Obsessively Good: Understanding Scrupulosity OCD and How CBT Can Help

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By Lindsey Collins Conover, PhD,
Lindner Center of Hope

Jennifer has always cared about doing the “right” thing, but she has recently started wondering if her actions are good enough. This has led her to doubt her, previously habitual, actions and second-guess every move she makes. “Was I kind enough when the cashier asked if I wanted my milk in a bag?”, “When I was reading my Bible, did I spend enough time to understand it fully?”, “Am I a good enough person/Christian?”. As these thoughts increase in intensity, Jennifer finds herself seeking reassurance from others (e.g., “Did I offend you just then?”), re-reading her Bible passages over and over until it feels “right”, and avoiding church services out of fear that she is not worthy enough. Jennifer is developing scrupulosity OCD.

What Is Scrupulosity OCD?

Scrupulosity, like other forms of OCD, involves doubt about whether something is right or as it should be. However, for this type of OCD, the obsessional doubt is targeted at a person’s faith, religious performance, or moral standards. It can present in people who are new to their faith, seasoned religious leaders, and those without a significant religious belief system or practice.

Common symptoms in scrupulosity OCD:

  • Common obsessions include fear of being judged or eternally damned for moral imperfection, fear of having thoughts that are opposed to your values or beliefs and not feeling enough of faith.
  • In response to these obsessive fears, individuals with scrupulosity OCD will spend an excessive amount of time either trying to figure out if they are good enough or making amends for perceived wrongdoings. Common compulsions include excessive prayer (e.g., praying for hours until it feels “right”), avoidance of images, numbers, or other content that brings on fears of blasphemy (e.g., depictions of the Devil), reassurance seeking about religious or moral concepts, and overanalyzing thoughts as “good” or “bad”.

How can Scrupulosity OCD impact someone’s mental health? 

  • Scrupulosity OCD can lead someone to become so consumed by their quest for certainty about their moral or religious standing that they neglect what they truly value. They may begin avoiding religious services or time with family and friends, or have difficulty sleeping. Like other forms of OCD, the symptoms can become so significant that performance at work and school is impacted. Often, despite one’s best efforts, scrupulosity OCD can also lead someone to be less connected to their faith or religion.

How Can Cognitive Behavioral Therapy (CBT) Help with Scrupulosity OCD?

  • The Basics of CBT for OCD Treatment
  • CBT is a gold-standard treatment for OCD with decades of research supporting its effectiveness (Law & Boisseau, 2019). The main approach used in CBT for OCD is Exposure and Response Prevention (ERP), which involves gradually facing feared thoughts or situations (exposure) while resisting the urge to engage in compulsive behaviors (response prevention). By facing their fears and resisting compulsions, a person can relearn that their thoughts do not represent true threats and that they can tolerate the uncertainty of their fears. Over time, this can lead to a significant reduction in OCD symptoms and improve quality of life.

How CBT Addresses Guilt and Moral Fears in Scrupulosity OCD

  • CBT exercises for scrupulosity OCD may include attending a religious service, expressing displeasure about someone’s behavior, setting time limits for religious practices, or resisting mental analysis. As they challenge their fears, individuals learn that their thoughts about morality or sin do not need to determine their actions or self-worth. Over time, this reduces the power of doubting thoughts and can allow the individual to reconnect with their values, such as compassion, honesty, or faith, without being controlled by OCD’s rigid demands. CBT helps people shift from living in fear of doing “wrong” to living with purpose and integrity.

Practical Steps You Can Take Today to Manage Scrupulosity OCD

  • Be Aware of Emotional Reasoning: If you feel wrong or guilty, it does not mean that you committed a wrong or a sin.
  • Try Accepting Uncertainty: No amount of reassurance will provide the certainty that you are looking for. Alternatively, accepting the uncertainty of your moral standing and having radical faith can lead to freedom from OCD and bring you closer to your values.

References:

Law, C., & Boisseau, C. L. (2019). Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychology research and behavior management, 12, 1167–1174. https://doi.org/10.2147/PRBM.S211117