OCD with Scrupulosity: When morality becomes obsession
Obsessive Compulsive Disorder (OCD) is often perceived as hyper-organizational behaviours such as closing doors repeatedly or washing hands until the skin is raw. In reality there are various subsets of the OCD condition, one of which is often called scrupulosity in which the primary anxiety has nothing to do with germs or cleanliness rather it is the fear of being guilty of religious or moral failure. In this case the sufferer fears that their efforts, which are often intense and excessive, are still not good enough in the eyes of God or their own moral compass. While a typical sufferer of OCD might become obsessed with germs getting them sick, this particular form of the condition strikes the individual at their core. Their fear is that they are morally or spiritually inadequate and they risk eternal consequence because of it.
This condition can be particularly insidious for the following reasons. First, treatment for OCD in the form of Cognitive and Behavioral Therapies is highly effective but this involves challenging distorting thought patterns and progressively exposing the sufferer to that which they most fear so as to extinguish the anxious response thus reducing the frequency of the compulsion. With a morally scrupulous individual, whether religious or not, mere suggestion of challenging their black or white thinking may bring feelings of guilt, shame, or apostasy eg. "The bible says if you lust upon a woman you have committed adultery and if I consider any alternative belief on the matter than not only have I committed adultery but now I have shown a lack of faith or obedience to the scripture I hold so dearly."
Another reason why this condition can be tricky to cope with is because in some closed cultures, religious or not, questioning practices or doctrines is highly frowned upon and even met with punishment. This is likely to reinforce the shame that comes from having questions about faith.
OCD with scrupulosity, while different in manifestation, follows the same cyclical pattern of typical obsessive-compulsive disorder.
The obsessive thought (ie. I have offended God) leads to a deep, existential anxiety (ie. I am doomed to eternal hell), which is likely to be followed by a compulsive or avoidant behaviour (repetitive confessing of the same act or withdrawing from church completely). This gives the sufferer relief from the anxiety but the relief does not last long. They begin obsessing that they did not divulge enough details in the last confession for example or that by missing church last week they have now exponentially disappointed God, further entrenching them in their own personal hell.
It is important to note, that although those who suffer from this condition tend to be people who hold strict standards of religious perfection, non-religious or atheist people are not immune to OCD with scrupulosity. The obsession over moral perfection might be related to their diet (ie. a vegan who obsesses about eating meat once last year), their exercise (ie. feeling that one is immoral and defective because of missing a day at the gym), or any general moral sense. The role of the priest who receives the confession might be replaced by a family member, friend, or hair dresser. Regardless of setting, the idea is that this person obsesses about the most minute detail of their morality and feels a need to get it off their chest with whomever represents some kind of moral authority figure to them.
Moral Obsessions
The following are common obsessions as listed by Kevin Foss MFT
Typical Compulsions found in moral scrupulosity
In order to gain the perception of control as well as relief from anxiety the person then engages in compulsive, repetitive behaviours. These behaviours usually involve some kind of internal, spiritual cleansing ritual.
This condition can be particularly insidious for the following reasons. First, treatment for OCD in the form of Cognitive and Behavioral Therapies is highly effective but this involves challenging distorting thought patterns and progressively exposing the sufferer to that which they most fear so as to extinguish the anxious response thus reducing the frequency of the compulsion. With a morally scrupulous individual, whether religious or not, mere suggestion of challenging their black or white thinking may bring feelings of guilt, shame, or apostasy eg. "The bible says if you lust upon a woman you have committed adultery and if I consider any alternative belief on the matter than not only have I committed adultery but now I have shown a lack of faith or obedience to the scripture I hold so dearly."
Another reason why this condition can be tricky to cope with is because in some closed cultures, religious or not, questioning practices or doctrines is highly frowned upon and even met with punishment. This is likely to reinforce the shame that comes from having questions about faith.
OCD with scrupulosity, while different in manifestation, follows the same cyclical pattern of typical obsessive-compulsive disorder.
The obsessive thought (ie. I have offended God) leads to a deep, existential anxiety (ie. I am doomed to eternal hell), which is likely to be followed by a compulsive or avoidant behaviour (repetitive confessing of the same act or withdrawing from church completely). This gives the sufferer relief from the anxiety but the relief does not last long. They begin obsessing that they did not divulge enough details in the last confession for example or that by missing church last week they have now exponentially disappointed God, further entrenching them in their own personal hell.
