Article written by Caitlin Claggett Woods, PhD, C.Psych.
This section is dedicated to spiritual and religious leaders seeking to provide support to members of their congregation impacted by OCD and scrupulosity. The following information is designed to equip faith leaders in identifying OCD and effectively provide support throughout an individual’s OCD journey.
What Is OCD and Scrupulosity?
Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions (also referred to as “rituals”) are behaviors or mental acts that an individual engages in to attempt to get rid of the obsessions and/or relieve the anxiety caused by the obsessions. The term “rituals” as used in OCD refers specifically to compulsions and avoidance and does not overlap with the rituals inherent in religious practice. In general, OCD is diagnosed when these obsessions and compulsions become extremely time-consuming, cause significant emotional distress, and may greatly interfere with day-to-day functioning and interpersonal relationships.
Scrupulosity is a subtype of obsessive compulsive disorder (OCD) involving religious or moral obsessions. Scrupulous individuals are overly concerned that something they thought or did might be a sin or other violation of religious or moral doctrine. They may worry about what their thoughts or behavior mean about who they are as a person. This can lead them to avoid religious practice altogether, or they may focus on perfecting a trivial aspect of religious practice while ignoring more important ones.
Learn more about what is OCD?
Being the Front Door
Many individuals suffering from OCD seek counsel from their spiritual or religious leaders either exclusively or prior to seeking treatment from a mental health professional. More than doctors or psychiatrists, individuals are looking to their spiritual and religious leaders for guidance on mental and emotional issues. As the leader of your congregation, members have trust and familiarity with you, which likely makes bringing concerns to you first feel easier. Your influence has the power to help steer an individual with OCD towards appropriate treatment and on a path to living their religious practice in a more thriving and joyful way.
Scrupulosity Amongst the Religious Community
Our data is limited, but we do know that OCD occurs in about 2.5% of the population or 8.25 million people in the USA —meaning 8.25 million people in this country alone are trapped within the confines of their mind’s relentless barrage of intrusive thoughts and repetitive and time-consuming compulsions. Of those, a full third will experience it in the form of scrupulosity.
Although we do not have exact numbers, scrupulosity hides amongst our members at greater rates than we know.
Overcoming Shame & Accessing Appropriate Treatment
People who live with OCD/scrupulosity experience overwhelming shame and self-condemnation. Due to the nature of unwanted intrusive thoughts, these individuals may fear coming forward to ask for help. They may hide in terror, for fear that they will be condemned and rejected for the disturbing unwanted content spiralling through their minds.
On average, individuals experience 11 years of OCD symptoms before even speaking up about what they’re experiencing, and an additional 6 years before they receive appropriate care. This amount of time is expanded if their first attempts at disclosure result in being shamed or guilted for not being spiritual enough, for not trusting enough in God, or if encouraged to self-sacrifice or punish themselves for these unwanted thoughts. You can help to decrease the amount of years an individual suffers in silence, and without adequate treatment, by understanding the true nature of OCD and adopting strategies to provide effective support.
Spiritual Doubt vs OCD Doubt
Doubt is a part of healthy spiritual development. Doubt begins a spiritual quest and within it initiates and grows the hunger for a connection with God. In the spiritual journey, faith follows doubt’s lead. For many religions, God is the encompassing all, is a mystery beyond our comprehension. A perpetual uncertainty that we seek to understand. We seek guidance from leaders in our religious traditions to better understand and deepen our relationship with God.
Having a spiritual struggle does not inherently mean that someone needs treatment through a mental health provider. But doubt driven by scrupulosity operates differently than the spiritual doubt that the average person of faith will experience. With scrupulosity, they are stuck in a never-ending loop of pursuing r absolute certainty, caught in a frantic and overwhelming amount of anxiety. In an effort to reduce this anxiety, the individual may seek reassurance from their spiritual or religious leaders. Without the ability to recognize these doubts as part of OCD symptoms, a faith leader may unknowingly provide accommodation or reassurance that actually fuels the condition and deters their recovery.
Where One Ends and the Other Begins
It can be difficult to determine where spiritual/religious rituals end and where OCD/scrupulosity begins. In determining this, you might consider the ways that others within the faith community engage in their practice. Typically, individuals with scrupulosity move beyond the norm when engaging in religious rituals. In fact, many will intensely focus on a minor aspect of their religious practice at the cost of more important practices in the faith, losing the forest for the trees. Others might avoid engaging with religious practice or even reminders of their religion altogether to avoid feeling anxiety and guilt.
