• Seeking repeated reassurance from religious leaders
• Taking pains to understand every detail of religious faith and practice
• Repeated confessions, attempting to remember every sin
• Repeated prayers, attempting to perform them perfectly
• Intense rumination (being “stuck in your head”) in an attempt to solve spiritual questions
• Avoidance or excess in religious practice:
  • Avoiding church, mosque, temple, synagogue, etc. to not experience an increase of spiritual questioning, or
  • Being rigidly exact in performance of every jot and tittle of religious codes

Anything sound familiar?

Yep, and that’s only a quarter of the symptoms.

But seriously, here’s a shoutout to anybody who was ever told that their spiritual doubts are a “faith” problem. Ain’t no faith problem here — we got entire chunks of our brain that fail to function correctly! Read on carefully as we continue defining the contours of the beast and then segue into proven ways to get you out of your head and back to “real faith.”

Scrupulosity Symptoms, Category 2: False Guilt

The second main category of scrupulosity symptoms involves an intense measure of false guilt. However, to the scrupulous person, it does not feel like false guilt, it feels like completely justified and reasonable guilt.

But that’s just it. It feels like real guilt.

In 9 cases out of 10, though, the persistent guilty feeling can’t be justified by facts, Scripture, or the norms of the larger faith community. This is because the feelings of false guilt are an error message from the brain.

Imagine a morse code operator having an epileptic seizure with his finger still on the telegraph key. The false guilt of scrupulosity is a brain glitch.

It is not real.

But the person with scrupulosity receives it as a valid telegraph and then frantically tries to decode it.

Some of the most common “false guilt” messages that scrupulosity sends to the brain include the following:

• I have committed the unpardonable sin.
• I am unforgivable.
• I am not saved, and will go to hell.
• If I don’t do enough evangelism, other people will be lost and it will be my fault.
• I am responsible for the sins and eternal welfare of other people.
• My mind wandered while I was praying — I must have spiritual “problems.”
• I looked around the room while taking the test — I must be a cheater.

There is also a peculiar “superstition glitch” that seems to happen with some scrupulous individuals. The superstition glitch is an error message tying together two completely unrelated phenomena: typically a religious behavior with an unrelated outcome. For example:

• If I don’t complete my prayers perfectly, someone in my family will get in a car accident today, and their death will be my fault.
• If I have immoral thoughts, God will punish my children.
• If I don’t pick up trash when I see it on the street, God will never let me get married.

Such superstitious thinking is false guilt, and cannot be supported by Scripture. The Bible tells us that God judges us based on the trajectory of our lives, not on the occasional good deeds or bad deeds we may do. “If anyone sins, we have an Advocate with the Father,” the apostle John tells us. God is not eagerly waiting for the chance to destroy us. “He does not afflict willingly, nor grieve the children of men” (Lamentations 3:33).

The false guilt of scrupulosity bypasses the entire Biblical message of grace and love. It offers fake news instead of real news, and the scrupulous person swallows it hook, line, and sinker. The Bible tells us “by grace you have been saved through faith,” but the scrupulous person feels that he is responsible to avert disaster at every turn. He cannot feel the joy of salvation because the fake news is blasting too loud.

We’ve now looked at half the symptoms of scrupulosity. If you’ve read this far, you’re probably getting an eerie feeling that maybe you’re not the only person who has felt this way.

Scrupulosity Symptoms, Category 3: Compulsive Religious Behaviors

Religious OCD introduces a constant undercurrent of anxiety into the spiritual experience. Although it may not manifest as a panic attack or something more easily recognizable on the anxiety spectrum, it is there, needling away at our relationship with God. (And for those who have severe cases of scrupulosity, panic attacks do occur.) This anxiety urges us into compulsive religious behavior.

What do we mean by “compulsive” religious behavior?

We mean that our behaviors are brought on by a sense of fear, doom, obligation, or anxiety. We long for a feeling that everything is “right” or feels “safe,” and we do these behaviors to achieve that feeling.

