Religious & Scrupulosity OCD: Symptoms, Causes & Treatment

What is scrupulosity?

As with other forms of OCD, scrupulosity involves both obsessions and compulsions. Obsessions are intrusive thoughts which the individual attaches great significance to and which cause great distress. Compulsions are rituals or repetitive actions carried out to try to ‘cope’ with the obsessions. Unfortunately compulsions feed into the OCD cycle and worsen anxiety in the longer term.

An individual struggling with scrupulosity will struggle with obsessions in the form of intrusive thoughts and fears focused around not being good or devout enough, about ‘sinning’, or about not meeting their idea of religious perfection. They will carry out compulsions to try to ‘cope’ with the anxiety caused by these obsessions, or to try to ‘prevent’ something bad happening as a result of their obsessions. The International OCD Foundation explains that, “Scrupulous individuals are overly concerned that something they thought or did might be a sin or other violation of religious or moral doctrine.”

This form of OCD may affect someone who already follows a specific religion, or someone who does not follow a specific faith but holds religious beliefs. It can also occur in those who are not religious, but have strict, set ideas of what is moral: in this case it would be known as moral scrupulosity. The OCD Center of Los Angeles explains that, “Scrupulosity is not partial to any one religion, but rather custom fits its message of doubt to the specific beliefs and practices of the sufferer.”

History of scrupulosity

Scrupulosity dates back to the 1600s in the Catholic Church when it was noticed that Monks were excessively praying. Their practices didn’t seem to ‘fit in’ with what was expected of them by the church. The mental health charity Made of Millions explains that, “They were actually trying to achieve an unrealistic state of holiness.”

In 1691 a sermon by Bishop John Moore of Norwich provided one of the first documented references to scrupulosity. He mentioned that men and women were becoming overwhelmed by what we now know are intrusive thoughts. He referred to intense feelings of guilt and shame experienced by these individuals, who felt that they were not good enough religiously. They began to come to confession multiple times a day to confess to the same sins repeatedly, hoping to ease these feelings of guilt. The Bishop described this as ‘religious melancholy’.

Causes of scrupulosity OCD

Like other forms of OCD, there is no one known cause of scrupulosity. Instead, there are a number of factors which are thought to play a part in causing scrupulosity. These causes include differences in the way the brain functions, along with chemical imbalances in the brain which are thought to contribute to OCD.

Other potential causes include genetics, trauma, other mental illnesses, the experiences you go through as you grow up, and personality type. For example, if you were brought up in a very religious setting, you may be more likely to develop scrupulosity. This article from Center for Treatment of Anxiety and Mood Disorders states that, “Experts estimate that anywhere between 5% and 33% of people with OCD may experience scrupulosity and the number likely rises to between 50% and 60% in OCD sufferers who come from within very strict religious cultures.”

Finally, there are a number of cognitive distortions or dysfunctional beliefs which are thought to contribute to scrupulosity. This simply means ways of thinking or beliefs which make you more inclined to develop scrupulosity, and which perpetuate the religious OCD cycle. These include:

• Perfectionism

  You may feel that your religious practice has to be perfect, and that anything which is imperfect is simply not acceptable. This may lead you to feeling you have to follow religious rules and practices exactly, with no mistakes, all of the time.

• Thought-action fusion

  You might also hear this referred to as ‘magical thinking’ or ‘over importance of thoughts’. This means you feel that your thoughts are equivalent to actually carrying out a behaviour. So if you thought about sinning, then you feel this makes you a bad person in the same way as you had actually carried out the sin. This can also lead you to believe that simply thinking about something bad happening, actually increases the chances of it happening.

• Overestimation of threat

  This means that you are more likely to see threats or to consider a negative outcome in any situation. Essentially this means that you are likely to think the worst and find your mind spiralling into all the possible negative results.

  For example, if you have an intrusive thought which goes against your religious beliefs, such as picturing sleeping with someone other than your husband, you may think that God is going to punish you. Your mind may then spiral to thinking that this punishment will lead to you losing your husband, then your children, then your home, and so on. You may feel that God is going to send you to hell and that there is no hope for you.

• Black and white thinking

  You might struggle to see ‘grey areas’: in your mind everything is either completely wrong or completely right. This may lead you to thinking that small mistakes make you a terrible person. For example, if you were a few seconds late to church one day, you may think that God will never forgive you and you are an awful person.