Another, more personal, area to consider is the reason an individual is engaging in the practice, prayer, ritual, or custom. When faith engagement is driven by OCD, religious rituals tend to be initiated due to fear, obligation, guilt, or shame. When faith engagement is driven by values, the individual is likely leaning into meaning, joy, peace, hope, or gratitude. There are legitimate times someone must pray out of fear (such as in the midst of a traumatic event), but it is important to consider the function. You might ask, “Is the person praying for support in the midst of a fearful situation, or are they praying because they fear the consequence of not praying?” Praying to seek support from the Divine is different from praying out of fear/guilt/obligation directly about not engaging in the ritual/practice. It is important to consider appropriate and customary faith engagement within the tradition.
If you believe the religious engagement is a result of OCD or if you are unsure whether this is the case, it can offer a wonderful space to collaborate with a mental health provider rather than offering accommodation/reassurance. Then, as the individual moves through treatment, you might support their clinician by asking questions like, "Where do you find joy and meaning? What is your understanding of the nature of God?" as you help the congregant re-engage with faith in a value-driven way.
Collaborating with a Mental Health Provider:
To first understand the importance of collaborating with a mental health provider, it is useful to understand the therapist’s goal in treatment. The mental health clinician’s focus is to respect (and work within) the individual’s religious tradition. Their goal is to help the client grow in healthy faith and theology and to help them practice their faith from a place of freedom and love rather than fear. Clinically, the therapist aims to help their client disengage and recognize their thoughts as ideas rather than facts, to change hurtful beliefs (e.g., I am unworthy of God’s love, God seeks to punish me), and to regain functioning and engagement with values.
Faith leaders serve an important role in someone’s recovery from scrupulosity that serves a different purpose than a mental health clinician. As a faith leader, you hold an important and influential role in the spiritual direction and well-being of your congregation. Individuals will often listen to and follow the guidance of their spiritual or religious leaders before everyone else — including family, friends, doctors, and therapists. Helping the client to gain trust in their support network and their clinician is an important role that you serve.
Another way in which collaboration between faith leader and clinician is valuable is in giving guidance on the faith itself. The mental health provider may not share their client’s religious practice. As such, they will need your guidance to identify and differentiate healthy religious practice from scrupulosity.
Finally, the individual will need ongoing support and encouragement throughout their recovery journey. Recovery from OCD is incredibly challenging and requires a community of support. As the old adage goes, it takes a village. Your support can help bolster someone in continuing forward on their path.
You can offer crucial support, which includes:
- Helping individuals re-engage with faith in a value-driven way once it is separated from the OCD
- Supporting an individual who might be grieving aspects they thought were a part of their faith but were truly based on OCD
- Affirming a different relationship with faith than the individual had before treatment
- Helping an individual grieve what they have lost to OCD, while offering a new sense of meaning as they reclaim their life
What is Symptom Accommodation?
Symptom accommodation are behaviors that supporters do to enable OCD symptoms by aiming to decrease the person’s anxiety in the moment. Although the accommodation is done with good intentions, these behaviors lead to increased OCD severity. Accommodation functions like OCD compulsions, serving to prevent or quickly alleviate the distress associated with unwanted intrusive thoughts in the short-term, and increasing OCD symptoms in the long-term. The only difference is that compulsions are performed by the OCD sufferer themselves, whereas symptom accommodation is undertaken by those in the individual’s support network. The more that the support network can learn about their own responses to OCD and the impact they have on the person with OCD, the more they will become empowered to make a difference!
Here are some examples of symptom accommodations for scrupulosity:
As a spiritual or religious leader, it may be that your typical approach to someone struggling with anxiety would include providing reassurance and a sense of safety that their fears are unwarranted. You may help to find ways that they can avoid experiencing their fear. After all, you want to support them and alleviate their suffering. However, this approach is actually counterproductive to the recovery of an individual with OCD. Doing what comes naturally to you and comforting your parishioner/member struggling with anxiety in these ways inadvertently strengthens their disorder as opposed to decreasing their distress.
Alleviating someone’s anxiety in the moment:
- Reduces the opportunity for them to learn that their feared outcomes are not actually likely to occur.. (E.g., that saying a specific phrase, such as, "stay away demons") keeps them from becoming possessed).