It is important to note, that although those who suffer from this condition tend to be people who hold strict standards of religious perfection, non-religious or atheist people are not immune to OCD with scrupulosity. The obsession over moral perfection might be related to their diet (ie. a vegan who obsesses about eating meat once last year), their exercise (ie. feeling that one is immoral and defective because of missing a day at the gym), or any general moral sense. The role of the priest who receives the confession might be replaced by a family member, friend, or hair dresser. Regardless of setting, the idea is that this person obsesses about the most minute detail of their morality and feels a need to get it off their chest with whomever represents some kind of moral authority figure to them.
Moral Obsessions
The following are common obsessions as listed by Kevin Foss MFT
- Repetitive thoughts about having committed a sin
- Exaggerated concern with the possibility of having committed blasphemy
- Excessive fear of having offended God
- Inordinate focus on religious, moral, and/or ethical perfection
- Excessive fear of failing to show proper devotion to God
- Repeated fears of going to hell / eternal damnation
- Concern that one’s behaviors will doom a loved one to hell
- Unwanted sexual thoughts about God, Jesus, or a religious figure such as a priest
- Unwanted mental images such as Satan, 666, hell, sex with Christ, etc.
- Excessive fear of having acted counter to one’s personal morals, values, or ethics
Typical Compulsions found in moral scrupulosity
In order to gain the perception of control as well as relief from anxiety the person then engages in compulsive, repetitive behaviours. These behaviours usually involve some kind of internal, spiritual cleansing ritual.
Common compulsions may include the following but keep in mind that in isolation not all of these behaviours are indicative of OCD rather it is the excess and compulsiveness that indicate the potential need for a diagnosis: (adapted from Kevin Foss MFT)
- Repeated and ritualized confessing (to religious figures such as priests, church elders, and/or to friends and family)
- Reassurance seeking about behaviors and thoughts related to religion, morals, ethics, or values (ie. Am I bad because..., Should I have ...., etc.)
- Excessive, ritualized praying and/or reading of the bible or other religious texts
- Repeating specific verses from the bible or other religious texts (either out loud or silently)
- Mentally reviewing past acts and/or thoughts in an effort to prove to one’s self that one has not committed a sin or acted in a manner thy construe to be immoral or unethical or counter to one’s faith
- Ritualized “undoing” behaviors to counteract perceived sins and transgressions
- Excessive acts of self-sacrifice (i.e., giving away relatively large amounts of money or earthly possessions)
- Avoidance of situations in which one fears the onset of obsessions related to issues of faith (i.e., church, temple, mosque, prayers, movies with devil themes, dating)
- Avoidance of certain objects that one associates with immorality or sin (i.e., certain clothes, certain numbers)
- Making deals with God to avoid eternal damnation (or merely to reduce current anxiety and discomfort)
The Cost of OCD with Scrupulosity
In a general sense, like any subset of OCD, quality of life may be drastically effected. The individual is likely to suffer from deficits and disturbances in their social life, their self-worth, work, and family. It can disable people socially in that they may be unwilling or feel unworthy or incapable of making deep, long lasting relationships. They will take few social risks which limits their ability to meet new people. They might miss work or have diminished productivity. They may place great burdens on their family and loved ones or transversely, they may isolate themselves from them.
People of faith may especially struggle emotionally due to their OCD because of the seemingly endless cycle of unmet standards and shame for not having enough faith for their problem to get better. Some people will actually be driven away from their faith, even though their religious beliefs give them the deepest sense of meaning and joy in their life. In a spiritual suicide of sorts, they abandon their faith in order to relieve their anxieties, only to be continually haunted by the shame of having given up on God.
Moral scrupulosity is an excessive mutation of the otherwise healthy practice of striving for moral congruence. A moral person will say, "I know how I want to live and my conscience corrects me with feelings of guilt so that I will move closer to my ideal behaviour." A morally scrupulous person leaves no room for error and becomes obsessed with moral perfection. They don't accept any gray area when it comes to ethics and will get markedly disturbed by any deviation from their moral perspective. They will never get it right and therefore will never be right and sufficient so they search for any type of reassurance or absolution to rid them of their imperfection.
A More Excellent Way
Through mindfulness cognitive behavioural therapy and exposure and response prevention there is hope that the individual can develop a healthier relationship with his or her faith and/or morals.
Practicing mindfulness allows us to have thoughts without judging them and being pulled into the OCD cycle. We can recognize that just because a thought entered our mind it doesn't mean it will come true or manifest as an action.
