Scrupulosity is one of the various subsets of Obsessive Compulsive Disorder (OCD), that can be identified in individuals who experience repetitive, intrusive thoughts (otherwise known as obsessions) surrounding a discrepancy in their religious or moral beliefs. These disruptive thoughts often lead the individual to engage in a series of compulsive behaviours, brought about by their overwhelming urge to eradicate the level of distress that their obsessive thoughts are causing them.

What are the symptoms?

Notably, an individual experiencing Scrupulosity OCD may experience obsessive thoughts that are not followed by compulsive actions, which is why the symptoms can vary quite considerably for each individual case. However, the most common and detectable themes associated with scrupulosity OCD include:

Obsessive thoughts or mental images associated with:

  • Having committed a sin that violates their spiritual or religious laws
  • Fear of behaving immorally
  • Not behaving consistent with one’s desired moral character
  • Believing that something significantly bad will happen as a result of their mental thought patterns, images, or past behaviours –often associated with death, going to hell, or being judged a failure according to their beliefs
  • Lack of impulse control
  • Not performing ‘good’ enough religious behaviours (ie: praying, going to church) or failing to meet particular moral ‘rules’ for living (ie: being a good Samaritan, or living a life of ‘purity’)
  • Fearing that their thoughts (however unrealistic) will be actually acted upon or the irrational belief that may have acted upon their thought (ie: committed blasphemy) when they did not

Compulsive mental thoughts or behaviours associated with:

  • Excessive praying rituals
  • Repeating specific religious words, images, or phrases aloud (or mentally), in an attempt to counterbalance their distorted perception of their religious wrongdoings or ‘immoral’ thoughts and/or behaviours
  • Avoiding particular places, activities, or people due to the belief that being in these situations may lead them to think and behave in certain ways that would trigger their mental thoughts or lead them to engage in particular behaviours that undermine their religious beliefs.
  • Attending excessive church confessions associated with the same sin or moral judgement

What causes it?

Just like the various other forms of obsessive compulsive disorders, there has yet to be a definitive and underlying root cause for Scrupulosity OCD. However, there are a range of factors that may contribute to its onset – including one’s genetic predisposition, exposure to their environment, and the sum of their life experiences.

How does Scrupulosity OCD differ to religious faith?

Unlike other forms of OCD, the thoughts and behaviours associated with Scrupulosity can be disguised with the codes of behaviour that are true to one’s religion – which can be confusing for the individual trying to differentiate between their true religious beliefs and values and their maladaptive thought patterns. The important distinction between Scrupulosity and one’s faith however, revolves around the individual’s irrational fear that thinking particular thoughts (they consider to violate their religion or moral values) will lead to a series of negative occurrences (such as religious damnation, ethical failure, sin, negative judgement etc).

Individuals may also confuse their distorted thoughts with reality, believing that they may have actually acted upon their thought by accident and therefore committed a sin (even though they have not). Another distinct feature of Scrupulosity is that individuals only focus on adhering to a narrow selection of religious values or doctrines whilst dismissing others, whereby the various behaviours they engage in exceed what is considered an appropriate, realistic standard to the counterparts of their religious law and community.

Moral Scrupulosity in OCD

Unlike religious Scrupulosity, moral Scrupulosity presents itself quite differently, whereby an individual experiences intrusive and negatively biased thoughts surrounding their moral character – typically involving unrealistic evaluations of themselves as “bad” or immoral, based upon internalised judgements of their thoughts and actions. An individual’s moral obsessions are commonly followed by a series of compulsive or avoidant behaviours, in their attempt to reduce the distress they are feeling and prevent their distorted fears from coming true or being exposed to others.

How is it treated?

The first step in treating Scrupulosity is identifying the need to seek help. For some individuals, this first step can be particularly challenging, as questioning ones faith, can in some religions be perceived as questioning or abandoning their religious beliefs entirely – which is why seeking psychotherapeutic treatment is often left unconsidered.

Similarly, for individuals experiencing moral Scrupulosity, challenging their irrational moral obsessions can be quite difficult and ambiguous, as what’s considered morally “right” and “wrong” varies across individuals and depends upon the sum of their personal life experiences and how they have been brought up. However, individuals experiencing both forms of Scrupulosity OCD can be assured that they are not alone and psychological help and support is both attainable and effective.

There are various methods to treat Scrupulosity OCD, although the most successful form of treatment has been achieved through Cognitive Behavioural Therapy (CBT). The core principles of CBT involve identifying the individuals irrational thought patterns to achieve more realistic, evidence based cognitions through gradual exposure therapy – with the guidance and ongoing support from a psychologist. A major component of CBT involves teaching the individual various mindfulness techniques and relaxation strategies that can be applied to manage their distressing thoughts more effectively.