Scrupulosity OCD: What it is and how to treat it
Everything you need to know about scrupulosity OCD, including examples, causes, and how to overcome it
Scrupulosity OCD symptoms are among the most common
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Introduction
Someone who is having religious or moral obsessions may at first make subtle changes to their behavior that go unnoticed. Their behaviors may even seem like a good thing—maybe a child is extra polite to her parents, or maybe a young teenager becomes more involved with his church youth group.
However, over time, scrupulosity OCD symptoms become increasingly impairing, with the individual performing religious or moral actions based on fear rather than on genuine beliefs and values.
Scrupulosity OCD is a type of OCD that relates to religion and morality. People who experience scrupulosity have a “fear of being guilty of religious, moral, or ethical failure” (ocdla.com). While scrupulosity doesn’t just come up for people who are religious—more on this later—scrupulosity can be especially frightening for individuals who identify as religious, or whose families are religious.
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What is scrupulosity?
Scrupulosity OCD is marked by obsessions and compulsions related to religion, morality, and ethics. Individuals with scrupulosity may feel that what they do, say, or think makes them a bad person, and they may feel that God will punish them because God finds this so offensive. They could experience anxiety or worry that they’ll end up in Hell, that God will strike down their loved ones, or that they’ll end up in jail when the world finds out how bad a person they really are.
To try to counteract these very difficult thoughts, people with scrupulosity OCD engage in compulsions that they feel will “undo” their awful thoughts or immoral actions. If they have a negative thought about another kid in their class, they may say a prayer in their minds (e.g., “God, forgive me for my sin”), or they may say something complimentary to their peer instead.
Over time, the obsessions become more difficult to bear, and the compulsions become more intense and time-consuming. What started off as a child’s worry that he offended God by gossiping may turn into a fear that his gossiping will lead God to kill his mother. While at first a quick, silent prayer could bring comfort to a teen who had a negative thought about her friend’s outfit, she must now recite prayers for over an hour to reverse the “sinful thought.”
Even parents, who at first enjoyed their child’s interest in attending their synagogue with the family, start to recognize that this “religious” practice looks very different or more intense than their family’s practice, perhaps even to the point of seeming fanatical. Parents may learn that, no matter how many times they reassure their child that they’re a good person, it just doesn’t seem to sink in.
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Scrupulosity OCD examples
(Note: As with all clinical examples, I use fictional names and compile information from multiple clients to protect client confidentiality.)
To better understand what this looks like, let’s dive into some examples based on kids and teens I’ve treated in my own practice.
Hannah is a 14-year-old female who is afraid of offending God. She identifies as Catholic, and her family attends church weekly. Every day, she spends hours praying out loud and in her mind. She has not been attending church lately because she worries that she’s so immoral that her being there would offend God. If Hannah thinks a negative thought in her mind (e.g., “I don’t like that girl’s shoes”), she has to repent with specific prayers in her mind and be excessively nice to that person instead. Hannah feels like if she isn’t overwhelmingly positive and kind at all times and if she doesn’t pray in just the right way, God is going to punish her by killing her parents in a car accident.
When I first met Hannah, she was incredibly anxious and stressed, and you can see why! It’s hard enough to say just the right thing all the time—to have the fear that even thinking something that offends another person could mean her parents get killed? That’s a lot of pressure to be under. You could see how distressing and debilitating this was for Hannah.
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What causes scrupulosity OCD?
Kids, teens, and particularly their parents often want to know what causes scrupulosity OCD. Did a parent put too much pressure on their child to be a “good” kid? Does religion cause OCD?
We don’t know exactly what causes OCD or why a child or teen develops, say, scrupulosity OCD as opposed to harm OCD.
Research tells us that differences in the brain, genes, and life stressors may all play a role in developing OCD (iocdf.org). However, we can be confident that parenting styles or religion, in their own right, do not cause OCD. Many children grow up in houses with high expectations and don’t develop scrupulosity OCD. Many youth raised in different faiths don’t go on to develop scrupulosity, and atheists develop scrupulosity OCD, too.
While understanding a child’s background is important for treatment (more on this later), the good news is that we actually don’t need to know the cause to treat scrupulosity OCD effectively.
