What is OCD?
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” refers specifically to compulsions 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. Learn more about what is OCD?
What is Scrupulosity?
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.
What are the symptoms of scrupulosity?
Common obsessions seen in scrupulosity include excessive concerns about:
Fear of committing blasphemy, or offending/angering God
- Fear of having committed a sin
- Behaving overly morally
- Excessively striving for purity
- Fear of going to hell or being punished by God
- Fear of being possessed
- Fear of death
- Fear of the loss of impulse control
- Doubting what you truly believe or feel
- Needing to acquire certainty about religious beliefs
Along with excessive worry about religious and moral issues, scrupulosity sufferers engage in mental and/or behavioral compulsions and avoidance of triggering situations.
Behavioral compulsions may include:
- Writing prayers to check they’re done “correctly”
- Excessive confession
- Repeatedly seeking reassurance from religious leaders and loved ones
- Repeated cleansing and purifying rituals
- Acts of self-sacrifice
- Treating attendance of religious services as obligatory when they are not actually so
Mental compulsions may include:
Avoidance may include:
- Avoiding religious services where a moral error may occur or cause something bad to happen
- Not reading religious texts seen as triggering
How can scrupulosity be distinguished from typical religious practice?
Unlike typical religious practice, scrupulous behavior usually exceeds or disregards religious law and may focus excessively on one area of religious practice while other, more important areas may be completely ignored. OCD can masquerade as religion. To others, someone with OCD may appear to be very devoted to their religious practices potentially due to the nature of one's compulsions - for example, spending hours researching religious doctrine - however, this excessive behavior is typically in an effort to alleviate the anxiety caused by the obsessions. OCD is never helpful and can create barriers to practicing one's faith traditions.
The behavior and mental life of scrupulous individuals are typically inconsistent with that of the rest of the faith community. In addition, scrupulous behavior is motivated primarily by distress and leads to functional impairment. Functional impairment can look like avoiding worship, missing work, isolating from loved ones, and experiencing extreme discomfort in situations where others might feel peaceful or calm.
How common is scrupulosity?
This depends a lot on cultural factors. OCD tends to be opportunistic and latches onto areas of personal relevance. In Western, secular countries, up to as many as a third of people with OCD have some scrupulous symptoms and about 5% have primary scrupulosity. In some religious cultures and subcultures, religious symptoms are present for the majority of people with OCD (Eisen et al., 1999; Mataix-Cols et al., 2002; Foa and Kozak, 1995; Tolin et al. 2001; Greenberg and Huppert, 2010).
Is scrupulosity more common among people of a particular religion?
Scrupulosity is an equal-opportunity form of OCD, meaning it can affect individuals from a variety of different religious traditions. Although more research is needed to truly answer this question, there is currently no evidence to link scrupulosity to a specific religion. In fact, a significant minority of people with scrupulosity do not identify as having any religious or spiritual affiliation at all.
What causes scrupulosity?
The exact cause of scrupulosity is not known. Like other forms of OCD, scrupulosity may be the result of several factors including genetic and environmental influences. Since OCD latches onto domains of personal importance, people who are religious/spiritual and also have OCD are likely to experience OCD symptoms in their practice. Read more about what causes OCD.
Can scrupulosity be treated?
Scrupulosity responds to the same treatments as those used with other forms of OCD. Cognitive behavior therapy (CBT), featuring a procedure called exposure and response prevention” (ERP) is the primary psychological treatment for all subtypes of OCD, including scrupulosity. A certain kind of medicine called selective serotonin reuptake inhibitors (SSRIs) are the primary drug treatment for OCD. Treatment for scrupulosity may also include consultation with leaders of the patient’s faith tradition. The goal of treatment is to disentangle OCD from the religious and moral values of the sufferer so that they can live a life consistent with their beliefs and values, unadulterated by OCD. Learn more about how OCD is treated.
Are other members of a person’s faith community ever involved in therapy for scrupulosity?
Sometimes. It depends on the preferences and needs of the individual. There are a couple of ways in which religious leaders, family members, or friends from the individual’s faith community can be helpful. They may be asked to help clarify a religious institution’s stance on a particular issue relevant to the patient’s recovery process
Article originally written by C. Alec Pollard, PhD and revised in 2022 by Jedidiah Siev, PhD.