Scrupulosity: An Overview of Religious or Moral OCD

Scrupulosity is a particular set of obsessive compulsive disorder (OCD) symptoms where obsessions and compulsions are focused on religious or moral beliefs. People who experience this with OCD become hyper-focused on something they think they did wrong or may do wrong in the future. They avoid situations they think will harm their religious devotion or purity. It’s been estimated that between 5%-33% of people with OCD experience scrupulosity, and about 0.05-0.33% of people in the general population exhibit signs of it.

Let’s take a look at what scrupulosity is, what causes it, signs and symptoms, how it’s treated, and how to cope if you or a loved one is experiencing it.

What Triggers Scrupulosity?

Researchers aren’t sure what triggers scrupulosity. Scrupulosity isn’t linked to any one religion in particular; it’s seen across various world religions. However, it’s more typically associated with people who are involved in religious or spiritual practices than people who are not. It’s most common in people who both have OCD and are involved in a religious or spiritual practice.

Since scrupulosity can occur within OCD, it’s caused by many of the same factors that trigger OCD. It’s thought that OCD is caused by a combination of genetic and environmental factors. OCD tends to run strongly in families, with genetic links thought to be seen in 45-65% of children with OCD, and in 27-45% of adults with the condition.

What Are the Signs of Scrupulosity?

Scrupulosity will present differently in different people, but the main symptoms have to do with an unusual and abnormal focus, compulsion, or obsession with religious and moral values. Some of the ways that scrupulosity may manifest include:

• An obsessive belief that you will do wrong by your religion and endure the consequences (e.g., the belief you that you will commit sins even if you try not to, or that your doomed to suffer in hell)
• Behaviors that are beyond what is expected of your in your religion (e.g., engaging in many more hours of prayer than most; going to religious services much more frequently than others)
• Compulsively avoiding situations that you perceive will make it more likely that you will sin or be tempted to sin
• Worrying obsessively that some small transgression means that you have done wrong by your religion or spiritual practice
• Intrusive thoughts about religious wrong doing, or other obsessive thoughts about your religion or religious practices
• Constant feelings of self-doubt, low self-esteem, self-hatred in relation to your religious or spiritual faithfulness
  

Is Scrupulosity an Anxiety Disorder?

Scrupulosity is a set of obsessive compulsive disorder (OCD) symptoms rather than a specific diagnosable subtype. The subtypes of obsessive compulsive disorders include hoarding disorder, body dysmorphic disorder, and skin picking/hair pulling disorders. OCD is its own disorder, separate from anxiety disorders. However, OCD and scrupulosity often cause anxiety in people. Moreover, people with scrupulosity often engage in obsessive behaviors and compulsions as a way to quell feelings of anxiety.

What Is the Best Treatment For Scrupulosity?

Like OCD, treating scrupulosity involves a multi-faceted approach. Usually, OCD is treated with a combination of therapy and medication. Here’s what to know about scrupulosity treatments.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is considered the first line of defense for treating OCD and scrupulosity. CBT involves becoming more aware of your thoughts and beliefs and understanding how they affect your emotions and behaviors.

People with scrupulosity usually benefit most from CBT with an exposure and response prevention (ERP) component. The exposure aspect of ERP focuses on having the patient confront the thoughts and feelings surrounding the obsessive thoughts. The response aspect asks patients to make conscious choices to stop engaging in compulsive behavior, even when triggered.

Acceptance and Commitment Therapy

Acceptance and commitment therapy focuses on learning to accept intrusive or negative thoughts rather than trying to push them away. The idea is that accepting these thoughts will decrease their hold on you.

One small study found that acceptance and commitment therapy was an effective way to manage OCD and scrupulosity specifically. After treatment, participants were 74% less likely to experience compulsions, and 79% less likely to engage in avoidant behavior. Effectiveness increased even more at three months, with an 80% reduction in compulsions and an 87% reduction in avoidant behavior.

Medication for Scrupulosity

OCD, including scrupulosity, can be effectively treated with medication. The main types of medications used to treat OCD are selective serotonin reuptake inhibitors (SSRIs). SSRIs used to treat OCD include fluoxetine (Prozac), escitalopram (Lexapro), fluvoxamine (Luvox), and paroxetine (Paxil).

Will Scrupulosity Go Away?

With treatment, scrupulosity and OCD in general can be managed. But OCD is a lifelong condition. People often find that their symptoms will ebb and flow, and can flare up when stressful or unusual life circumstances arise. If you have OCD, it’s important to stay in close touch with a mental health provider so that you can engage in further treatment or adjust your medication when needed.

Coping With Scrupulosity/OCD

Getting an OCD diagnosis can be a tough pill to swallow. But the truth is that learning what has been at the root of some of the turmoil you’ve lived with can be freeing, and knowing what is happening is the first step toward healing.

If you are coping with scrupulosity, there are many things you can do to get through your days, and become stronger and more resilient. Here are some ideas:

• Research has shown that adopting mindfulness and medication practices can help treat OCD symptoms, and one study found that two-thirds of people doing an 8 weeks of Mindfulness-Based Cognitive Therapy saw improvement in symptoms.
• Making healthy lifestyle choices can help mitigate OCD symptoms; this might include getting enough sleep, eating whole foods, and engaging in healthy moving daily.
• Techniques that are used to help soothe anxiety, such as yoga, relaxation techniques, deep breathing and massage can help reduce OCD symptoms.
• Sharing your journey with others who have scrupulosity can help you feel less alone; people who live with this condition may also be able to share techniques that they find particularly helpful.

If you or a loved one are experiencing OCD and scrupulosity, you are not meant to handle this on your own. Please reach out to a mental health professional or your primary care physician to get your started on the road to recovery.