Scrupulosity OCD: Symptoms, Examples, & Treatment Options

What Is Scrupulosity OCD?

Scrupulosity OCD (sometimes called religious OCD or moral OCD) is a form of obsessive compulsive disorder in which the person finds themselves experiencing obsessions related to morality or religion.² They may be overly concerned with whether they commit blasphemy or sin, act according to their morals, and maintain their purity, as well as whether they are going to hell and when they will die.¹

Generally, if a person is suffering from scrupulosity OCD, they will suffer from a lack of impulse control.¹ These impulses may include both behavioral compulsions (like excessive trips to confessional) and mental compulsions (like excessive praying) that relate to their religion and morals.²

“Scrupulosity can present as excessive interest in one’s religious or spiritual life, as in the case of Religious Scrupulosity, or a never ending effort to be the best possible person or do all the right things. However, these perceptions are motivated by fear, anxiety, and uncertainty about their religious standing, moral quality, or intrinsic character. Scrupulous individuals may exhibit outward compulsions of repetitive prayer, ritualistic washing or routines, checking with others that they did the right thing or did not do the wrong thing, or repeating activities until done “right.” The Scrupulous can also have covert, or internal, compulsions of evaluating the quality and quantity of their feelings, intention, or physical sensations, or mentally reviewing previous events or interactions to ensure their ‘purity’ or ‘rightness.’” – Kevin Foss, MFT, Founder of CalOCD

Normal Religious Practice vs. Religious OCD

Scrupulosity OCD causes someone to obsess over a particular area of religion or morality rather than on faith or morals as a whole. Oftentimes, the best way to tell whether someone is simply practicing their religion or suffering from religious OCD is to note how much the practices affect their everyday life. People with religious OCD will likely hone in on a very specific part of the religion.¹

Common scrupulosity obsessions include:^1,3

• Angering God
• Committing a sin
• Committing blasphemy
• Maintaining your purity
• Not practicing a religion perfectly (like misunderstanding religious teachings, attending the wrong place of worship, or practicing your religion incorrectly)

These worries may result in the practice of obsessive rituals, including:^1,3

• Excessive praying and/or trips to confessions
• A need for reassurance from religious leaders
• Repeated rituals to cleanse and purify yourself
• Obsessively avoiding situations in which sinful or immoral acts may happen
• Self-sacrifice
• Repeating passages from scriptures in your head
• Making pacts with God

How Common Is Scrupulosity?

It is estimated that about 2% of the population will experience OCD symptoms, and within that group a third (or 0.6% of the population) of those symptoms are related to scrupulosity.¹ It is important to recognize that the culture we’re in can perpetuate such occurrences, and these numbers may be underreported.

Is Scrupulosity More Common Among People From a Specific Religion?

There is no evidence to suggest that one religion is more prone to influencing people into developing scrupulosity OCD. It is important that people who find support from their religions find supportive care when dealing with scrupulosity.¹

Religious OCD Symptoms

While many religious people worry or think about certain things related to their faith or belief system, they eventually get over it. People with scrupulous OCD symptoms take these worries to a point of obsession that begins to take over other aspects of their life. Along with obsessions, scrupulosity OCD involves compulsions in response to their obsessions; these could be excessive praying or asking for forgiveness, or avoiding their triggers.

Scrupulosity OCD Obsessions

Common obsessions associated with scrupulosity OCD include:³

• Angering God: Excessively worrying that they will say the wrong thing, think the wrong thing, or do the wrong thing and end up angering God. This can show up as worries of committing sin or blasphemy, maintaining purity, or whether or not you’re going to hell.
• Going to Hell: Living in constant fear of going to hell for committing any sin or immoral act.
• Not practicing a religion perfectly: Whether it is prayer or religious activities, excessive worry over the perfection of religious practice is common.
• Committing sins or acting immorally: Scrupulous OCD may lead to being afraid of committing a sin or immoral act, causing crippling fear and anxiety.

Scrupulosity OCD Compulsions

Common compulsions of scrupulosity OCD include:³

• Excessive praying: Praying for hours a day while it is normal for religious people to pray a few times a day.
• Frequent confessions: Making frequent confessions due to fear of angering God, doing something wrong, or committing a sin.
• Avoiding situations that may lead to immoral or sinful acts: Avoiding any and all situations that could conceivably lead to committing a sin or an immoral act. Some  may refuse to leave the house out of fear of committing sinful acts.
• Seeking reassurance from religious leaders: Continuously seeking reassurance from leaders of the religion to avoid imperfect religious practice.
• Repeated cleansing or purifying rituals: Due to fear of not being pure enough, people may participate in excessive cleansing or purifying rituals.¹
• Mentally repeating passages from scriptures: An excessive repeating of scriptures could be a compulsion in scrupulosity OCD.¹

Moral Scrupulosity OCD

Not all scrupulosity obsessions and compulsions have to be religious in nature; instead, some people’s scrupulosity OCD obsessions will involve being moral and living “above reproach.”

Common moral obsessions include:

• Thinking that you are not doing well enough in life
• Worrying that you are accidentally hurting or causing harm to your family or community
• Feeling that you are a sinner and continuously sinning
• Thinking that you aren’t doing enough to help others

Potential moral compulsions could include:

• Asking for forgiveness from people in your life
• Excessively reading books about morality
• Engaging in charity work and doing helpful deeds

Scrupulosity Examples

Someone experiencing scrupulosity OCD could be challenging to identify just by presentation.

Someone with scrupulosity OCD may show their symptoms through repetitive behaviors like:

• Always talking to you about religion, sin, and morality
• Consistently complaining about their faults or failings
• Reading and rereading their religious texts
• Engaging in specific rituals that are outside of the norm, like praying for hours before each meal

What Causes Scrupulosity?