Why do some people with ritualistic OCD touch the doorknob a certain number of times before exiting? They crave that elusive feeling that everything is “ok.”

Well, same story for religious OCD.

There’s an undefined, fuzzy feeling that things aren’t quite right, and we mentally attack ourselves to figure out what might be wrong with our spiritual lives. We act as our own holy spirit, convicting ourselves of sin when there is no sin.

Our brains crave equilibrium. We feel “off,” but don’t know why. Subconsciously we try to dig up a reason why we feel so vaguely bad.

What does the pre-compulsion feeling feel like?

It’s as if you got in an ugly squabble and punched your best friend in the gut, then went home feeling awful about yourself and fell asleep. Some hours later, you wake up, fuzzy-headed. For a few moments, in that zone of just having woken up, you don’t remember the fight. You just have a vague, pressing perception that something is very, very wrong.

You sit up, rub your eyes, and try to remember what you did.

That, THAT, my friend, is the fuzzy-guilty moment the scrupulous person lives in from day-to-day — but without having punched anyone. Constantly scanning our brains, fishing for what’s wrong. We begin with a heavy feeling of guilt — through no fault of our own — and desperately try to come up with a logical reason for why we feel so awful.

This is the story of how a scrupulous person sees sin where there is none.

That’s why scrupulosity is often (though not always) accompanied by religious compulsions, which help to temporarily fix these nebulous feelings of wrongness. Religious compulsions may include the following:

• Saying prayers a certain number of times, for a certain length of time, or up to a certain standard of “correctness”
• Carrying out devotional practices or Bible reading in a highly specified manner
• Having a fixation with food preparation or religious dietary laws (halal, kosher, vegetarian, etc.)
• Being kind and generous at all costs, even when being taken advantage of
• Compulsively engaging in evangelism, charitable deeds, or acts of kindness (unable to stop when it is appropriate)
• Inability to sleep or go about the day unless religious rituals are performed “correctly”
• Making pacts or vows with God to “make up for” mistakes (often involves the sacrifice of something)
• Excessive repetition of verses or religious mantras
• Excessive engagement in religious rituals, such as washing or purification (Hinduism and Islam) or confession (Christianity), much more than others in the same faith community

Some people with scrupulosity have more of a “Pure O” form of OCD, wherein compulsions are less obvious. However, these individuals may engage in a compulsion known as “reassurance seeking.” This is the practice of answering those inner feelings of anxiety by relying on others — typically spiritual experts — to alleviate those fears. Reassurance seeking often takes the following forms:

• Repeatedly seeking advice on the same spiritual issues but failing to find comfort
• Seeking out spiritual leader to give reassurance
• Making excessive internet searches to feel better about spiritual standing
• Asking spiritual leader to explain the same matters many times, taking pains to understand every point perfectly

When does normal spiritual dialogue cross the line to become unhealthy “reassurance seeking?”

Let me start with a caveat: I encourage vigorous spiritual dialogue. Over the centuries, dialogue has refined doctrine, led people out of dangerous cults, and clarified our understanding of God. Even for the scrupulous person, I would be hesitant to suggest, like the Jesuit mystic Ignatius of Loyola (who suffered from scrupulosity himself) that we place ourselves blindly into the care of a spiritual guide.

Dialogue is important, and even the scrupulous person must be led to retain his or her sense of identity and personal responsibility.

However, when reassurance seeking becomes emotionally irresistible, takes up several hours or more per day, and leads to cycles rather than forward progress, it is probably an unhealthy compulsion that needs to be curbed.

God didn’t intend for us to have omniscient knowledge. While we may seek for comfort and truth, we overshoot our goal to aim for infallible knowledge. See my article about OCD and the fallacy of omniscience for more on this theme.

Scrupulosity Symptoms, Category 4: Intrusive Thoughts

Intrusive thoughts are unwanted thoughts that seem to just pop into the mind unbidden. They cause negative feelings, so people with OCD generally get caught on an endless cycle trying to fight, block, cancel out, or escape these dreaded thoughts (note: “thought stopping” is a terrible way to get rid of intrusive thoughts. Keep reading to the end when I talk about treatment options.)

