to do anything immoral,” assures Kilduff. “But what’s really important within that statement is that we have to understand the line of what is considered immoral based on your religious or ethical system, versus what OCD is telling you is immoral.” This might mean having a discussion about your religion or ethics, or even talking to a religious or spiritual leader, to better understand the lines that can and cannot be crossed. 

ERP is highly effective when done correctly, and it can offer hope for people who are stuck in a seemingly endless cycle of questioning their worth as a person. Still, it can be understandably scary to take the first step. 

If you’re scared to start, Kilduff offers this advice: “This is the gold standard treatment. Thousands, if not millions, of people have done this and gotten better. If it did harm, it wouldn’t be the gold standard.” It’s also important to remember that ERP is tailored individually to each person’s unique experiences and needs. “We’re always going to start at a low level and go gradually. We’re not going to do the scariest thing you can think of: we’ll meet you where you’re at and help you find a good challenge zone to work in.” 

Finally, it’s also worth noting that you are not alone in your struggle. Many other people also deal with Scrupulosity OCD. Meeting with a support group can help you connect with others who are going through similar struggles, share your stories, and remember that you’re not in this alone. Learn more about NOCD’S Support Groups to get connected.  

Your OCD might be telling you that you’re a bad person, but this doesn’t mean that you are. Finding help with ERP therapy and a trained mental health professional can help you break out of that endless cycle.