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Scrupulosity OCD treatment
(Note: The therapeutic techniques described in this section are for educational purposes only and do not constitute advice or therapeutic recommendations. Don’t try these techniques on your own, but please contact me or another qualified provider if you’re interested in learning about how OCD treatment could help you or your child.)
While technically you may never “get rid of” religious OCD, we have the tools we need to tackle scrupulosity OCD treatment effectively—namely, Exposure and Response Prevention (ERP) and other complementary treatments (e.g., Cognitive Behavioral Therapy [CBT], mindfulness).
There is a lot to learn about ERP, but here’s a quick summary. ERP is a treatment that can be used for all people with OCD to essentially teach the brain, through behavioral experiments, that something that we thought was too scary to handle or that we thought would lead to a horrible outcome is ultimately okay. This treatment involves facing your fears, little by little, so that the fears that first seemed insurmountable don’t seem as frightening any more.
The two parts of the treatment are: 1) exposure—meaning that you do something anxiety-provoking on purpose to face your fear; and 2) response prevention—meaning that you don’t do the thing you’d normally do to make yourself feel better temporarily.
Here are a few exposures that I did with Hannah:
Critique a celebrity’s outfit in a magazine
Make negative comments to me (e.g., “I don’t like your haircut”)
Read an informational article about prayer practices in another religion
Go to church
Pray to God, but not the “right” way (e.g., have a more casual, authentic conversation with God, rather than the scripted OCD prayer ritual)
Each time, we worked together to make sure that she didn’t do the compulsion she normally did to make herself feel better in the moment—in her case, saying prayers in her mind or out loud, making nice comments to other people, or apologizing. It wasn’t easy, but over time, she learned that even when she did something that she thought was “really bad” or when she had immoral or scrupulous thoughts but didn’t do her compulsion, the things she thought would happen didn’t happen (e.g., God killing her parents), and she learned that these were just OCD thoughts after all.
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Frequently asked questions
Does scrupulosity OCD treatment involve getting rid of people’s religion?
Absolutely not! When I work through scrupulosity OCD treatment with a child or teen, I do not attempt to influence their religious beliefs and practices. Rather, I want to clear up their scrupulosity symptoms so that they’re able to have an authentic faith and spiritual life rather than just having religious OCD or spiritual OCD masquerading as religion.
In treating scrupulosity OCD, I always take the time at the start of treatment to familiarize myself with someone’s faith background. This can involve speaking with the client’s family or collaborating with their faith leader. What does faith look like in this community? What about spiritual or religious practices?
Sharing with your therapist about what faith typically looks like in your community is a great way to help them figure out what’s an OCD thought or ritual versus a belief or practice that’s consistent with your religion or spiritual practice that aligns with your values.
Is religious OCD a sin? What about the offensive acts that are part of scrupulosity OCD treatment?
I won’t claim to be a faith leader, or to have the authority to discern what is “sinful” or not for my clients. However, in my experience collaborating with my clients’ faith leaders, I’ve seen that leaders from many different religions recognize that what my clients are struggling with looks very different from an authentic faith life. In fact, I’ve been encouraged to see faith leaders themselves refer clients to mental health treatment for scrupulosity OCD and support them as they participate in ERP.
One thing that’s always really hard for kids and their parents is the concept of exposures going above and beyond what most people—even those without OCD—would find anxiety-provoking. Do we want to teach kids that it’s okay to litter? Would we typically encourage a teen to say mean things to his friends, or to be disrespectful in her place of worship? No!
This relates to a critical part of ERP called “overcorrection.” The pendulum has swung too far in one direction, and overcorrecting in the exposure process allows individuals to ultimately settle into a nice middle ground. In this case, Hannah feared that she must be excessively moral and good at all times, and overcorrecting with these immoral or offensive actions allowed her to return to a middle ground in which, while striving to be moral and ethical, she also exercised self-compassion and gave herself room to be imperfect.
Conclusion
Scrupulosity OCD can be very frightening for kids, teens, and their families, and we don’t know exactly what causes it. Fortunately, we do know how to treat scrupulosity symptoms effectively, and many scrupulosity OCD stories end happily as these individuals find relief to develop or return to their own religious and spiritual practices rather than be burdened with religious OCD. If you or your child are struggling with scrupulosity OCD, let’s explore how scrupulosity OCD treatment could bring you the relief you’ve been looking for.