• Selective abstraction

  This causes you to take a detail out of context, focusing on this detail and ignoring any other evidence in context. For example, if a film has some aspects which go against your faith, you may feel you should not watch the film at all because this will mean you will go to hell. Someone without scrupulosity but who is religious may realise that there are aspects of the film which do not line up with their beliefs, but understand that it’s fiction and watching it does not take away from their religious beliefs.

How is scrupulosity different to other forms of OCD?

All forms of OCD involve both obsessions and compulsions. Sometimes ‘nicknames’ are given to subtypes of OCD, like religious OCD, to help both individuals and professionals identify specific symptoms and better direct treatment. These names can also help an individual to find their place within the OCD community, and get the support they need.

Scrupulosity is somewhat different from other forms of OCD because of the theme of the obsessions and compulsions involved. Another fundamental difference is that most forms of OCD involve themes and intrusive thoughts which do not reflect the individual’s own beliefs, thoughts, or values. In fact, often the OCD creates intrusive thoughts which are very far from the individual’s beliefs, and this is what causes the guilt and shame.

However with scrupulosity, the theme of the obsessions focuses around the individual’s actual religious or moral beliefs. This can make it very difficult to distinguish the OCD from their own personality and faith. Understandably, the fact that the theme of their OCD stems from their own real religious beliefs, can make them feel all the more vivid and distressing.

Non-religious moral scrupulosity

While we will be primarily focusing on the religious side of this type of OCD, it is possible to struggle with scrupulosity without the religious aspect. You will typically hear this referred to as moral scrupulosity. This involves obsessions and compulsions centering around personal moral and ethical standards.

OCD specialist Stephanie Woodrow explains that, “When someone has moral scrupulosity, they might be worried about not treating people equally, lying, or having bad motives for doing something.” Just like religious scrupulosity, this will cause significant distress and it’s likely that the individual will feel extremely guilty when they aren’t able to stick to their strict morals.

Scrupulosity obsessions

We’ll take a look at some of the more commonly experienced scrupulosity obsessions.

Sinning

It’s very common to have intrusive thoughts, images, or fears about sinning. This may involve worrying that your actions are sinful, or that you have been sinful in the past. This fear can feel overwhelming and infiltrate every moment of the day. These sins can be anything related to your religious beliefs, such as lying, acting out of greed, acting in anger, or being unfaithful to your spouse for example.

Going to hell/eternal damnation

It’s common to fear or have intrusive images that you are going to be sent to hell or be damned for eternity. This might be due to the fear of sinning we mentioned, because you don’t feel ‘good enough’ for God, or it may simply be a fear that plagues your mind with no particular ‘reason’. This is a very real and vivid fear which can cause extreme distress for the individual.

You might also find that you are fearful that your loved ones are going to hell. This might stem from worries that their actions do not fit in with the strict rules your scrupulosity has set, or because they have sinned. It’s also common to fear that it will be your fault that they will be sent to hell.

Not praying correctly

Many people with scrupulosity worry that they are not praying correctly, or enough. You might fear that you missed a certain word during prayer, or that you didn’t say something in the exact right way. You might feel that you are never able to pray enough, or feel that you are constantly striving for your prayers to ‘feel good enough’.

Fear of acting against religious beliefs, rules, or morals

Many scrupulosity obsessions focus on fears of acting in a way which doesn’t fit in perfectly with personal morals or religious beliefs. This may include fear of what will happen if these rules are not strictly maintained. The charity Beyond OCD explains that this can include fears, “that one has broken a religious law related to speech, dress, food preparation, modesty, etc.”

Losing touch with God

Often those with scrupulosity fear losing touch with God or losing their faith. For someone whose faith means so much to them, this can be a terrifying concept. They may fear what will happen if they do lose touch with their religion, fearing that something awful will happen as a result.

Offending God

Fears of offending God or doing something which would upset a religious figure can be all consuming. It’s common to be constantly on edge at the thought of doing something which could be interpreted as offensive.

Blasphemous

Blasphemy refers to saying or doing something which would cause disrespect to God or another religious figure, to a religious place, or a religious practice. Fears and images of blashemony are common within scrupulosity. This can include, “repeated blasphemous thoughts or images; fears of saying something blasphemous during prayer, meditation, or other religious observances (all of which “contaminate,” and therefore negate, the value of these activities)”.

