Scrupulosity OCD: An overview of symptoms and treatment

By: Suzanne Feinstein, PhD

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Scrupulosity OCD refers to a specific subtype of obsessive-compulsive disorder (OCD) where individuals experience persistent and intrusive thoughts and compulsive behaviors that revolve around religious, moral or ethical concerns. People with this type of OCD often struggle with distressing thoughts about committing blasphemy or violating religious or moral principles. The obsessions and compulsions are often driven by the fear of moral or religious consequences rather than a genuine reflection of their religious beliefs. 

These individuals remain hypervigilant to their behaviors for fear of being morally inferior. They may engage in compulsive rituals to try to alleviate the anxiety and guilt caused by their perceived moral transgressions. Fears about performing sacrilegious acts can be particularly distressing during religious activities and can result in difficulty concentrating during prayer or religious ceremonies. Individuals may engage in self-punishment behaviors to atone for their perceived sins. They might also compulsively pray, seek reassurance from religious figures, or perform rituals to “undo” their perceived moral wrongdoings.

Dichotomous thinking is heavily associated with scrupulosity OCD. Individuals often group themselves and others as good or bad, moral or immoral, right or wrong. They tend to be very rule-bound and any transgression is viewed very critically. 

Here are some examples of thoughts and behaviors associated with scrupulosity OCD:

 Fear of Harming Others:

  • Obsessive thoughts: Constantly worrying that one might unintentionally harm someone, either physically or emotionally.
  • Compulsive behaviors: Checking and rechecking behaviors to ensure no harm has been done, seeking reassurance from others, avoiding situations that trigger religious or moral anxiety

Concerns About Morality:

  • Obsessive thoughts: Intrusive thoughts about being a bad person or questioning one’s moral character.
  • Compulsive behaviors: Engaging in mental rituals such as repeating specific phrases or prayers to counteract perceived moral failings; confessing perceived sins to religious figures

Fear of Moral Contamination:

  • Avoiding or excessive cleaning around certain people, places, or objects believed to be associated with sin.
  • Extreme preoccupation with moral purity and fear of being tainted by immoral influences.

Fear of Offending Religious Beliefs:

  • Obsessive thoughts: Constantly worried about offending religious beliefs or violating moral codes.
  • Compulsive behaviors: Engaging in rituals related to religious practices, seeking constant reassurance from religious figures or others.

Excessive Guilt:

  • Obsessive thoughts: Feeling overwhelming guilt for past actions, regardless of their severity.
  • Compulsive behaviors: Apologizing repeatedly, confessing to others, seeking reassurance to alleviate guilt.

Concerns About Being Responsible for Bad Events:

  • Obsessive thoughts: Believing that one is responsible for negative events or outcomes, even when evidence suggests otherwise.
  • Compulsive behaviors: Engaging in mental rituals to counteract the perceived responsibility, seeking reassurance from others.

Fear of Betrayal:

  • Obsessive thoughts: Worrying about betraying others or being betrayed, even in situations where no betrayal is likely.
  • Compulsive behaviors: Avoiding situations that might involve potential betrayal, seeking constant reassurance in relationships.

Scrupulosity OCD can be challenging for individuals who experience it, as it can significantly impact their daily lives and well-being. If you or someone you know is struggling with OCD or scrupulosity, it is advisable to seek professional help from a mental health professional.

The following are some common treatment strategies:

Cognitive-Behavioral Therapy (CBT): CBT is the most widely used and evidence-based psychotherapy for OCD, including scrupulosity. Exposure and Response Prevention (ERP) is a specific type of CBT that is often effective. In ERP, individuals are gradually exposed to thoughts, images, or situations that trigger anxiety (exposure) while refraining from engaging in the compulsive behaviors that usually accompany the anxiety (response prevention).

Mindfulness-Based Cognitive Therapy (MBCT): Mindfulness techniques can be incorporated into treatment to help individuals observe their thoughts without becoming overwhelmed by them. Mindfulness can enhance awareness of intrusive thoughts and help reduce emotional reactions to them.

Medication: For some individuals, medication may be recommended. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed antidepressant medications that have been found to be effective in treating OCD. It’s important to consult with a psychiatrist to determine the most appropriate medication and dosage for your specific situation.

Support Groups: Joining a support group, either in person or online, can provide a sense of community and understanding. Sharing experiences with others who have similar struggles can be comforting and can reduce feelings of isolation.

Religious or Spiritual Counseling: Some individuals find it helpful to seek guidance from religious or spiritual leaders who are knowledgeable about mental health. It’s important to work with someone who understands scrupulosity within the context of OCD and can provide support without reinforcing compulsive behaviors.

Psychoeducation: Understanding the nature of OCD and scrupulosity is crucial. Learning about the disorder, its causes, and the available treatment options can empower individuals to manage their symptoms more effectively.

Lifestyle Factors: Maintaining a healthy lifestyle, including regular exercise, sufficient sleep, and a balanced diet, can contribute to overall well-being and may complement other treatment strategies.

Learn more about the treatment we offer for scrupulosity OCD.

Contact us today at Advanced Behavioral Health to schedule an initial consultation. Dr. Suzanne Feinstein is an Instructor in Medical Psychology at the Columbia University Department of Psychiatry/ NYSPI.

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