“I’m not sure if I really have scrupulosity or if I’m just making excuses for not dealing with a deeper spiritual problem. Does my situation sound typical for religious OCD? I mean, could you please just define scrupulosity with some real-life examples?”

This is a question I get asked all the time. Because the nature of OCD is to doubt everything, most of us doubt our own diagnosis at some point. Unfortunately, doubting the diagnosis makes it harder to give ourselves permission to let go of our spiritual obsessions and compulsions.

Case Studies to Define Scrupulosity

Because scrupulosity can vary from one person to another, some people will get online in a support group or forum, hear what others are saying, and conclude, “that doesn’t sound exactly like me. I must not have OCD. This must be a spiritual problem.”

Then they fall on their knees again and try to cure their mental health condition through more prayer and more faith.

(And God does work through prayer; but He sometimes chooses to work through therapists. See this post for more on that.)

In my work as a scrupulosity coach, I have shared spiritual advice with almost 400 people with religious OCD. As I’ve worked with them, I’ve identified seven unique scrupulosity subtypes. These subtypes are based on symptom groupings, and they help me quickly get a handle on the issues that need to be dealt with in each unique case. You see, not everyone with scrupulosity experiences intrusive thoughts. Not everyone prays a lot. Some don’t ruminate at all but are caught up in fear-based compulsions.

I don’t have space in a single blog post to describe all seven scrupulosity subtypes. But I’d like to give a few case studies of people with very different symptom groupings who were all diagnosed with scrupulosity. Hopefully, this will help you define scrupulosity in a way that includes a broader range of symptoms, some of which you’ll have, some of which you won’t.

And here’s the pragmatic point I’m hoping to make: just because you don’t have every single symptom in the scrupulosity handbook doesn’t mean you should conclude that you’ve got a spiritual problem.

(And yes, I do have an upcoming resource that will talk more about each of the seven subtypes. Keep your eyes out for that.)

So let’s dive into a few case studies.

Case Study 1: Demons, Blasphemy, and Weird Sensations

Mark* was a truck driver from Arizona. He was a kind, handsome young man who had once been a guitarist and weekend weightlifter. But now he was a shell of his former self. He no longer played music or lifted; his muscles had atrophied and the hollows of his cheeks had sunken in. As terrifying thoughts and sensations closed in on him, he resigned from his job to try dealing with the fears.

Mark couldn’t understand what was happening. He had scary, unwanted thoughts urging him to blaspheme God’s name. He experienced word-order switch-ups, where his brain would replace God’s name with Satan’s name while praying or listening to worship music. He feared demonic oppression.

Increasingly, Mark started having unusual bodily sensations. A twitch in his abdomen, an ache in his head. Small things. Things that most people would simply ignore. But Mark fixated on these sensations. He began to interpret them through a hyper-spiritual filter.

“I think the demons have entered me,” he told me over and over again. “I didn’t have my guard up enough. I didn’t pray enough. I felt it when they entered me, and now I can’t get rid of them!”

The blasphemous thoughts that coursed through his mind seemed like proof that he had sold his soul to the devil, despite having absolutely no desire to do so. He battled against these thoughts with all his might, squeezing his eyes shut, shouting “no,” blowing air out of his mouth, stomping his feet, and punishing himself by not eating.

None of these compulsive methods worked.

Mark represents a unique grouping of scrupulosity symptoms. He didn’t really struggle with moral issues, compulsivity in his spiritual disciplines, or theological obsessions. His issue was almost purely related to bodily sensations, intrusive thoughts, and the unhealthy interpretations that he made about them.

However, if we define scrupulosity as a disorder that always involves intrusive thoughts, some of us might read Mark’s story and go away concluding that we don’t actually have OCD.

Case Study 2: Sin, Morality, and False Guilt

Faye* didn’t have a clue what intrusive thoughts were. When her therapist tried to define scrupulosity and asked if she ever had unwelcome thoughts, Faye was baffled to hear about blasphemous or harm-related thoughts. She’d never experienced anything like that!

Instead, Faye found herself caught in a loop of never-ending self-doubt. She worried constantly about her relationship with God, about whether she had committed a sin, and about the morality of the teensiest details of everyday life.

