History’s earliest mentions of what we now know to be obsessive-compulsive disorder (OCD) often happened in a religious context. Scrupulosity, for instance, was first used by the Roman Catholic church around the 15th century to describe obsessive concern with sin and compulsive acts for the purpose of atonement.
John Locke, one of history’s most influential philosophers, wrote in the 1600s that he “cannot imagine that God, who has compassion upon our weakness and knows how we are made, would put poor men, nay, the best of men, those that seek him with sincerity and truth, under almost an absolute necessity of sinning perpetually against him, which will almost inevitably follow if there be no latitude at all allowed as in the occurrences of our lives.”
Locke is essentially saying he doubts any higher power who cares about humans would make it so they’re always sinning—especially when they’re trying extra hard to be moral. He thinks we should allow ourselves a little wiggle room so we’re not always exhausted by the fear of sinning.
Faith played a huge role in daily life during this time period, so it’s not surprising that early descriptions of obsessions and compulsions appeared through religious perspectives. While much has been uncovered about OCD in the centuries that followed, some concepts stuck. Today, mental health professionals still use the term scrupulosity to describe a subtype of OCD related to religion, ethics, and morality.
What is scrupulosity or religious OCD?
You’re probably somewhat familiar with obsessive compulsive disorder (OCD), a mental health disorder in which a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, and/or urges that cause distress. Compulsions are repetitive, ritualistic behaviors or mental acts that those with OCD engage in to relieve anxiety caused by obsessions. Sometimes, compulsions are done in an effort to prevent something “bad” from happening.
Scrupulosity, also called religious OCD, is a subtype of OCD that involves religious, moral, and/or ethical obsessions. People with scrupulosity OCD experience frequent worry and guilt about violating a religious or ethical code and what it means about them as a person. Scrupulous individuals experience intrusive thoughts about something they thought or did that goes against their faith or moral doctrine.
They may wonder: “Did I allow myself to have an ‘impure’ thought in church? Does it mean that I’m a sinner and must repent?” The guilt and anxiety drives these people to engage in various compulsions aimed to alleviate their distress.
Can you have non-religious scrupulosity OCD?
Yes. Scrupulosity can affect people who are atheist, agnostic, or have no set faith. Moral scrupulosity latches onto how an individual sits with personal beliefs. They may not believe in any higher power, but spend hours ruminating on whether or not their world view is the “correct” one.
It’s normal to spend time thinking about these big concepts, but it turns into OCD when these thoughts become constant interruptions that you can’t disengage from. For example, someone with non-religious scrupulosity may wonder if it’s “bad” that they don’t have a religion. Their mind keeps circling around all the “what if” scenarios about faith, like “What if my parents were right about Allah?”, “What if I get punished for eating non-kosher?”, or “What if I’m demonic because I’m an atheist?” They might choose to stop attending church, but then be plagued with thoughts about going to hell because of that decision. They have trouble sitting with their own doubts about faith and the uncertainty that comes with all the things one cannot definitely prove.
Tracie Zinman-Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD, has seen secular patients who have compulsions that mimic religious rituals. “You could be totally not religious, but always have a little ritual you do or a little prayer that you think somehow protects you,” she says.
You could be totally not religious, but always have a little ritual you do or a little prayer that you think somehow protects you.
Non-religious scrupulosity doesn’t have to focus on belief systems at all. With cases of moral OCD, an individual may be overly concerned with how they treat people, animals, or even the planet. They’re obsessions revolve around being a “good” person. They constantly worry what will happen if they do something that doesn’t perfectly line up with their values.
Is scrupulosity OCD different from existential OCD?
It’s always possible to have a combination of various subtypes of OCD. Existential OCD focuses on the big questions in life, usually related to one’s purpose and general existence. Like all other forms of OCD, these thoughts are intrusive and often paired with compulsions.
It’s common for people without OCD to think deeply about philosophical concepts. But when you have existential OCD, you become obsessively preoccupied with these ideas. For example, someone may wonder about the meaning of life for hours every day. They’re spending so much time thinking about life’s meaning that they’re not present in their own daily life. They end up stuck in a thought cycle that they’re not able to break out of.
