Treatment for Scrupulosity

Scrupulosity is a form of Obsessive-Compulsive Disorder (OCD) that involves persistent concerns about morality, religion, sin, or doing the right thing. People with scrupulosity may experience intrusive thoughts about religious or moral subjects and then feel compelled to pray, confess, seek reassurance, review their actions, or otherwise try to resolve their doubts.

These concerns can be especially difficult when they involve your faith or your sense of right and wrong. You may find yourself repeatedly asking whether you have sinned, whether your intentions were good enough, whether you have been forgiven, or whether you can trust your own judgment.

At Northart Counseling, I use Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) to treat scrupulosity and religious OCD. Treatment focuses on breaking the cycle of obsessions and compulsions and learning to tolerate the uncertainty that OCD creates.

Scrupulosity can involve religious concerns, moral concerns, or both. Some common symptoms include:

• Fear of Sinning: Worrying that you have committed a sin or violated a religious or moral rule, even when there is little evidence that you have.

• Intrusive Religious or Moral Thoughts: Unwanted thoughts, images, or impulses about God, religion, morality, sexuality, or other subjects that are important to you.

• Excessive Confession or Reassurance Seeking: Repeatedly confessing, asking others whether you have done something wrong, or searching for answers online.

• Compulsive Prayer: Repeating prayers or other religious practices because you feel that you need to do them correctly or to neutralize an unwanted thought.

• Checking and Reviewing: Going back over conversations, actions, memories, or intentions to determine whether you did something wrong.

• Fear of Being a Bad Person: Doubting your character or intentions and worrying that you may be immoral or fundamentally bad.

• Avoidance: Avoiding religious practices, situations, people, or decisions because you are afraid of doing something wrong.

• Difficulty With Uncertainty: Feeling that you need to know for certain whether something was right or wrong, sinful or permissible, before you can move on.

These compulsions can take a significant amount of time. They may also make it difficult to participate in your faith, make decisions, or simply move on from an uncomfortable thought.

The first step in treatment is understanding how scrupulosity is affecting you. We will look at the thoughts and situations that trigger your OCD as well as the things you do to get relief from the resulting anxiety or doubt.

Treatment may involve:

• Exposure and Response Prevention: ERP involves gradually facing situations, thoughts, or uncertainties that trigger OCD while reducing the compulsions you normally use to feel better.

• Reducing Reassurance Seeking: Reassurance can provide temporary relief while keeping the OCD cycle going. We will work on recognizing reassurance seeking and finding other ways to respond to uncertainty.

• Addressing Mental Compulsions: Not all compulsions are visible. Mentally reviewing an event, analyzing your intentions, or trying to prove to yourself that you did not sin can also become part of the OCD cycle.

• Learning to Tolerate Uncertainty: Scrupulosity often creates questions that cannot be answered with complete certainty. Treatment helps you become more comfortable with that uncertainty rather than continually trying to resolve it.

• Using Your Values: ACT can help you identify what is genuinely important to you and make decisions based on those values rather than on the demands of OCD.