Scrupulosity - Really a Matter of Faith?
According to the International OCD Foundation (IOCDF), 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.”
Some of the earliest suspected cases of obsessive-compulsive disorder (OCD) were of individuals who experienced symptoms of what we now know as scrupulosity. These accounts date back to before the 1600s. Back then, people often sought help from their clergy for their symptoms. Some of these early accounts were contributed by Ignatius of Loyola, John Bunyan, Robert Burton, Jeremy Taylor, John Moore, and John Locke. Religious melancholy was the term utilized to describe some of these earliest reported symptoms of OCD and scrupulosity.
OCD is often misunderstood, and scrupulosity is no different than other subtypes in its misinterpretation by non-specialists. Scrupulosity symptoms usually fall into one of two different subtypes.
The first is religious-based scrupulosity symptoms. Religious- or faith-based scrupulosity symptoms can be experienced by people of a religion or faith. Some of the more common obsessions we see in practice include worries about offending God, fear of committing a sin, fear of dishonest thoughts, fear of going to hell, fear of being possessed, fear of disobeying God’s rules/laws, concerns about breaking rules, fear that a higher power is upset, and fear of sexual thoughts as immoral. These obsessions can be brought on by numerous triggers.
Some people misinterpret scrupulosity as something that is experienced by only one religion or faith, usually Christianity. While more research is needed, the data shows that scrupulosity symptoms have been experienced by individuals in a number of faith traditions, including Judaism, Islam, Christianity and Buddhism, to name a few.
Secondly, there are morality-based scrupulosity symptoms. Additionally, many people with scrupulosity report not following any faith tradition or religion. In these cases, the fear is of transgressing one’s moral code rather than failing to adhere to one’s faith. Strict rules about morality, being a good person, and doing the right thing often plague individuals experiencing moral scrupulosity.
Obsessions of this flavor can sound like “Am I a good person?” “Was doing that the right thing?” and “What if that wasn’t ethical or fair?” One way to think about scrupulosity is that it’s perfectionism and anxiety related to whatever determines your morals, be that religious or otherwise.
As you can imagine, these thoughts are distressing and can lead to anguish and attack the core identity of an individual. One of the main strategies that OCD utilizes is to attack/latch on to things that are important to people. In the case of scrupulosity, this can be especially difficult to untangle due to the amount of doubt, shame, guilt, remorse, and disgust that accompany these obsessions.
While the list of compulsions that individuals who experience scrupulosity might experience is virtually endless, it is imperative to note that individuals experiencing scrupulosity often engage in both physical and mental compulsions. Some of the more common compulsions seen in the clinical setting that include repeated prayer, making promises/or agreements with God, repeating holy/sacred images in one’s head, replacing or neutralizing “bad” thoughts with “good” ones, confessing, reassurance seeking, and avoiding people, places or things that could bring on obsessions.
It is estimated that up to a third of all individuals with OCD have some form of scrupulosity symptoms. People often have questions about how to distinguish between practicing their faith and engaging with scrupulosity. A common way to assess this is to ask them if individuals in their faith community would engage in the same behaviors (compulsions) or if they have ever voiced the same thoughts (obsessions). Oftentimes, OCD places strict rules on individuals, and determining if these rules differ from those of others in the same faith tradition can be helpful in determining if it is OCD or not.
There is hope, and people with OCD can experience relief from these symptoms and live the lives they want and deserve. Evidence-based frontline treatment practice for obsessive-compulsive disorder is cognitive behavioral therapy (CBT) and exposure and response prevention (ERP). Acceptance and commitment therapy (ACT) is another commonly used treatment modality. Finding a trained clinician who can walk alongside you during your journey can make the difference between living a life based on what-ifs and one firmly rooted in your values.