Sexual

Sexual obsessions within scrupulosity can focus on any religious figure, such as God, Jesus, or a priest for example. These obsessions may come in the form of thoughts or images of carrying out sexual acts with these figures, which can cause deepset shame and guilt. As with other forms of OCD, sexual obsessions don’t align with the individual’s personal desires or values.

Other sexual obsessions may focus on thoughts and images of sexual acts which don’t fit in with the individual’s religious values or rules, such as sleeping with someone other than their partner. Sexual obsessions are often the most shame-filled for those with OCD.

Possession

Some people who struggle with scrupulosity may fear that they are, or are going to become, possessed by the devil or an evil spirit. They may have very vivid images of this possession, which can be disturbing to say the least. They might also fear what religious rules they will break if they are possessed, and what will happen as a result of this.

Scrupulosity compulsions

Just as with obsessions, scrupulosity compulsions can come in many forms. Some may seem to correspond with obsessions, and others may not. They will vary in severity and type for each individual. An individual can display more than one type of compulsion.

Excessive praying

One of the most common compulsions within scrupulosity is excessively praying. This might involve repeating specific prayers or re-doing prayers when they aren’t done perfectly. It may be repeating a prayer until it feels right or good enough. Praying can go on for hours and take up a lot of the day.

Excessive religious actions

Alongside praying, it’s common to carry out excessive religious actions. This might be repeatedly performing religious rituals or practices, again taking up many hours of the day. It may involve attending church or another religious building (depending on your religion), multiple times a day. It’s also common to repeatedly read religious texts.

Confessing

This might involve attending confession (if this is part of your religion) regularly and excessively to confess your sins. It can also involve confessing your sins. or anything you feel is less than perfect, to a religious figure. The OCD Center of Los Angeles explains that this can include, “repeated and ritualized confessing (to religious figures such as priests, church elders, and/or to friends and family).”

Asking for forgiveness

Many people with religious OCD will ask God or another religious figure for forgiveness for their perceived sins. They may repeatedly seek forgiveness and beg to be cleansed of their sins, and often of the obsessive thoughts which have been plaguing them.

Making ‘deals’ with God

Seeking forgiveness is often accompanied by making ‘deals’ with God. For example, an individual may ask for forgiveness and not to be sent to hell, and in exchange they will promise never to sin again. They may also beg to be released from their sinful intrusive thoughts.

Reassurance seeking

The individual may seek reassurance from their loved ones or from religious figures. They may ask for reassurance that they are carrying out religious acts and prayers properly. They seek reassurance that they are a good person, and that they are not going to hell for example. It may also entail asking religious figures, such as priests, the answer to religious questions over and over again, so the individual can ‘ensure’ they understand the answer completely and that they haven’t missed anything.

Counting and repeating

The individual might feel that specific numbers are lucky and others are unlucky. They may then carry out religious acts a ‘lucky’ number of times. This may involve praying a specific number of times every time. In another example, someone may make the sign of the cross a specific number of times after praying.

Avoidance

Avoidance is a very common compulsion in OCD. Someone with scrupulosity might avoid anything which will trigger their obsessions. For example, they might avoid a religious figure they’ve had a sexual obsession about, or avoid films with hell in them if they have fears of being sent to hell.

Washing and cleaning

An individual might compulsively wash and clean themselves, or their surroundings, to try to ‘cleanse’ themselves of evil or negative energies. This might involve taking repeated showers, repeatedly washing their hands, or excessively cleaning their home.

Excessive self-sacrifice

Some people may try to counteract negative thoughts and feelings of guilt, by carrying out acts of excessive self-sacrifice. For example, they might give away excessive amounts of money, gifts, and their possessions to others.

Mental reviewing

Mental reviewing involves mentally going over memories of past thoughts and actions, looking for evidence that you are not a bad person or that your obsessions are not true. Just as with other compulsions, this can take up many hours of the day and be debilitating, even though the compulsion is carried out mentally.

Rumination

Rumination involves mentally going over thoughts and situations repeatedly. This might entail wondering if past actions or thoughts had a meaning which suggests that you are a bad person. It may be thinking about your obsessions for many hours of the day and not being able to take your attention away from them.