There is no specific cause of this type of OCD, however, causes for developing OCD can include:

• Environmental factors
• Genetic factors
• Values of family of origin
• Family trauma history
• Personal trauma history

Scrupulosity Treatment

Seeking professional mental help will help to find the best way to work through, cope with, and treat OCD. Sometimes medication management and lifestyle changes are also recommended.

Therapy

Exposure and Response Prevention (ERP) is the gold standard treatment for OCD. It involves the patient exposing themselves to obsessive thoughts while preventing themselves from engaging in their compulsive behaviors or rituals.³

Examples of Exposures for Scrupulosity

During ERP, potential exposures that the therapist could have someone face might include:

• Reducing their time praying
• Limiting their time reading religious texts
• Avoiding conversations about morality
• Stopping compulsive behaviors from occurring
• Limiting visits to church to once or twice a week

Will an ERP Therapist Make Me Do Bad Things?

No, an ERP therapist will not make you do bad things. Instead, the therapist will show you how to allow more time and energy in your life for good things, like engaging in healthy relationships and increasing your life satisfaction.

Medication

In some cases of moral or religious scrupulosity, a psychiatrist may prescribe medication for OCD. The medications that have been found to work in these kinds of cases are selective serotonin reuptake inhibitors (SSRIS).⁴

Lifestyle Changes

Recognize negative thought patterns that may be fueling your OCD.¹

Negative thought patterns to watch out for include:¹

• Thinking in extremes like, “I must not commit a single sin or I am going to hell.”
• Extreme sense of responsibility: you may find yourself worrying about upsetting God or the people around you by behaving incorrectly.
• A belief that your thoughts are able to be controlled.

Foss states, “Accept that you cannot be perfect, no matter what you do. The best we can be, both religious and morally, is good enough. And, good enough is OK. Attempt to recognize which thoughts are consistent with you and your genuine values, and which ones are obsessive, impossible, and well beyond reasonable. Once you do this, spend as little time as possible considering them, evaluating their merit, or wondering what role they have in your life. Any amount of time thinking about them will only reinforce their presence in your life and lead you further away from your desired goals and values. Just because you have the thought doesn’t mean you have to do it. Accept that those thoughts will show up sometimes, but that you are in control about what you do.

You don’t have to do bad or sinful things to get better, but you have to put yourself at the risk of doing bad or sinful things. In other words, the compulsive “safety” behaviors are an attempt to ensure that you are OK and that you will never do the wrong, immoral, or sinful thing. This is ultimately fruitless. Resisting the compulsion is not the same as doing a bad or sinful act, and resisting the compulsion put you in the same place as everyone else; at risk of doing something bad or sinful. Which again, is not the same as actively doing something bad and sinful.”

How to Get Help for Scrupulosity OCD

Find a therapist who specializes in OCD, or reach out to a trusted religious leader to seek advice. A therapist will guide treatment discussions after determining what may be causing the symptoms. Referrals can be obtained by calling your insurance provider or speaking with your primary care provider.

How to Find a Therapist

To find a therapist, consider asking your primary care provider for a referral or using an online therapist directory. You could also go through your insurance provider. If you have one, call them or access their website to find a therapist who can help.

Examples of Scrupulosity & Religious OCD

Scrupulosity OCD does not show up in the same way for everybody. The symptoms of OCD will show up depending on a number of factors, including personality, religion, morals, and whether or not OCD shows up as a moral or religious subtype.

Terrified of Sinning, Praying Constantly & Isolating

Wendy finds herself praying excessively throughout the day, crossing herself multiple times to ensure she has done it perfectly. She has stopped hanging out with friends out of fear that she will be tempted to sin. She is single because she fears that going on dates will lead to sinful thoughts or actions. She has begun to feel alone because her friends no longer reach out, knowing she will turn them down.

When Wendy finally decides to seek help, her treatment involves cognitive behavioral therapy (CBT). Her therapist talks to her about what she was afraid of, why she felt that she needed to cross herself perfectly, and why she feared going out with her friends. Slowly, Wendy finds herself able to resist her impulse to pray and worry. She slowly starts reaching out to friends again and getting out of the house. Wendy has a date this Friday. While she is not completely cured yet, she is on the right path to healing.

Compulsive Hand Washing

Ned believes it is morally wrong to touch things that other people may touch with dirty hands. Because of this belief, Ned washes his hands to the point that they are extremely cracked and dry. Ned’s productivity at work is impacted by his compulsions and he is on the brink of losing his job. He finally decides to seek help from his therapist, who assigns him exposure and response prevention (ERP) therapy. Ned’s therapist exposes Ned to his fear of touching things with unwashed hands slowly and teaches Ned methods to avoid his compulsion. Ned finds, over time, that his compulsion to wash his hands before touching things is beginning to fade.

Terrified of Breaking Rules, Stops Leaving the House

Sam finds herself terrified of committing any act that may involve breaking the rules or getting into trouble. She becomes so terrified of getting into trouble that she stops leaving her house altogether out of fear. Her friends and family are becoming concerned and suggest that she seek help. Her therapist suggests CBT. As Sam talks through her reasoning behind her OCD, her therapist presents methods to manage it. She begins to see positive results the more she practices her methods.

Final Thoughts on Scrupulosity

Scrupulosity OCD is difficult to experience. What you’re dealing with may be unique to you, but you’re not alone. Talking to a therapist, religious leader, or a trusted friend or family member can make a big difference in how you feel. They can help you find new methods for understanding your negative thought patterns, establishing methods to help you carry on with resilience.