What causes scrupulosity OCD?

As with other kinds of OCD, the exact cause of scrupulosity is not known. It is thought that a combination of genetic and environmental factors might be at play, but more research needs to be done.

How prevalent is scrupulosity OCD?

OCD affects about 2.3% of adults in the United States. Of those diagnosed with OCD, it is estimated that 5%–33% also experience scrupulosity.

Is scrupulosity more common among people of a certain religion?

Non-Catholic Christians and Muslims are more likely than other religions to display scrupulosity. Research has shown that non-Catholic Christians are 1.73 times more likely to display scrupulosity than those not identifying as such; Muslims are 6.45 times more likely to display scrupulosity.

What Is Scrupulosity OCD?

By Jaime R. Herndon, MS, MPH

Published on July 13, 2022

Medically reviewed by Steven Gans, MD

Obsessive-compulsive disorder, or OCD, is a common psychiatric disorder in which a person experiences recurring, uncontrollable thoughts (obsessions) as well as behaviors they feel they have to do over and over (compulsions).

There are several subtypes or themes within OCD, including scrupulosity. This subtype involves religious anxiety and moral perfectionism. It is not the same as having a healthy religious practice or being spiritual.

Read on to find out more about scrupulosity and its symptoms and treatment.

Woman deals with obsessive thoughts — FS-Stock / Getty Images

What Is Scrupulosity OCD?

Scrupulosity is a form of OCD that involves obsessions about religion or morality. People living with scrupulosity are very concerned with whether they have thought or done something that could be considered a sin or a violation of religious or moral code.

Religious Devotion vs. OCD

Being devout or highly religious is very different from scrupulosity OCD. People with a healthy religious practice live their lives according to the tenets of their faith, and their behavior is not excessive or different from their peers in their religious community.

Scrupulosity is different: Individuals living with scrupulosity act differently than others in their faith community. It sometimes causes a person to focus on one minor aspect of religious practice while more important parts are ignored.

Signs and Symptoms of Scrupulosity

A mental health professional who is diagnosing scrupulosity will need to take cultural and community norms into consideration, being mindful of different faiths and cultures. Here's a look at some of the common signs and symptoms of scrupulosity.

Common Obsessions

An individual may have obsessions about:

Blasphemy (showing lack of reverence to God or something holy)
Having sinned
Behaving in a moral way
Going to hell
Purity
Losing impulse control
Death

Common Compulsions

Compulsions accompany the obsessions and can include:

Making excessive trips to confession (the practice of asking for forgiveness of sins)
Repeating rituals to cleanse/purify
Practicing acts of self-sacrifice
Praying excessively
Making agreements with God
Repeating religious passages in one’s head
Avoiding situations because of worry about moral or religious failure

Treatment for Scrupulosity

There are different treatments for scrupulosity, including therapies, medication, and social support. You and your healthcare provider can work together to find the best treatment plan for you based on your symptoms.

Exposure and Response Prevention

Exposure and response prevention (ERP) is typically the first-line therapy for OCD. This type of therapy exposes the individual to the situations that trigger them while preventing them from performing compulsive behaviors. As a result, people learn to tolerate distress while also breaking free from their compulsions and obsessions.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) uses strategies of acceptance and choosing behaviors based on values to help people become more flexible in their thinking. Clients learn to stop denying their thoughts and feelings, and they also commit to changing their behavior, even if they're conflicted about doing so.

Medication

Selective serotonin reuptake inhibitors (SSRIs) have been used to help reduce symptoms of OCD. These are often taken at higher doses than for depression and can take some time to start working. Some people whose symptoms are not sufficiently relieved by SSRIs may benefit from augmentation from other types of medications such as certain antipsychotics. Talk with your healthcare provider about whether this is an option for you.

Mindfulness

Mindfulness can be used in addition to cognitive behavioral therapy for OCD. The goal of mindfulness is to notice how you feel in the present moment, without judging or analyzing yourself. People with OCD often view their thoughts or feelings as unacceptable; mindfulness can help them reframe the situation. When people don't judge or deny their obsessive thoughts, they are less likely to respond with compulsive behavior.

Social Support

Social support is important for people living with OCD. Without adequate social support, people with OCD are more likely to have negative perceptions of themselves, which can perpetuate obsessive thoughts and compulsive behaviors. OCD support groups can help connect you to others who understand what it’s like to live with scrupulosity.

Summary

Scrupulosity is a form of OCD that focuses on moral or religious obsessions. It is not the same thing as being devout—people with scrupulosity deal with obsessive thoughts and compulsive behaviors that are not in line with how other people in their faith community act. Treatment for scrupulosity includes therapy, medication, and social support.

A Word From Verywell

Living with any form of OCD can feel isolating and overwhelming. With scrupulosity, you might be inclined to reach out to your clergy for assistance, and that’s great—social support is an essential part of treatment. But it’s also important to seek assistance from your healthcare provider. A medical professional can connect you with a therapist or someone who specializes in OCD who can work with you to develop a treatment plan.

Frequently Asked Questions

What causes scrupulosity OCD?

As with other kinds of OCD, the exact cause of scrupulosity is not known. It is thought that a combination of genetic and environmental factors might be at play, but more research needs to be done.
How prevalent is scrupulosity OCD?

OCD affects about 2.3% of adults in the United States. Of those diagnosed with OCD, it is estimated that 5%–33% also experience scrupulosity.
Is scrupulosity more common among people of a certain religion?

Non-Catholic Christians and Muslims are more likely than other religions to display scrupulosity. Research has shown that non-Catholic Christians are 1.73 times more likely to display scrupulosity than those not identifying as such; Muslims are 6.45 times more likely to display scrupulosity.

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