Scrupulosity OCD: Signs, Causes, and Treatment 

Overview 

Scrupulosity OCD is a common subtype of obsessive-compulsive disorder in which a person feels intrusive thoughts, images, and urges that they have violated some moral or ethical beliefs. Which in turn makes the person feel anxiety, guilt and engaged in compulsive behavior such as excessive prayer and avoiding that place, person, or thing. 

The roman catholic church used the term scrupulosity to narrate the obsessive concern with sin and then compulsive behavior for atonement. Scrupulosity was first identified in a religious context, with obsessions and compulsions related to fear of involving in immoral behavior, not particularly related to a specific belief system. 

However, some further categorize scrupulosity to secular/moral scrupulosity and religious scrupulosity to divide the thoughts and behaviors observed with this OCD subtype.

Also read: breathing techniques for anxiety 

Maybe you don’t get how someone can feel this way, so these two examples below can help you in understanding what exactly is scrupulosity. 

Moral/secular scrupulosity Example

Jennie has made a joke, while having lunch with her friends, and nobody laughs at it, and now she is worried if she has made any offensive joke.

So all of a sudden, she will get intrusive thoughts such as:-

  • I think I must have said something bad, that’s why nobody laughs. 
  • What if they talk to me again
  • Was my joke offensive
  • Oh no I must have not told this, maybe I hurt someone 

So, now Jennie is anxious, guilty, and sad over what she had said. She used to revisit her memory over and over to find if she said something offensive. And by the time she became reluctant to join with their friends on further lunches. 

Eventually, she chooses to avoid having lunch with them and starts making excuses for not being able to join them. 

Religious scrupulosity Example  

John is in a religious service. So, a religious dialogue is read aloud in the place and John finds it funny. And immediately realized that he is in the place of worship and feels guilty over that. He starts to think:-

  • I should not laugh at scripture
  • I will be punished I don’t atone for this
  • Am I an evil person, I laugh at religious places
  • God will send me to hell for sure

John gets overwhelmed by the incident and suddenly starts confessing to the religious leaders that he has made a blasphemous act and starts praying several times per day. Also, to avoid such an act, he starts escaping from reading religious texts and attending worship places. 

Also read: how to cope up with relationship anxiety 

Well, now you might get a clear answer to this. So, it basically happens in overanalyzing the situations and moral ethics. 

Symptoms 

Scrupulosity is the same as another OCD subtype when the person finds it difficult to tolerate uncertainty in the context of religion or moral ethics. 

Just like in the above scrupulosity examples, Jennie and john feel that they did something offensive. John feels he should not laugh at the religious dialogue and he attempts to be blasphemous. 

The need to not do something manifests as an obsession that is connected to a person’s moral and religious beliefs. These obsessions can result in thoughts, urges, and doubts such as:-

  • I must have committed a sinful act
  • What if I told a lie?
  • What if I hurt someone?
  • Intrusive mental images of opposing someone’s belief system such as tearing apart holy texts. 

When these obsessions arise as a thought connected to a person’s belief system, the resulting compulsive behavior generally goes far beyond the rules of that system. 

For instance, the compulsion include:-

  • Repetitive reassurance that you have not committed any sinful or immoral act
  • Excessive prayer to atonement
  • Revisiting memories of the incident and trying to recognize whether any immoral or unethical behavior has occurred or not.
  • Avoiding such places, people, and objects which trigger obsessive thinking, like worship services, religious symbols, and reading holy texts, etc. 

The question is why do some people think like that? What differentiates such people from normal people? 

Is it the difference of thoughts and past experiences or something beyond this? Let’s discuss each. 

Causes 

OCD has no particular reason to occur, and is generally a combination of genetic and environmental factors, and is considered a neuropsychiatric disorder. Or else can be the result of a medical condition such as severe brain injury. In children, it might be caused by a streptococcal infection. Hence, no exact cause you will observe.

But we do know that OCD causes people to think intrusive thoughts about the beliefs they hold. For example, people with deep religious and moral beliefs can develop intense, illogical doubts about their beliefs and replay them again and again in their minds to get to know if they disrespected those beliefs. 

However, the types of intrusive thoughts people experience in scrupulosity may vary from person to person, but the anxiety and urge to perform compulsive behavior tie them all together. Woefully, these symptoms or compulsions are like a cycle that leads to worsening the symptoms of OCD. 

As it’s a subtype of OCD and needs to be overcome as soon as possible. The treatment will be just similar to normal OCD. 

Treatment Options For Scrupulosity 

The first-line treatment will be a behavioral therapy such as exposure reaction therapy used in general OCD disorder. So, what is ERP? ERP basically is an exposure therapy that helps in resisting the urges of compulsion and exposes the person to their weird beliefs or obsessions. It’s a therapy of preventing the person’s reaction over their obsessions and accepting them. After successful sessions, the person can go back to their normal state of mind and life. 

 So, in scrupulosity OCD, ERP therapy includes the exposure to a trigger that is connected to a patient’s urge for compulsion. For example, John, who had this disbelief of attempting a blaspheme and was confessing to the priest about his act over holy dialogue. In this case, the ERP will include the recognition of such incidents when he used inappropriate behavior or dialogue about holy scripture. The therapist then would help in accepting the obsession by confession and help him in avoiding compulsive urges to scrutinize reassurance through confession. Over time, he would be able to learn to accept his obsessions and would stop relying on compulsions to overcome his anxiety for the short term. 