Scrupulosity and existential OCD often co-exist because they both deal with the mysteries of life. Someone may excessively pray to God, but then their mind shifts to wonder if they’re even a real person: “Do I even exist? Does all this praying even matter?” Their obsessions and compulsions bounce between religious themes and existentialism, especially if they’re worried about moral goodness. These subtypes are tied together by an ever present uncertainty with the world.
Scrupulosity OCD symptoms
Many religious people may be concerned that they have sinned and want reassurance. However, with scrupulosity OCD, those worries are never-ending. A person without OCD might feel the need to acknowledge their sins via confession. After they confess, they’re able to move forward in a way that an individual with OCD struggles to do. Those with OCD may confess their sins, but keep ruminating over them. They may feel the need to confess their sins multiple times until they get their declaration “just right” otherwise they will face spiritual punishment.
Here’s a list of common obsessions and compulsions in scrupulosity OCD:
Religious-focused OCD thoughts:
- Have I prayed correctly? Have I prayed for the correct amount of time? I was a bit distracted. Maybe I should do it again.
- Today I thought my religious leader is ugly. Does that make me a bad person?
- During religious services, I found it hard to concentrate and thought about my to-do list for a few minutes. Is that a sin?
- At the supermarket, I accidentally picked up pork and immediately put it down. Am I contaminated from having touched it? Should I confess?
- I wanted to laugh today during services. Does this mean I don’t take my religion seriously?
- Did I do something that offended or angered God?
- I’m striving for purity and I fear I’ve done something wrong.
Moral/secular OCD obsessions:
- I told someone I’ll call them at 5 p.m., but I called them at 5:01 p.m. Have I lied? Am I a bad person?
- Did I offend my friend without knowing during our conversation yesterday?
- Was the question I asked in class rude? Have I accidentally offended the teacher?
- Is it OK that my friend edited my essay? Does that count as cheating?
- I didn’t say ‘thank you’ to the person who held the door for me. I am a bad person.
- I told my spouse that I am great when they asked how I am. But the truth is I’m upset. Am I deceiving my partner? Do I deserve to be in this relationship?
- I told a prospective tenant that I ended up choosing someone else, but the truth is I let my cousin stay in the apartment. Am I a horrible person for “telling a white lie?”
Scrupulosity OCD compulsions:
- Excessive prayer: You pray extensively — longer than the standard for your particular faith, sometimes hundreds of times a day, in order to make sure your prayers have been performed perfectly. If there’s a mistake or hesitation, you may repeat yourself until you believe the prayer is flawless.
- Excessive confession: You repeatedly go to your religious leader/authority to ask about or confess sins you are worried about having committed. It could be minor questions, like, “was it a sin when I found a woman attractive, even though I’m married?” You may return multiple times to confess about the same event, for fear that you haven’t communicated the sin properly and may still be guilty.
- Excessive rituals: You develop rituals to calm obsessive thoughts. This may look like coming up with a number of minutes to pray, asking for a higher power’s forgiveness a certain number of times, or performing established religious rituals a certain number of times.
- Reassurance seeking: You repeatedly turn to the people in your life for reassurance. You might ask loved ones if they’ve ever experienced the same thoughts you have, to affirm whether or not it’s sinful. You may also spend hours in online forums asking strangers whether something they’ve done would be considered a sin. You may ask your teacher if it’s okay that a friend helped with your homework, even if the teacher already clarified it is. You may ask a friend if they would consider this cheating.
- Mental checking: You mentally review past experiences and try to evaluate whether you behaved in an immoral or sinful way. If you’re concerned that you offended a friend, you might replay the face he made over and over in your mind, and think back to other times their friend has made this face. “Is this the face he makes when he’s offended?”
- Avoidance: You avoid your place of worship for fear of behaving in a sinful way. You may avoid certain people who cause you to have thoughts you’ve determined are immoral or sinful.
Is Scrupulosity OCD more common for people of a certain religion?
