What is Scrupulosity?

Scrupulosity is best understood when viewed as a subset of OCD. There are some differences in its manifestations, but many of the patterns and characteristics are the same. Let’s first take a step back: what is OCD?

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is characterized by obsessions and compulsions. OCD is a mental disorder where obsessions and/or compulsions are frequent, repetitive, time-consuming, and often hinder daily life. Anyone may have obsessive and/or compulsive behaviors from time to time; however, they do not distress them and are not evidence of OCD. The person with OCD is troubled by and often ashamed of their thoughts and behaviors.

The International OCD Foundation defines obsessions as “unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.” Often obsessions take the form of persistent, recurring doubts. Compulsions are “behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress” (International OCD Foundation). Often these behaviors appear more like mental rituals or avoidance of obsession-triggering situations. OCD specialists have categorized certain types of OCD: checking, contamination, hoarding, intrusive thoughts, and rumination (Northpoint Recovery). OCD may revolve around areas of one’s life such as relationships, sexual attraction, and religion/faith. For example, some strugglers may find their OCD manifests itself in near-constant rumination and doubt; others may have intrusive, unwanted thoughts such as “what if I’m a pedophile?” (not stemming from a genuine desire or temptation but causing much anxiety). They may feel the urge to check the stove they know they’ve already turned off: “Did I really turn the stove off? What if it’s on and it causes my house to burn down? Maybe I should just check…” This is different than double-checking, like any person may do; this is checking so many times due to your nagging doubt (even though you know you turned it off) “just to make sure.”

Other types of OCD may revolve around tic-like behavior, where one repeatedly looks, touches, taps, or engages in some other bodily behavior until “it feels right.” With this kind of OCD, there is often no obsessive thought directly driving the behavior, but rather an urge or sensation that something needs to “feel just right.” However, it is no less distressing and life-impeding.

The above are merely some common themes; most people with OCD, however, struggle with a combination of different types of OCD, and no two strugglers are identical.

Scrupulosity

So what, then, is religious OCD (aka scrupulosity)?

It’s a type of OCD that is characterized by obsessive thoughts, doubts, and worries revolving around one’s spiritual life, accompanied by compulsive means of relieving the stress and anxiety caused by such obsessions. Common themes include fear of sinning or being morally wrong or bad, fear of God’s rejection, fear of blasphemy, or fear that one is not saved but eternally damned. Obsessive thoughts, then, may revolve around these fears:

• “Am I really saved?”
• “Have I committed the unforgivable sin?”
• “Maybe I didn’t pray that prayer right—I should do it again.”
• “Have I adequately confessed my sins?”
• “Was that action a sin?”

Many of these questions in and of themselves are not obsessions; however, they become such when OCD latches on and causes one to obsess over them. Likewise, most people may have thoughts like these from time to time, but they are easily resolved or immediately ignored. The person with OCD cannot do so with such ease.

The obsessions may not even seem to be connected to faith, but still revolve around moral issues: “My failure to pick up that piece of litter on the highway as I was driving by is a sin that proves I am self-centered.” Such an intrusive thought may result in either the compulsion to go back and pick up the trash or a nagging sense of guilt that persists even when you’ve moved past it.

Here is another example of how the scrupulosity cycle may look:

I have the intrusive thought, “Maybe I sinned against that person when I (fill in the blank)” (obsession). This causes much anxiety (response). Some of the ways I may deal with it is by obsessive inward-searching for evidence that I meant the person no harm, over-confessing that sin to the Lord/repeatedly asking him to forgive me, asking others for reassurance that I hadn’t sinned, or repeatedly approaching the person to make sure I hadn’t sinned or to confess. These various compulsions are enacted for the sake of calming the obsession and relieving the anxiety it causes.

Other characteristics of scrupulosity include an ongoing, intense concern for moral purity; an overly-tender conscience; and “fearing sin where there is none” (Abramowitz and Jacoby). It is no wonder scrupulosity is termed “the doubting disease,” because of all the doubts and uncertainty surrounding the sufferer. It is not neutral questioning, where the sufferer is open to all options and simply wishes to get down to the truth; it is persistent, unwanted, distressing, dogged, negative doubt.

There are no clear-cut causes of OCD or scrupulosity in particular, but it may be a combination of brain-based, genetic, and environmental factors.

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To learn more about scrupulosity, check out the Resources page, where I have links to various articles and websites that explain the struggle more in-depth.

To read about my story with scrupulosity, check out the blog.

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