For people with scrupulosity, these intrusive thoughts can take on a life-or-death feeling, because these “thoughts” feel like they originate with our true self.

Here’s a video that explains intrusive thoughts very well. This is the best short video I found on intrusive thoughts, and I highly recommend taking a moment to watch it.

For those with scrupulosity, intrusive thoughts generally (but not always) follow themes like the following:

• Urges to sell soul to the devil
• Urges to blaspheme God
• Thoughts that you may commit a terrible crime
• Fears that you may have committed a sin you can’t remember
• Urges to commit sacrilegious acts
• Unwanted sexual thoughts about religious clergy, Jesus, Mary, or other religious figures
• Thoughts that the devil will make you completely lose control
• Thoughts that God is giving special direction or revelation of His will that you must understand and follow precisely

Recurrent intrusive thoughts on religious and moral themes are a hallmark of scrupulosity. Rest assured, the weirder your obsession, the higher the likelihood that it really is OCD. One woman with scrupulosity was absolutely terrified that God was going to punish her by making her grow male genitalia (again, this type of “punishment” can be found nowhere in Scripture, but this lack of justification did not prevent her from being obsessed with making sure it did not happen). These strange intrusive thoughts gave her great anxiety, and she would repeatedly check herself to make sure nothing was growing downstairs.

Think it sounds cute and quirky? Don’t be misled. Religious OCD can be severe and disturbing enough to cause people to take their own lives. Individuals with OCD are 10 times more likely to die from suicide than the general population. Part of it comes from the distress of these incessant intrusive thoughts.

Bottom line: if you or a loved one suffer from scrupulosity, don’t wait. Get help. Keep reading to see who is most likely to suffer, where this disorder comes from, and what can be done to help.

How Long Has Scrupulosity Been Around?

Scrupulosity has been around for a very, very long time — probably much longer than written human records can remember. One of the first records that appears to refer to religious anxiety of this kind comes from Plutarch, a first century priest for the Greek god Apollo. He wrote about the so-called “superstitious” man, who

turns pale under his crown of flowers, is terrified while he sacrifices, prays with a faltering voice, scatters incense with trembling hands, and all in all proves how mistaken was the saying of Pythagoras that we are at our best when approaching the gods. For that is the time when the superstitious are most miserable and most woebegone….

Plutarch

On the Egyptian side of the Mediterranean Sea, about 600 years after Plutarch, John Climacus lived in the wilderness as a monk. In those days, men striving for holiness and purity of life would live in the desert. They took vows of poverty, spent much time in prayer, and offered spiritual advice and blessings to commoners who sought them out. They believed that the desert was a place where demons lived, and like Jesus was temped by Satan in the wilderness, they viewed it as a testing ground for their faith.

But for some, the desert experience was too much.

John Climacus wrote about those exhausted by intrusive, blasphemous thoughts. He wrote,

This unholy demon not only blasphemes God and everything that is divine. It stirs up the dirtiest and most obscene thoughts within us, thereby trying to force us to give up praying or to fall into despair. It stops the prayer of many and turns many away from the holy Mysteries. It has evilly and tyrannously caused the bodies of some to be worn away with grief. It has exhausted others with fasting and has given them no rest. It has struck at people living in the world, and also at those leading the monastic life….

Anyone disturbed by the spirit of blasphemy and wishing to be rid of it should bear in mind that thoughts of this type do not originate in his own soul but are caused by [the] unclean devil…. So let us make light of him and pay no regard whatever to his promptings…. To tackle the demon of blasphemy in any way other than this is to be like a man trying to hold lightning in his hands. 

John Climacus

By the fourteenth century, this phenomenon had a name: scruples. It came from the Latin term scrupulum, a sharp stone — indicating the sharp pain of a stabbing conscience. Theologians wrote about those with an oversensitive conscience, which they viewed as a precursor to the deadly sin of despair.