Thought neutralization

Thought neutralization refers to trying to ‘cancel out’ a negative thought by replacing it with a more positive one. When an individual has a negative intrusive religious thought, they will actively try to think about something really positive religiously to replace it. Often people will try to ensure that they have the same number of positive thoughts as negative thoughts, as a way to ‘make up for’ their obsessions.

Scrupulosity vs ‘normal’ religious practice

Many people without OCD are very committed to their religion and many stick to strict religious rules and personal morals. They may engage in strict religious practices and always strive to be the best they can be. This is all completely ‘normal’ and doesn’t mean they have scrupulosity.

The difference in those with scrupulosity, is that they struggle with persistent, unwanted, and very distressing intrusive thoughts. These thoughts will drive excessive actions (compulsions) as we’ve discussed. So rather than simply trying to strive for improvement because of ‘normal’ religious beliefs, they are desperately trying to ease anxiety and emotional distress coming from obsessions.

Rather than feeling good and enriched as a result of their religious practices, those with scrupulosity will be in an almost constant state of stress, anxiety, and fear. This article on the topic explains aptly that, “Unlike non-sufferers, you don’t feel a sense of satisfaction by doing right by God. When it comes to ethical standards, non-sufferers feel a sense of success. Sufferers, on the other hand, don’t.”

Some compulsions in scrupulosity may be more obvious from an outside perspective, such as washing and cleaning, or constantly asking for reassurance. However, others (such as mental compulsions) may be more difficult to detect. You might notice in a loved one that they are acting out of character, or seeming generally emotionally distressed and upset. Typically an individual with scrupulosity will come to be aware that the feelings they are having are not part of ‘normal’ religious practice.

Treatment for scrupulosity

The treatment focuses on changing OCD symptoms, rather than trying to change your faith. Treatment for scrupulosity doesn’t mean that you need to withdraw from your religion. In fact, once OCD symptoms are under control, you will be able to engage in your religious practice in a way that enriches your life and allows you to follow your true beliefs. This article explains that: “studies have shown that after completing treatment, people with religious scrupulosity actually enjoy their faith more than prior to treatment”.

You may be able to access treatment through your doctor or mental health professional. In regards to medication, this can only be prescribed by a medical professional. For psychological therapies, you may be referred for in person therapy by your doctor or mental health services. Alternatively depending where you live, you may be able to self refer. This often involves being on a waiting list to see a therapist.

Other options when seeking treatment include seeking private treatment. While this is a more costly option, it allows you to have more control and access therapy when you need it. Another option is using an online OCD treatment programme: these provide therapy in your own time, in your own home, as well as being more cost effective than private therapy.

When deciding how and where to access treatment, it’s important to do some research to figure out what is going to work best for your individual needs, preferences, and budget. Let’s take a look at some of the treatments available for religious OCD.

Medication

Some people may be offered medication to help them control their symptoms. The medication prescribed is typically Selective Serotonin Reuptake Inhibitors (SSRIs), which are a form of antidepressants. These are thought to help correct the chemical imbalance within the brain which is thought to play a part in causing OCD.

SSRIs do have side effects, so it’s important to talk about your options fully with your doctor before making an informed decision. It’s common for medication to be prescribed alongside psychological therapy, to help the patient get the most out of their therapy.

Cognitive Behavioral Therapy (CBT)

CBT helps the patient to understand how the OCD cycle works. Once they are more self aware of how their thoughts and behaviors are actually perpetuating their OCD, they can learn to react in more productive ways. This article explains that CBT, “helps an individual identify and modify patterns of thought that cause anxiety, distress or negative behavior. In other words, CBT helps patients understand that the brain is sending “error” messages.”

Exposure and Response Prevention (ERP)

ERP is a form of CBT which is commonly the first line of treatment for all forms of OCD. ERP works to help the patient face their obsessions, without reacting with compulsions: this actively breaks the OCD cycle. This is done in a very gradual, manageable way, starting with the least feared obsessions. As the patient’s anxiety begins to ease, they gain confidence and realise that nothing bad happened when they didn’t react to their obsessions.

Acceptance and commitment therapy (ACT)

Rather than trying to change negative thought patterns as in CBT, ACT focuses on helping the patient accept their negative thoughts. They learn that thoughts are just thoughts, and don’t need to lead to actions. The patient learns to acknowledge negative thoughts and the feelings that come with them, and let them pass by, rather than reacting to them. This breaks the OCD cycle. Another vital part of ACT is helping the patient to commit to more positive behaviours which enable them to continue overcoming their OCD.