Often, the people with scrupulosity OCD are concerned about being asked to go against their moral values and actual sin. So, it’s contradictory to the goals of ERP, which is to help people engage in important activities. The ultimate goal of the trained ERP therapist is to make you live with your values and not as dictated by OCD triggers. 

Although, the process of ERP is a bit unpleasant and requires patience and dedication from both sides. And on the good side, the treatment takes about 10 weeks- which is an average duration compared to how long someone has lived with scrupulosity symptoms. 

ERP is more effective with an experienced licensed therapist, who has prior experience in treating few people with scrupulosity OCD. in some cases ERP is done along with certain medications prescribed by a psychiatrist. 

NOCD therapists are trained therapists who will work with you to calm down your OCD symptoms and will reduce your compulsion within a few weeks. So, talk to a therapist today and treat your obsessive anxiety with subsequent sessions. 

Conclusion 

Scrupulosity is a subcategory of obsessive-compulsive disorder in which the person has irrational religious beliefs and they are highly restricted to violate those. Such as laughing at a worship place or making a joke which nobody laughs at and then you will be guilty if you have made it offensive. The person will feel intrusive thoughts and urges to compulsive behavior like praying several times and doing any weird thing for atonement. However, it has a treatment ERP therapy which will help in reducing compulsion within a few weeks. 

Frequently Asked Questions 

Is scrupulosity a mental illness?

Scrupulosity is a psychological disorder characterized by obsessive thoughts about religious beliefs and concern and guilt over violating them. The person will feel extremely anxious if they somehow violate their obsession and result in compulsive behavior such as praying several times and revisiting the situation, again and again, to scrutinize if they attempted any sinful act. They would feel like they will be punished over the act and which is why they do things for atonement. 

Is scrupulosity a sin?

Well, it’s not a sin but a psychological condition, that the person does unwillingly due to some urges and intrusive thoughts. However, factually in the 19th century, Christian spiritual advisors in the U.S and Britain were concerned that scrupulosity is not only a sinful act but also led to sin, by opposing and attacking the morality of faith, charity, and hope. 

How do I get rid of scrupulosity?

Scrupulosity OCD is just similar to that of general OCD in which the person feels excessive obsession which then occurs in compulsive behaviors like doing certain things in a certain pattern or washing hands repeatedly or doing things in a particular way. Similarly, scrupulosity happens in a religious context. And the treatment for both is the same. Either cognitive behavioral therapy or exposure-response therapy. Sometimes these both are used combined. Medicines are also prescribed in certain cases. 

What causes moral scrupulosity OCD?

There is no particular cause of scrupulosity and is a neurological psychiatric condition driven by compulsions. Well, this can be caused due to the combination of genetic and environmental factors. Maybe you are taught about certain things during your childhood which triggers you now when you don’t do it that way. So, there is not a single thing which we can pinpoint, but several possible reasons. 

How do you know if you have scrupulosity?

It’s like overthinking or revisiting a certain situation based on religious context. Like if you have laughed at religious dialogue or make a certain joke, you will immediately feel guilty for doing so. You will feel it as a sinful act for which you will be sent to hell or you need to atone for the specific act or else you will be punished. So summing up you will feel extremely anxious and concerned about what you did even if nobody told you that you were wrong. 

How do you deal with moral scrupulosity?

You can talk to an ERP therapist. The therapist should be certified and should have a license. So, this is called exposure response prevention, which is driven by exposure of your obsession to you and preventing the subsequent compulsions. ERP therapy is somehow unpleasant and stressful at the start. But with a few sessions, you will feel less obsessed and won’t rely upon compulsion anymore. 

Similarly, CBT can also be practiced in such conditions but according to studies, ERP is more effective than this. Medications can also be prescribed by a psychiatrist. 

How can religious scrupulosity be overcome?

To overcome scrupulosity one can do the following things:-

ERP therapy:- its exposure response prevention, involves exposure to the religious obsessions of the person by resisting the prevention.

Cognitive-behavioral therapy:- it’s a behavioral therapy involving talk and empathetic behavior with the person with symptoms and making them understand right thinking and patterns about living. 

Pastoral therapy:- it’s another branch of counseling by priests, ministers and imams, and others. 

Family therapy:- involves family support and care without judgment. It usually works when the person isn’t much affected by the compulsions. 

Is scrupulosity in the DSM 5?

Yes, after its recognition as an anxiety disorder, it was moved to DSM-5 to its own category of OCD-related disorders. 

How common is scrupulosity OCD?

People with scrupulosity OCD strongly believe that they will be punished from divine energy for making inappropriate jokes or dialogue over holy text or place or if it violates any moral ethics. Experts say that anywhere between 5% to 33% of people with OCD deal with scrupulosity and the ratio increases between 50% and 60% in OCD patients who come from a very strict religious culture. 

Can scrupulosity be cured?

It is curable with the right support and treatment. So, the recommended treatment options include cognitive behavioral therapy and exposure-response prevention therapy. Both the therapies involve the confrontation of extreme obsessions and the resultant compulsions. This is why the person needs a certified ERP therapist to help them in getting rid of the unnecessary thoughts and behavior. 

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