Obsessive compulsive disorder affects people of all walks of life, and that’s certainly true for Scrupulosity OCD as well. To date, there’s no evidence that shows people of a particular religion are more likely to experience this form of OCD. Keep in mind, as previously mentioned, that it’s certainly possible to suffer from scrupulosity OCD and not have any religious affiliation.
Some people may wonder if their faith says anything about having OCD. For instance, they might Google “does the bible mention OCD at all?” Zinman-Ibrahim has seen patients who try to tease this question out through various holy texts, but asserts that there’s no sacred text that explicitly mentions the condition.
“I bet if you ask twenty religious leaders, you’d probably get twenty answers, because there’s nowhere for them to look it up either—it’s an opinion,” Zinman-Ibrahim says.
People may read certain scriptures through a mental health lens, but remember that all texts are up for individual interpretation.
What does scrupulosity OCD look like in different religions?
Scrupulosity OCD can manifest differently based on the themes in one’s spirituality. It doesn’t matter if you follow an organized religion or a practice with a smaller following. OCD can even attach to beliefs that are unique to an individual. The common thread is the inability to sit with the spiritual doubts that arise in the mind.
Let’s examine some common obsessions and compulsions in major belief systems.
Christianity
Example obsessions:
- “I’m bored when I read the bible. Does that mean I don’t care about my faith?”
- “I don’t feel connected to God. Does this mean I’m not a true believer?”
- Worries about sins you don’t remember committing
Example compulsions:
- Penitence rituals aimed at cleansing a contaminated soul
- Monitoring the mind for evidence of sin of blasphemy
- Demanding spiritual leaders share a black-and-white truth rather than accepting gray areas in religion
Judaism
Example obsessions:
- Worries about violating Jewish law
- Perfectionism in prayer, ritual, and study
- Modesty and purity
Example compulsions:
- Excessively checking food to make sure it’s kosher
- Needing constant reassurance from rabbis
- Avoiding all potentially “impure” activities
Islam
Example obsessions:
- “My cleaning ritual was interrupted and therefore I am dirty.”
- Excessive worries about offending Allah
- Constantly wondering if they accidentally ate haram food
Example compulsions:
- Excessive cleaning rituals
- Constantly rereading scriptures to stay in “good standing” with Allah
- Redoing prayers until they feel “just right”
Atheism
Example obsessions:
- “What if I am punished by a higher power for not believing?”
- “What if my beliefs are wrong and I regret them?”
- Fears about offending a higher power
Example compulsions:
- Avoidance of people, places, and things that remind you of spiritual doubts
- Constantly googling research on atheism
- Seeking reassurance from those with similar views
Hinduism
Example obsessions:
- Fears of negative karma
- Excessively worrying about one’s reincarnation
- “Did my actions impact my progress in dharma?”
Example compulsions:
- Repeating a puja over and over again until it’s done “correctly”
- Consistent self-shaming
- Setting up rangolis “perfectly” before festivals
Is it a spiritual practice or an OCD ritual?
Religions traditionally use rituals as a way for believers to reaffirm their faith. For someone with OCD, it can be tricky to tease apart these practices from compulsions. Many spiritual rituals require actions to be done in a specific, repetitive way. OCD rituals often present in a similar fashion.
If this is an issue for you, Zinman-Ibrahim recommends thinking about it this way: How do people without OCD perform spiritual rituals? Let’s say it’s typical in your faith to say a certain prayer twelve times. Someone without OCD would be able to repeat the prayer twelve times and then move on with their day. But someone with OCD might feel like twelve times is “not enough” and double or triple that. They might keep repeating the prayer until they feel like they performed it perfectly. Maybe they feel like they need to be in a good mood when they repeat it, or it won’t count. Or they tell themselves to only perform the prayer in a space that is very clean.
“Now you’re adding all these other compulsions that have nothing to do with religion—it has to do with OCD,” Zinman-Ibrahim says.
Now you’re adding all these other compulsions that have nothing to do with religion—it has to do with OCD.
