What Is Scrupulosity OCD

Reviewed by Aaron Horn, LMFT

Published 07/01/2022

Scrupulosity OCD is about being obsessive and compulsive about your ethics, morality, or in terms of your religious matters. Perhaps the most recognized type of OCD is obsessively washing hands or keeping up with cleanliness habits, but that doesn't necessarily have to be the most traumatic.

Imagine being obsessed with your own conceptualization of an ethical framework. Not only would you hold yourself up to it, channeling every decision through this metric, you are also going to hold others up to it. Can you imagine the damage that can have on your personal relationships because of resentment, disappointment, or chagrin associated with others’ conduct, and your disapproval because it does not meet with your standards?

Understanding What Scrupulosity OCD Is

Scrupulosity OCD is similar to other forms of OCD because repetitive, persistent, intrusive, and unwanted thoughts continue. Those thoughts can drive mental practices or regimens used by the patient to calm their symptoms or feel less distress when dealing with these thoughts.

We have all dealt with thoughts that don't go away. When these thoughts take on a life of their own to the point of affecting the quality of life, it may be time to get professional help. You have likely seen people going through scrupulosity OCD in movies. It looks very ethical, but the struggle can be real on the inside.

Internally, someone with scrupulosity OCD will be dealing with fear, anxiety, and uncertainty. Patients have related wanting to somehow reeuce stressful thoughts or cut away from the message being replayed over and over at any cost. Patients will go out of their way to engage with something they believe will make the thought pattern go away. This often results in patients disrupting their routine to accommodate their compulsions.

Someone with scrupulosity OCD may only make a decision once they have referenced the scripture. They do this often to the point that their action seems to be in line with the ordained word. Additionally, many patients with scrupulosity OCD may mindlessly refuse to cross a boundary even though they may be doing more harm than good. For example, a patient may refuse to touch or engage with their children's wallets just because they interpreted that particular action as touching or handling money that belongs to their children and not to themselves.

Moral Or Religious OCD

Scrupulosity OCD is also known as Moral or Religious OCD. This is because the fear in the heart of a patient living with scrupulosity OCD has to do with engaging in something that will cross their religious boundaries, belief systems, or morality in general. Given the special case this disease makes, you want to look for an expert specializing in treating Scrupulosity OCD when seeking treatment.

What Goes Through The Mind Of Someone Living With Scrupulosity OCD? 

Imagine a time when you have been sitting in a place of worship and trying to pray. Your senses engage with something out of place, shocking, or even mildly unexpected. Suddenly, you find yourself toying with a blasphemous thought, not doing what people may assume you are. The normal reaction would be to let the thought go and move on with why you praying in the first place.

People with scrupulosity disorder or scrupulosity OCD, on the other hand, will end up thoroughly engaged in the intrusive thought. The result is that they struggle to move on and then experience a sequence of actions and reactions related to that one thought. Guilt is a commonly experienced emotion in such patients. The guilt is born out because something that was not supposed to happen ended up happening at the most unfortunate time.

Often, scrupulosity OCD patients will also experience fear. This fear is about offending a deity or God. People with scrupulosity often invest hours and hours trying and normalizing the situation. This could include engaging in ablutions, praying sessions, confessions, studying religious literature, etc. It does not matter what activity is, but the idea is that the compulsions are being engaged in to feel less distress and to find some kind of peace.

In this way, religion becomes something that brings anxiety for them, rather than providing them with the refuge it commonly is for most people. This also makes it difficult for such individuals to enjoy religious functions, practices, or services.

Common Obsessions And Compulsions With Scrupulosity OCD

Understanding the common obsessions and compulsions found with scrupulosity OCD can help identify it and get proper treatment. Some of the ruminations commonly reported with scrupulosity OCD include:

  1. Being sinful
  2. Offending God
  3. Not praying properly
  4. Not thoroughly understanding, or worse, misinterpreting religious scripture
  5. Not praying at the right place of worship
  6. Not appearing religious enough
  7. Not being entirely accurate in terms of ablutions; so, a patient may be overly obsessed with the pronunciation of religious dictum, or they may be very particular about certain colors associated with their religion, the order in which a ceremony is properly carried out, etc.

Compulsions should be understood as activities that patients may engage in to feel better or find relief from their obsessive thought pattern. Common compulsions associated with scrupulosity OCD are:

  1. Spending a lot of time and energy in their relationship with God; for example, spending long hours praying.
  2. Anxiety and guilt infested confessions periodically.
  3. Finding solace in reassurances from some sort of a religious leader or official
  4. Going out of their way to avoid potentially immoral or unethical situations
  5. Finding comfort in believing in religious messages very strongly

When It’s Time To Get Help

You likely have at least one relative who is very much into religion, morality, ethics, etc. So, how do you know if you need to be concerned?

You're looking for fear and unpleasantness. Someone living with from scrupulosity does not enjoy their religion, morality, or faith because they will always be controlled by fear. Likewise, someone with ethical or moral scrupulosity is likely wary about how they are treating people. For example, they would have a heightened sense of awareness or anxiety about discriminating unconsciously or subconsciously, harboring secret motives, etc.

Symptoms

Getting help means first recognizing the symptoms associated with moral scrupulosity. In most cases, most symptoms involve worrying about one or more of the following:

  1. About not being entirely truthful, even if done unconsciously or unintentionally. Examples include lying by omission.
  2. Not acting entirely ethically, devoid of self-interest.
  3. Somehow doing wrong to people, including discriminating against them, not helping them wholeheartedly, or not deriving enough joy to help people wholeheartedly.
  4. Continuously evaluating how good of a person we really are.

The compulsions that often accompany moral scrupulosity directly respond to these symptoms or obsessions. Someone who has scrupulosity OCD will likely:

  1. Go out of their way to make themselves appear like a nice person, mostly to themselves, but sometimes in public as well.
  2. Engage in oversharing, including relating a personal point of view that should be held in privilege.
  3. Repeat information, so it is well established that they're not trying to lie or conceal information.
  4. Debating ethical issues for long periods in their minds.
  5. Have extreme difficulty making decisions.
  6. Coming up with good things to do to make up for what they think was bad.

Scrupulosity Help And Treatment Options

As with any psychological disorder, early intervention is best. The more someone indulges in compulsions, the harder it may be to get them help.

However, where there is a will, there is a way - always!

A popular method of treating scrupulosity is through cognitive behavioral therapy. Just as disorders tend to hang out together, an overwhelming majority of them are addressed using cognitive behavioral therapy. For scrupulosity OCD, exposure and response prevention therapy (ERP), a type of cognitive-behavioral therapy, tends to be effective. Essentially, what ERP does is allow the patient to come face to face with their obsessive thoughts without being allowed to engage in their compulsions. Another type of cognitive-behavioral therapy that is commonly used is referred to as acceptance and commitment therapy. This type of treatment focuses on acceptance and adopting mindfulness routines.

When it comes to treatment, it is important to keep the component of guilt in mind. Some patients may not want to engage in treatment because they may experience guilt. However, research has shown that treatment allows people living with religious scrupulosity to enjoy their religion more. In certain cases, it helps if the patient’s religious leader gets involved in advocating for therapy. Professionals may also talk about making religion more meaningful as a means of encouraging their clients to continue therapy.

Like many other conditions, the best outcome for scrupulosity OCD is early detection and treatment. We have put together a complimentary test that will help you assess your symptoms and understand your OCD better so that you can better communicate with your doctor or therapist to get the help you need.