By Taneia Surles, MPH, NOCD
If you live with obsessive compulsive disorder (OCD), you already know how it tends to latch onto the things you value the most—your relationships, your sense of purpose, and even faith. Religious OCD, also known as scrupulosity, is a common subtype that centers around intrusive thoughts and compulsions tied to spiritual, moral, or ethical concerns. It can turn acts of worship—like prayer, cleanliness, and fasting—into distressing and time-consuming compulsions.
For Muslims, this may show up as Islamic scrupulosity: recurring, intrusive doubts and compulsive behaviors aimed at proving one’s sincerity or avoiding religious punishment. A person might repeat their wudu (the ritual washing before prayer) over and over, restart prayers, or mentally check whether they’ve committed blasphemy—all to feel certain they’re a “good” Muslim.
When OCD interferes with your religion, it can feel isolating, but know that recovery is possible. With the right support, you can learn to manage your symptoms while restoring your relationship with your faith.
OCD in disguise: When faith becomes fear
Yusra Shah didn’t start experiencing scrupulosity until middle school, though she didn’t know it was OCD at the time. “I remember being deeply afraid that if I weren’t a 'good enough' Muslim, I would go to hell,” she says. “That fear became really overwhelming. During prayer, I’d obsess over whether I had broken my wudu. I’d worry that I might’ve passed gas—something that invalidates wudu—even if I wasn’t sure it actually happened. That uncertainty would lead me to stop praying midway, go repeat wudu, and start over.”
OCD often mimics religious devotion, making it harder to recognize. In Muslim communities, behaviors like repeating prayers or washing frequently might seem like signs of piety, but when they’re driven by fear, not faith, they may actually be compulsions.
“OCD will hijack a person’s religion and create a new version of it,” says Mubeena Mirza, LCSW, a licensed clinical social worker, therapist, and Muslim who treats clients with scrupulosity OCD. “It will create a new Islam and a set of rules that were not intended.”
What clinicians need to know
When treating Muslim clients with OCD, it’s the clinician’s responsibility to have a solid understanding of Islamic practices. Islam is built on five pillars: Shahada (declaration of faith), Salat (prayer), Zakat (almsgiving), Sawm (fasting), and Hajj (pilgrimage). According to Mirza, OCD commonly targets three of these pillars.
“First, a person must believe that there’s only one God, so a person’s OCD can latch on to that,” Mirza explains. They may have intrusive doubts like: “Do I actually believe there’s one God? How do I know that there’s only one God?”
The second pillar is Salat—praying five times a day, facing Mecca. Here, OCD themes like contamination can mix with religious obligations. “To pray as a Muslim, you need to be in a state of cleanliness and purity,” Mirza says. “For a person with contamination OCD, they might excessively clean themselves after going to the bathroom or in the shower. They’re afraid that if they’re not clean, not only are they contaminated, but their prayers won’t count.”
Fasting during Ramadan—part of the fourth pillar, Sawm—is another area where OCD can intrude. “For example, if a person is fasting and water drips near their mouth during a shower, they can spit it out, and that’s allowed [by Islam],” Mirza explains. “But for a person with OCD, they might start a ritual, thinking that their fast is broken. That’s not the religion at all.”
Because Islam includes structured rituals and emphasizes spiritual purity, it can be difficult to distinguish between religious practice and OCD-driven behaviors. That’s why Mirza stresses the importance of cultural competency. “A clinician might want to ask a clergy person, like an Imam, Sheikh, or Sheikha (female Sheikh), to get informed on common religious practices,” she says.
Understanding stigma: It’s not the faith—it’s the misunderstandings around OCD
While neither Shah nor Mirza describes Islam itself as a barrier to seeking treatment, there are a few cultural misunderstandings about OCD that may delay diagnosis and treatment.
“Some families and communities perpetuate the belief that a person just needs to work harder and be better, and then they wouldn’t be going through that,” Mirza says.
In some communities, these intrusive thoughts may be mistaken for waswasa—whisperings from Shaytan (Satan). While this concept exists in Islamic theology, it doesn’t negate the reality of OCD. “Whether the cause is biological, whisperings, or both, OCD is OCD,” Mirza says. “Islam allows for you to go with what you know and leave the doubt.”
The role of ERP: Reclaiming authentic faith
If you’re navigating religious OCD, the most effective treatment to help manage your symptoms is a form of cognitive behavioral therapy (CBT) known as exposure and response prevention (ERP) therapy.
ERP is an evidence-based treatment that helps break the cycle of intrusive thoughts and compulsions. With the guidance of a therapist, you’ll gradually confront your fears, build tolerance for uncertainty, and resist the urge to engage in compulsions.
“ERP falls in line with our spiritual practice, and makes it more authentic to what it was actually meant to be,” Mirza says. She explains that OCD often adds rules that weren’t part of the faith to begin with, and ERP helps strip those away.
Take, for example, a common prayer-related fear: losing track of how many cycles (rak’ah) you’ve completed during Salat. Islam acknowledges that people aren’t perfect—if you’re unsure, you’re taught to go with what you most likely remember and keep going. “OCD doesn’t want that uncertainty,” Mirza says. “Instead, it says you need to know for sure. By doing exposure and response prevention, we allow for a person to lean into that doubt and learn to sit with that anxiety.”
A warning for providers: Harmful exposures
When treating Muslims with OCD, clinicians must ensure that ERP exercises don’t violate the person’s religious beliefs. One of Mirza’s clients had previously worked with a clinician who proposed an exposure that crossed a sacred boundary, leading the client to avoid treatment for a year.
“The client was worried about committing blasphemy by praying toward an image, when we’re supposed to pray in a clear room in the direction of Mecca,” Mirza explains. “Their clinician told them to put a statue in front of them and pray toward it. That is total blasphemy—we’re not allowed to do that.”
Had that clinician been informed about Islamic practices, Mirza says, they would’ve known this crossed a line, which is why being culturally sensitive in OCD treatment is so important. There’s always an ethical way to do ERP therapy.
A path back to peace
Scrupulosity can disrupt your relationship with religion, replacing peace with fear and turning devotion into distress. But recovery is possible, and treatment doesn’t have to mean letting go of your faith. In fact, for many Muslims with OCD, getting the right help brings them closer to their religion.
“Religion and faith are meant to be beautiful and freeing,” Shah says. “If something is making you feel the opposite—whether it’s intrusive thoughts, endless comparisons, or this crushing fear that you’re not good enough—you deserve relief. You deserve to experience your faith in a way that brings peace, not fear.”
You don’t have to feel ashamed or afraid to seek support. With culturally informed care and evidence-based treatment like ERP, you can reclaim your faith—and your life.
If you’re seeking care, NOCD, the leading provider of virtual OCD treatment, offers access to over 650 ERP-trained therapists, many of whom have experience treating scrupulosity-themed OCD. They now accept more insurance plans, covering over 155 million Americans, making effective, culturally informed treatment more accessible than ever.
Resources
- IOCDF Resource Directory
- NOCD Therapist Directory
- Faith & OCD Resource Center
- The Islamic Workbook for Religious OCD: A Guide for Overcoming Intrusive Thoughts and Compulsions
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