For example, Faye felt guilty about touching produce in the grocery store and worried that she might need to buy it just in case she had “damaged” it. She worried that disposing of cleaning chemicals incorrectly might cause harm to sanitation workers, and she spent hours calling the trash and recycling centers just to “make sure” nobody would be harmed by the items she had discarded. During the coronavirus pandemic, she even found herself (to her great embarrassment) sanitizing public spaces that she had used, like the common elevator in her building, out of fear that she might make someone else sick and thus be judged by God for her carelessness.

Faye felt guilty about everything.

She would try to pray for the sick and would feel guilty when they didn’t recover immediately. She would try to drive somewhere to take a vacation and she would feel guilty for not stopping to leave gospel tracts in every gas station she passed. And by the time she reached her vacation destination, she felt so guilty about enjoying herself that she barely did anything at all.

No matter what she did, and despite having a cognitive knowledge of God’s love and goodness, Faye felt a constant sense of spiritual doom hanging over her head. Her compulsive behaviors illustrate her severe difficulty in being able to overlook this feeling.

Faye is an example of someone with scrupulosity who struggles predominantly with false guilt and its related compulsions. But again, if we define scrupulosity only in these terms, we might be missing other patterns that often emerge.

Case Study 3: Pure O and Religious Themes

Ryan* was a college student in Nebraska who had taken a semester off to try dealing with his scrupulosity. Things were getting out of hand. It was easy for him to define scrupulosity as it applied in his life: it was a constant round of impossible-to-solve obsessions.

By the time I’d met Ryan, he had been analyzing his salvation from every possible angle for years. He was afraid of committing the unpardonable sin, of not having enough faith, of being prideful, of becoming a reprobate, of being insincere, of failing to confess his sins properly, and so much more.

Ryan felt extremely anxious while ruminating on these themes. His thoughts would completely derail him from life (hence, his need to take a semester off from university). He didn’t enjoy these thought loops, but they felt urgent and important, as if he could lose his salvation if he didn’t “figure out” his fears. Ryan told me that he used to ask his pastor hundreds of questions, but after time, he said he could see the pastor visibly sigh when he saw Ryan approaching him. Ryan was tired of his endless questions, and so was everybody else.

But he couldn’t stop.

Ryan didn’t have many overt compulsions. He wasn’t the type to kneel down in random public places to pray compulsively. He wasn’t the type to wrestle and shout “no!” to his blasphemous thoughts. His issues were ruminative in nature, a constant urge to satisfy his brain’s unreasonable demands.

Ryan’s experience with scrupulosity was mentally taxing and emotionally draining. It represents a very common symptom grouping within the world of religious OCD. But if we define scrupulosity only by Ryan’s experience, we might miss the big picture. As we’ve seen, scrupulosity can manifest in multiple unique patterns.

A Reliable Way to Define Scrupulosity

As these case studies demonstrate, scrupulosity can look different from one person to another. That’s why I believe it’s important for us to look for patterns, not specific symptoms.

In my online master class, I talk about five main patterns that everyone with religious OCD experiences. These five patterns are:

1. Chronic Doubt
2. False Guilt
3. Overactive Control Tendencies
4. Emotional Reasoning
5. Misunderstandings of God’s Character

If we compare symptoms with each other, we need to be careful not to put too much weight in the varied experiences we each have. OCD is a shapeshifter, and it doesn’t really matter how it’s manifesting. We are all dealing with the same underlying patterns of doubt, false guilt, emotion-based reasoning, and so on.

Nevertheless, comparing and grouping symptoms can be helpful for many people, because it helps us define scrupulosity as the issue rather than spirituality as the issue. It can be much easier to accept the diagnosis when we see others suffering in the same way as us.

Let’s just be careful not to put too much stock in comparisons. Check for thought and behavioral patterns rather than symptomology, and I think you’ll find the puzzle pieces begin falling into place much quicker.

I hope this has been a bit helpful in your search to define scrupulosity. Remember to keep looking up and trusting God to carry you through to the end.

Best wishes on the journey,

*I’ve changed the names and identifying details of the people in these case studies. In some, I’ve taken liberties to combine the struggles of two people into one to make the point clearer.