Mindfulness creates cognitive space in which we can then examine and challenge the thoughts we have. Rather that judging thoughts as good or evil we can instead evaluate our thoughts on the basis of whether they are healthy, true, or helpful. The religious can look for scriptural support to challenge their black and white thinking (ie. focusing on forgiveness through God's grace rather than the sin itself). The non-religious can look to other moral authorities like philosophers, psychologists, or researchers to help them challenge their distorted thinking. These authorities can help scaffold the individual towards being more morally independent as they sort out which of their beliefs are helpful and which lead to obsession.
With greater confidence and moral independence the person can then experience their anxiety provoking thoughts/situations and learn to sit with the discomfort of feeling like one is being sacrilegious or immoral. They eventually learn to be comfortable with a certain level of ambiguity (ie. I believe killing is wrong but I guess if it's in self-defense there could be some gray area).
The goal here is for the religious person to be able to live their religion and faith freely and to truly feel the benefits of their faith and community. Treatment is not about persuading people to leave their faith, rather to embrace the positive, hope building, strength that can come from their faith. Recovery from scrupulosity involves more genuine and autonomous religious observance. People are empowered by their faith rather than enslaved by it.
Similarly the goal for the non-religious but morally scrupulous is for the person to feel stronger and more authentic in their morality. They have more realistic and healthy standards for themselves and others. They can make mistakes and be motivated to improve while not being thrust into the cycle of compulsions and temporary relief.
That all may live more authentically and more congruent with their values while allowing themselves to be human and imperfect, is my prayer.
In a general sense, like any subset of OCD, quality of life may be drastically effected. The individual is likely to suffer from deficits and disturbances in their social life, their self-worth, work, and family. It can disable people socially in that they may be unwilling or feel unworthy or incapable of making deep, long lasting relationships. They will take few social risks which limits their ability to meet new people. They might miss work or have diminished productivity. They may place great burdens on their family and loved ones or transversely, they may isolate themselves from them.
People of faith may especially struggle emotionally due to their OCD because of the seemingly endless cycle of unmet standards and shame for not having enough faith for their problem to get better. Some people will actually be driven away from their faith, even though their religious beliefs give them the deepest sense of meaning and joy in their life. In a spiritual suicide of sorts, they abandon their faith in order to relieve their anxieties, only to be continually haunted by the shame of having given up on God.
Moral scrupulosity is an excessive mutation of the otherwise healthy practice of striving for moral congruence. A moral person will say, "I know how I want to live and my conscience corrects me with feelings of guilt so that I will move closer to my ideal behaviour." A morally scrupulous person leaves no room for error and becomes obsessed with moral perfection. They don't accept any gray area when it comes to ethics and will get markedly disturbed by any deviation from their moral perspective. They will never get it right and therefore will never be right and sufficient so they search for any type of reassurance or absolution to rid them of their imperfection.
A More Excellent Way
Through mindfulness cognitive behavioural therapy and exposure and response prevention there is hope that the individual can develop a healthier relationship with his or her faith and/or morals.
Practicing mindfulness allows us to have thoughts without judging them and being pulled into the OCD cycle. We can recognize that just because a thought entered our mind it doesn't mean it will come true or manifest as an action.
Mindfulness creates cognitive space in which we can then examine and challenge the thoughts we have. Rather that judging thoughts as good or evil we can instead evaluate our thoughts on the basis of whether they are healthy, true, or helpful. The religious can look for scriptural support to challenge their black and white thinking (ie. focusing on forgiveness through God's grace rather than the sin itself). The non-religious can look to other moral authorities like philosophers, psychologists, or researchers to help them challenge their distorted thinking. These authorities can help scaffold the individual towards being more morally independent as they sort out which of their beliefs are helpful and which lead to obsession.
With greater confidence and moral independence the person can then experience their anxiety provoking thoughts/situations and learn to sit with the discomfort of feeling like one is being sacrilegious or immoral. They eventually learn to be comfortable with a certain level of ambiguity (ie. I believe killing is wrong but I guess if it's in self-defense there could be some gray area).
The goal here is for the religious person to be able to live their religion and faith freely and to truly feel the benefits of their faith and community. Treatment is not about persuading people to leave their faith, rather to embrace the positive, hope building, strength that can come from their faith. Recovery from scrupulosity involves more genuine and autonomous religious observance. People are empowered by their faith rather than enslaved by it.
Similarly the goal for the non-religious but morally scrupulous is for the person to feel stronger and more authentic in their morality. They have more realistic and healthy standards for themselves and others. They can make mistakes and be motivated to improve while not being thrust into the cycle of compulsions and temporary relief.
That all may live more authentically and more congruent with their values while allowing themselves to be human and imperfect, is my prayer.
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