The Archbishop of Florence, Antonius of Florence (1389-1459) was one of the first to suggest that scrupulosity could be caused either by the devil or by physical causes. He recommended medication and holistic treatments, and quoted a fourteenth century theologian, Jean Charlier de Gerson, on advice that sounds very much like today’s therapeutic response to scrupulosity’s symptoms. Scrupulous thoughts, he said, are like

…dogs who bark and snap at passers-by; the best way to deal with them is to ignore them and treat them with contempt.

Jean Carlier de Gerson

More than 600 years later, scrupulosity still seems to be relieved by similar means. But, more will come later on treatment.

A number of other monks, theologians, and scholars wrote about “scruples” during the Early Modern Period — including well-known names such as Ignatius of Loyola (founder of the Jesuit order), John Bunyan (author of Pilgrim’s Progress), John Locke (major Enlightenment thinker) and Martin Luther (famous leader in the Protestant Reformation).

During the 1700’s and 1800’s, doctors began devoting more time to other OCD manifestations, such as checking, washing, and sexual or violent obsessions. In the rising scientific age, religious “scruples” received less attention.

But it did not disappear.

As mental health specialists began trying to categorize and describe all known disorders, they used a few different titles for what is now called obsessive-compulsive disorder. Throughout the 1700’s and 1800’s, OCD was called by some interesting names:

• “Impulsive insanity”
• “Madness of doubt”
• “The secret illness”
• Grubelnsucht, a questioning illness (from the Old German for “racking one’s brains”)
• “Obsessive neurosis”

Finally, in the mid 20th century, “obsessive compulsive disorder” emerged as a generally accepted term to describe these common symptoms. Scrupulosity, though studied far less than other types of compulsions, is understood not as a separate disorder but as a theme within the broader OCD category.

As you can see, scrupulosity has been around since…basically forever. But it has been understood in different ways at different times in history.

Today, it is viewed as a sub-theme of obsessive compulsive disorder. The most successful treatment involves tackling it from both a clinical and a spiritual perspective. To understand this better, we need to look at the causes for scrupulosity.

What Causes Religious OCD?

Currently, there is no definitive consensus about what causes OCD. Scrupulosity, as a religious manifestation of obsessive-compulsive disorder, forms a part of this complex discussion.

Why do people get OCD? Nobody knows for sure.

However, there are a few generally agreed-upon theories. Most researchers agree that obsessive-compulsive disorder has both a biological factor and an environmental factor.

Biological Factors for Scrupulosity

Research suggests a strong genetic link for OCD. 25% of OCD sufferers have an immediate family member with the same disorder, and twin studies have shown a higher likelihood for identical twins rather than fraternal twins to share obsessive-compulsive disorder. Educated guesses suggest that genetics contribute about 45-65% of the risk for developing OCD.

In my own case, I have an immediate family member with severe and debilitating health OCD symptoms, which makes it easy for me to believe the theory that genetics plays a role in obsessive-compulsive disorder.

Data on OCD is notoriously difficult to obtain, though, because many people feel ashamed of their symptoms and avoid treatment. Less than 10% of people with OCD seek treatment, and those who do will go an average of 7-10 years after the first onset of symptoms till diagnosis and treatment.

This may explain why it’s so tough to research OCD.

Other theories, based on brain scans, have shown that the OCD brain works differently than the non-OCD brain. Specifically, research has discovered that the OCD brain is under-active in areas that should modulate and “stop” habitual behavior.

It’s basically like having the brakes out.

This can help us understand why people who suffer from OCD have a hard time stopping their thoughts and compulsions.

In another large brain scan study, patients with OCD showed hyperactivity in the “cingulo-opercular network.” This is the part of the brain that controls one’s level of vigilance and ability to spot errors. In laymen’s terms, this malfunction makes one overly sensitive to possible dangers.

An oversensitivity to possible dangers and an inability to stop trying to prevent disaster? Yep, that sounds like a good description of OCD.