Mindfulness

Mindfulness practices are all about relaxation and stress release through being present in the moment. This might involve guided meditations, visualization, and mindful movement among other mindfulness techniques. Mindfulness can allow those with OCD to gain relief from their anxiety, to sleep more restfully, and to regulate their emotions more effectively.

Mindfulness on it’s own won’t break the OCD cycle in the long term, but can provide relief. However, mindfulness techniques are often used as part of other therapies, such as CBT, to produce optimum results for OCD patients. This is often known as mindfulness based cognitive behavioral therapy (MBCT).

Pastoral counselling

When dealing with scrupulosity, some patients prefer to be counselled by someone who is from the same religion and who understands their beliefs. This may be offered as part of their church, and allows them to express their feelings and find ways to enjoy their religion again. However, counselling alone won’t break the OCD cycle, so it’s a good idea for pastoral counselling to be done alongside other psychological therapies specifically for OCD.

What to do if you have symptoms of scrupulosity

Monitor your symptoms

It’s always a great idea to monitor your symptoms: this way you (and any medical professionals) can get a clearer idea of how your OCD is affecting you. By identifying patterns in your symptoms, you will be able to engage more effectively in therapy. It’s also a great way to see improvements from treatment as you progress. You could note your symptoms down on your laptop or phone, or in a diary.

Seek treatment

You might not want to seek treatment. It’s common to feel afraid, worried about judgement, and ashamed. However, it’s vital you do reach out for treatment, because this is how things can get better and you can get your life back. Whatever route you choose to access treatment, ensure you do seek help.

Seek support

Aside from professional treatment, you need support to get through this. If you can, opening up to loved ones and allowing them to be there for you can be really helpful. You could also choose to seek support online, through social media, or through a support group. There are even mental health helplines you could call so that you have someone to talk to. You may also be able to find support within your own religious community.

Practice self care

Even though you are unlikely to feel like it, it’s so important to practice self-care as much as you can. This includes trying to keep a regular sleep schedule, eating well, staying hydrated, exercising, and making time to relax. These things may feel trivial at the moment, but they really can make a difference.

Hold onto hope

You might feel as though things are always going to be this way, and be struggling to see the way forward. Try to hold onto hope and know that treatment truly can help you overcome your symptoms. There is a way forward.

This article from the mental health charity Made of Millions states: “By prioritizing treatment and positive lifestyle habits, sufferers often gain confidence and freedom. Even if some anxiety is still present by the end of therapy, you’ll no longer feel debilitated by the condition.”

How to help a loved one with scrupulosity

Be there to listen

One of the simplest but truly most effective ways you can be there for your loved one, is just to be there to listen. Sometimes knowing you have someone who is there for you and who you can talk to, can make the world of difference.

Offer practical support

Offering practical support can often be really helpful. This might entail offering to help them keep up with self care, such as doing their shopping, helping with housework, and making them meals. It could also be offering to take them to therapy appointments.

Get involved in therapy

Often those with OCD involve loved ones in their compulsions, such as asking for reassurance. This is not their fault, but it can be hard to recognise this in a loved one, and even harder to refuse your loved one help if they are distressed. By getting involved in therapy, you can learn how to help your loved one break the OCD cycle rather than feeding into it.

This might involve going to family therapy with your loved one; discussing with their therapist how to help them; talking to your loved one about what they’ve learnt; and getting involved with ‘homework’ exercises your loved one is given between sessions.

Take care of yourself

Finally, it’s absolutely vital that you take care of yourself. You can’t be there for someone else if you are not first there for yourself. You must take time to practice self care, and take care of your own physical and mental health.

References

International OCD Foundation, (2010), “Scrupulosity Fact Sheet”.

OCD Center of Los Angeles, (2013), “Scrupulosity: Where OCD Meets Religion, Faith, and Belief”.

Made of Millions, (2020), “Living with Religious OCD”.

The Center for Treatment of Anxiety & Mood Disorders, (2020), “What is Religious OCD?”

Sian Ferguson, (2019), “Scrupulosity: When Religious or Moral Beliefs Become OCD”. Healthline.

Beyond OCD, (2019), “Recognizing and Counseling People Who Have Scrupulosity”.