- Prevents an individual from experiencing a reduction in anxiety after facing their feared situation without avoidance or compulsions – that is, it interferes with the process of natural fear reduction over time.
- Limits an individual’s opportunity to learn to cope with distress, instead sending a message that difficult emotions (such as fear and doubt) need to be avoided and cannot be tolerated. This in turn prevents an individual from building a sense of mastery and increasing their ability to cope with stressful situations.
- Leads to decreased motivation to change. If an individual is protected from the negative consequences of their symptoms through symptom accommodation, they are less likely to engage in treatment and work towards recovery.
What is Reassurance Seeking?
One of the ways in which someone with OCD might seek to reduce their anxiety is through reassurance seeking. This is one of the most common expressions of symptom accommodation and involves asking you lots of questions, asking the same question repeatedly, or seeking physical comfort. Reassurance seeking serves to reduce anxiety through increasing certainty about a feared situation by gaining perspective from a trusted source. Although providing answers to (often simple!) questions may seem harmless, providing reassurance serves to maintain the OCD cycle.
To identify whether a question is driven by a desire for reassurance or because the individual is actually lacking relevant information, it is important to identify the function of the question. Exploring the function behind the question with your parishioner/member may serve as a more effective method of identifying (and ultimately reducing) reassurance seeking.
To help determine the function of a question, make sure to ask:
- Why? For example, “Why do you want me to answer that question?”
- What? For example, “What will a particular answer do for your anxiety?”
Reducing Accommodations
Reducing accommodation is a gradual process that is best done collaboratively with the individual in treatment, their supporters, and the treatment team. It is important for everyone to work on the same team in the fight against OCD.
Steps to reduce accommodations:
Remember, reduction of accommodation is best accomplished through clear communication with changes that will be made being clearly discussed.
Reducing Reassurance
Reducing reassurance seeking is crucial to treatment success and should include as many support persons as possible. When the parishioner/member comes to you for reassurance, you can try responding with the following questions/phrases to give them the opportunity to answer for themselves:
- “What do you think?”
- “Have I already answered that?”
- “Maybe, maybe not.” or “It’s possible.”
- “I don’t have an answer for that."
You can also simply point out that they are seeking reassurance and, therefore, that it would not be helpful for you to provide an answer.Again, clear communication as to how reassurance will be addressed in the future is an important aspect of accommodation reduction.
Replacing Reassurance and Accommodation with Support
Not providing someone with reassurance or accommodation when they are in distress can feel mean. However, it is important to remember that one can be empathetic without being accommodating. The use of validation can be especially helpful when a member of your congregation is struggling.
Validation refers to the provision of acceptance, support, and confirmation. It is a message to another person that their emotions, thoughts, and behaviors have causes and are understandable in the current context. Validation takes the individual’s emotional and behavioral response seriously, without discounting or trivializing their experience. Validation is non-judgmental; it acknowledges someone else’s point of view, conveying understanding and empathy without trying to fix things or disregard their experience. When we validate, it is important to draw the distinction between validating that someone is struggling and reinforcing unhelpful thinking. For example, you can validate that someone is experiencing a lot of guilt from their intrusive thoughts without agreeing that their intrusive thoughts are something they should feel guilty about.
Validation includes 3 important aspects:
By responding with validation instead of reassurance, you can continue to support and care for your congregation while simultaneously helping them to move forward in breaking free from anxiety.
How do I talk to my congregation or members about OCD?
OCD and scrupulosity are often accompanied by significant experiences of shame. Individuals are incredibly hesitant to speak up owing to fears that they will be judged for the content of their thoughts. There are a few ways in which faith leaders can create a welcoming space for individuals to open up about their experience.
On a wider level, it can be helpful to include mental health-related topics in speeches. Additionally, guest speakers can be brought in to offer education sessions about various mental illnesses. When people see these topics widely discussed, it helps to reduce the stigma associated with their experience. On an individual level, it can be incredibly powerful to approach someone who you observe is struggling. Take them aside and share what you’ve noticed. Offer them space to open up about how they’ve been feeling. By talking, listening, and expressing your care for them you can create an opportunity to encourage someone to seek the help they need.
For spiritual or religious leaders that have been reading this, we hope you know how important you are: important in the lives of your congregation, important in their recovery, and so incredibly valued. We thank you for your service and commitment to the well-being of your community.
* Not all examples or descriptions apply to all religious traditions.
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