Environmental Factors for Scrupulosity

Genetic theories and brain function theories are usually thought to work alongside environmental factors. Some have observed that childhood exposure to streptococcal infection seems to activate predispositions to OCD. Stress and family background have been suggested as triggers for preexisting tendencies to OCD. Family background can also contribute to OCD if certain patterns and modes of thought are learned and reinforced during childhood, such as fear and avoidance.

While researchers aren’t 100% sure where OCD comes from, there’s a general consensus that it is partly caused by biological factors and partly caused by your thoughts and environment.

That’s why treatment of scrupulosity needs to respect both these factors. Brain patterns and structuring is not set in stone — the brain has incredible plasticity and the ability to adapt. However, it takes time and effort.

I work with my clients to recognize our God-given abilities to change and then commit to long-term results.

Typically, I’m wary of YouTubers or self-published authors who claim they were “cured” of OCD from just one book or sermon. This is like fad diets that claim to melt away your fat while letting you eat whatever you want.

Changing the brain is more like training for a triathlon. Bending, strengthening, and retraining the brain is tough, rewarding, frustrating, and beautiful.

But we’ll talk more about that in just a little bit.

What you need to know for now is that the causes for scrupulosity are usually biological and environmental. Whatever treatment you choose needs to:

1. Expect time and effort for reshaping brain patterns
2. Respect the two-steps-forward-one-step-back reality of cognitive change
3. Address environmental factors that have a role to play in overall mental health

(To work with me one-on-one, book your scrupulosity coaching session here.)

Who Is Most Likely to Get Religious OCD?

At this point, you might be wondering, “Why me? Why did I get religious OCD and everyone else in my family seems to be fine?”

Obsessive compulsive disorder indiscriminately strikes 1-3% of the world’s population; however, not everyone with OCD will have religious manifestations of the disorder (scrupulosity).

Research seems to suggest that OCD is a culturally adaptive disorder.

What does that mean?!

It means that the fundamental patterns of OCD will be common to everyone with the disorder, but the particular obsessional themes will adapt according to what is most important to you.

OCD is like an actor that changes masks to suit his audience. For those who are naturally drawn to order, he appears as the Lord of Symmetry. For those who are gentle and caring, he dons the costume of harm OCD. For the pious and God-fearing, he puts on the mask of religion. From one culture to another, and from one individual to another, OCD themes change — but the underlying pattern and structure of anxiety, rumination, checking, and compulsion will stay the same.

Studies that have shown that OCD sufferers in Rio de Janeiro, where death by violent crime is high, have higher rates of harm-related OCD themes.

In some Asian countries, contamination and cleanliness is the most important theme.

In areas of India where villagers believe they can get pregnant with a puppy fetus when bitten by a dog, obsessive checking for “puppy pregnancy” is high.

And…

For religious communities that have high standards of morality or sanctification, religious themes become prominent.

The most commonly cited cases are Islamic, Orthodox Jewish, and Catholic communities. In the Middle East, scrupulosity rates are much higher than the rest of the world — one study estimates about 50% of Egyptians with OCD and 60% of Saudis with OCD have religious obsessive themes (in the US, 10-30% of OCD sufferers experience religious themes). Another study demonstrated that Protestant OCD patients had higher rates of religious intrusive thoughts than nonreligious OCD patients.

Around the world, rates of obsessive-compulsive disorder remain the same — but the specific themes that surface appear to be highly contextual. Again, this supports the theory that OCD is both a biological predisposition paired with environmental factors.

So if you belong to a faith community with definitive teachings about sin, punishment, and morality…

and…

You are biologically predisposed to having obsessive compulsive disorder…

Then all the ingredients are right to set you up for having scrupulous obsessions. It appears to be a matter of both nature + nurture. We could make an equation like the following:

Biological predisposition + environmental triggers and learned behavior = likelihood for getting scrupulosity.

What should you do if you find out that you have scrupulosity? Start by suspending judgment for a while. Don’t immediately blame yourself, your religion, your family, or your faith community.

