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Scrupulosity (Religious) OCD

Please note:  The information on this page should not be construed as medical advice, nor should it be used to diagnose or treat any condition. The content on this page is written by recovered OCD sufferers, not by clinicians. Read More

A comprehensive guide to Scrupulosity OCD

Scrupulosity OCD is a form of OCD that involves religious, moral and/or spiritual obsessions.

According to the Clinical Handbook of Obsessive-Compulsive Disorder by Storch and Lewin, about 5-6% of OCD sufferers have religious symptoms as their primary set of symptoms; however, among those who have OCD, up to 33% have religious symptoms in general. This number is even higher in Middle Eastern countries, with 40 to 60% of people with OCD reporting religious obsessions.

The aim of this article is to provide the reader with practical and helpful information regarding Scrupulosity OCD – from its symptoms, to what its causes are, to how it is treated and so on.

How many people have Scrupulosity OCD?

The current data suggests that roughly 2 to 3% of the general population suffers from some form of OCD.

As 10-33% of OCD sufferers have religious symptoms in the Western world, and 40-60% in the Middle East, it can therefore be assumed that Scrupulosity OCD affects at least 0.2-0.99% of people in the West and 0.8%-1.8% of people in the Middle East.

However, these estimates don’t account for OCD that’s related to secular morals or a general kind of spirituality, as opposed to religious/scripture-related morals and spiritual beliefs.

What causes Scrupulosity OCD?

The causes to do specifically with religious, moral or spiritual types of OCD are not yet well understood; however, there are some general explanations for obsessive-compulsive behaviors that apply to Scrupulosity OCD, such as inflammation within the brain’s neurocircuitry, a lack of functional connectivity in specific brain regions, and so on.

In even broader terms, OCD seems to develop as a result of a combination of environmental and genetic factors, with the former being a slightly more important aspect than the latter.

Examples of Scrupulosity OCD

  • Obsessions about moral purity and being afraid of committing sin(s)
  • Obsessions about (potentially) committing an act of blasphemy
  • Excessive and systematic prayer
  • Obsessions concerning an afterlife (e.g. hell and heaven)
  • Ritual behaviors of self-purification or cleansing
  • Repeated assurance-seeking from a religious leader (e.g. online or in person)

How can Scrupulosity OCD be treated?

The best current treatment options for Scrupulosity OCD are outlined in the cognitive-behavioral model of scrupulosity proposed in 2014 by Professor Jonathan Abramowitz and Dr. Ryan Jacoby.

As for many other types of OCD, the first-line treatment for Scrupulosity OCD is cognitive behavioral therapy (CBT), which includes different cognitive therapy techniques, psychoeducation (a systematic explanation of the disorder and its treatment options) and exposure and response prevention (ERP).

Cognitive behavioral therapy (CBT) works by attempting to break the cycle of reinforcement between one’s compulsions and discomfort/anxiety relief, as well as trying to restructure and examine a patient’s beliefs and automatic/intrusive thoughts that maintain one’s symptoms. Exposure and response prevention (ERP) works by having the patient slowly expose themselves to more and more anxiety-inducing situations while preventing themselves from acting upon their compulsions.

As described in the paper, the aim of the treatment is for the scrupulous patient to eventually believe they’re able to tolerate their anxiety, as opposed to the patient believing that their anxiety will simply go away by the end of the exposure.

What is the Penn Inventory of Scrupulosity (PIOS)?

The Penn Inventory of Scrupulosity (PIOS) is a self-report scale meant for measuring religious OCD symptoms; it includes 19 items that are each rated on a 5-point scale from 0 (“never”) to 4 (“constantly”).

According to “Psychological Assessment” (a psychology journal published by the American Psychological Association), the PIOS is the most commonly used questionnaire for measuring scrupulosity.

You can take a look at the PIOS on page 6 of this paper.

How to help someone who suffers from Scrupulosity OCD

If a family member or friend of yours happens to suffer from Scrupulosity OCD, then the best course of action is to support them in getting professional help.

It is important to make sure your friend/relative does not rely on a religious leader (e.g. a pastor or an Imam) instead of a clinical psychologist/psychiatrist, as many studies (such as this one) have shown that some religious leaders tend to have very little experience with giving the correct advice on the topic of scrupulosity and OCD in general.

Keep in mind that you must not reinforce anyone’s compulsions or obsessions, but rather, should support them in a way that they seek a solution to their scrupulosity.

Talk to other people about Scrupulosity OCD

You can check out our community forum where you can talk to other people and share experiences about OCD, talk about treatments, and so on!

Read more about Scrupulosity OCD – some helpful resources

  • IOCDF (International OCD Foundation)’s fact sheet about scrupulosity
  • Peace of Mind Foundation’s guide to overcoming scrupulosity

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