It may be helpful to examine how others in your spiritual community perform religious rituals. When you compare your practice to theirs, do you notice that you’re adding unnecessary steps that lead to distress? That may be a sign that your behaviors are not of a devotional nature and instead represent OCD.
Manifestations, magical thinking, and OCD
One spiritual practice that has gained popularity in recent years is manifestation. It’s the idea that one can turn ideas into reality through setting mindful intentions. This could mean meditating on a specific affirmation like “I am a millionaire” by repeating it out loud or writing it down over and over again. Or you could visualize what your life would look like if you had millions of dollars. Manifestation is a form of magical thinking, which is the belief that one’s thoughts have an effect on how the world works.
Manifestation can be used in a positive way to advance a person’s intentions. Many people use it to gain confidence by envisioning a future where their goals are possible. But there’s a fine line between manifestation and magical thinking OCD.
It may be difficult for someone with OCD to differentiate between intentional and intrusive thoughts. All of the sudden, they might randomly think “I am a serial killer.” They worry that just by having this thought, they will manifest a world where they kill people. But that’s not how reality works. Everyone gets random, intrusive thoughts that seem to pop up out of nowhere—even people without OCD. Just because something appears in your mind, doesn’t mean it will ever come true.
Manifestation may also turn into a compulsion for someone dealing with OCD. Consider someone who has an obsessive fear of plane crashes, but has to fly regularly for work. Before every flight, they write out “I arrive at my destination safely” ten times in their journal. They feel like they have to do this, otherwise something will go wrong with their flight. They’re not using the practice as a guiding tool—instead, they’re relying on manifestation to attempt to control their situation. Their distress might be temporarily relieved by writing out manifestations, but simply setting intentions cannot totally protect anyone from the uncertainty of the world.
“At the end of the day, no matter whether you’re in an established religion or whether you believe you can manifest things, I would just say you’re taking a leap of faith and [outcomes are] still unknown,” Zinman-Ibrahim says.
How is scrupulosity OCD treated?
As with all forms of OCD, the gold standard treatment for scrupulosity OCD is exposure and response prevention (ERP) therapy. ERP is supported by decades of rigorous clinical research proving its effectiveness. You work with a specially-trained therapist to slowly put yourself into situations that bring on your religious, moral, or ethical obsessions. This gives you a chance to practice how you deal with obsessions.
Let’s say you’re someone with scrupulosity OCD and excessively concerned about telling the truth. You’ve just told your spouse you’ll be home at 3 p.m., but you actually arrived at 3:30 p.m. Each time this happens, you spiral into obsessive thoughts about being a liar, and the need to know if you’ve done something wrong, and sometimes ask your spouse for confirmation that this isn’t a serious lie and that you are still a good person.
In ERP therapy, the goal is to prevent yourself from acting on compulsions. Instead of asking your spouse for reassurance, a therapist may have you think to yourself, “Maybe I am a liar. Maybe I’m not. It’s impossible to know for sure.” This teaches your brain a new response to your anxiety and begins to help you tolerate the uncertainty fueling your obsessions and compulsions. In order to avoid becoming overwhelmed, you’ll work with your therapist to come up with a hierarchy of anxieties and related exposures and gradually work your way through them.
People with religious OCD may face particular challenges during ERP therapy because they may be convinced certain exposures will make them unfaithful to their religion. Working with a trained therapist who understands your faith and how important it is in your life will help you feel confident to begin the process of separating your faith from your OCD thoughts about it. The nature of these thoughts is to convince you that you aren’t devout. A therapist who’s familiar with religious OCD will be able to help you work through this.
How to get help today
Religious or scrupulosity OCD can be a tricky diagnosis to make because many of the behaviors can appear as concern about being faithful or ethical. A religious leader may tell you you’re simply overly concerned and have nothing to worry about, without knowing they are actually helping fill your need for reassurance. However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. Please know that effective and faith-affirming mental healthcare is out there for you. You don’t have to suffer from scrupulosity OCD forever, and you can get on the path to recovery—just as thousands of others with religious themes of OCD have before you.