It takes time to make the delicate surgery between obsessive-compulsive faith and true faith. Suspend judgment and give yourself space to make this separation.

Can Scrupulosity Be Cured?

Bottom line? Yes, scrupulosity can be cured.

But depending on the severity and source of your scrupulosity, you should know that the remission rate, relapse rate, and length of treatment will vary.

What do I mean when I say “source?”

Earlier I wrote about the causes for obsessive-compulsive disorder, which appear to involve both biological and environmental factors. This is typically what I am referring to when I use the word “scrupulosity.” However, there are at least two scenarios where scrupulous look-alike symptoms can emerge. In both of these cases, the outlook is very positive.

Scrupulosity Look-Alike: Spiritual Hangups

It is possible that spiritual hangups can cause symptoms remarkably similar to religious OCD. For example,

• Faulty doctrinal beliefs about salvation
• Legalism
• Unresolved addictions

Such spiritual problems can also cause recurrent doubts and guilt that can appear very similar to scrupulosity. These issues need to be dealt with from Scripture, and if one has a willing heart, can usually be resolved in a reasonable amount of time.

If your spiritual anxiety does not have “true” roots in OCD, your prospects of experiencing a full and total remission look very positive.

Scrupulosity Look-Alike: Dissonance with Religious Community

Other times, scrupulosity-like symptoms can be signs of a religious experience that is more mature and meaningful than others in your faith community.

For example, I once spoke with a lovely Tennessee lady who was being ostracized by her church.

Why?

Because she felt called to live in obedience to Biblical norms that her faith community felt was too “legalistic.” She began to wonder if there was something wrong with her for being so conscientious about God’s Word.

Having lived most of her life in a small rural community, she was not aware of other religious views. She didn’t realize that her seemingly unwelcome beliefs were lining up with tens of thousands of other believers in different denominations.

What her church called “legalism,” others called “Biblical sanctification.”

To treat her case as if it were scrupulosity would have squelched true spiritual growth. Thus, it’s important to remember that being more conscientious than others in our faith community is not the sole determinant for having religious OCD. Sometimes, spiritual dissonance, angst, and confusion is a normal and positive part of growth.

So, Will Scrupulosity Ever “Go Away?”

To answer the question about whether scrupulosity can be cured or not, let me make the following suggestion: scrupulous symptoms that are caused by spiritual hangups or community dissonance can be permanently resolved, usually in a very reasonable amount of time.

Scrupulous symptoms that are caused by religious OCD proper can also be cured. But there is a higher likelihood that your symptoms will be reduced and managed rather than go away entirely.

Multiple longitudinal studies have followed obsessive-compulsive patients over the course of treatment for one, three, or five years. They’ve discovered that full remission after treatment peaks at about 38%.

For most of us, religious OCD will continue to be an issue that we manage over the course of our lives, much like a diabetic takes measures to manage his blood sugar levels.

Can we live a normal life with scrupulosity? Yes.

In my case, being diagnosed with scrupulosity took about 11 years from the first onset of symptoms during adolescence. During that time, I struggled with religion and anxiety but incorrectly assumed that my problem was sin or a lack of faith. After treatment, however, I developed the ability to begin separating between the true and false manifestations of spirituality.

It took me several years, but eventually I was able to manage my obsessive-compulsive symptoms so well that I would at times forget about it.

But they haven’t gone away entirely.

In times of stress, overwhelm, uncertainty, or personal failure, my scrupulosity flares up, just like acne-prone skin can flare up after holiday chocolate binges. Anytime those “danger” signals get turned on in the brain, my automatic response is to leap into an obsessive-compulsive cycle.

But you know what? I don’t stress about it.

And I don’t ask my clients to stress about it, either. Obsessive-compulsive disorder has a pretty strong track record for sticking around long-term. (If you were looking for a stable, lifelong partner, OCD is your man.) As much as 59% of OCD patients experience relapse after treatment. Then we have to get back up, let Jesus dust us off, and try again.

We don’t fully understand the science behind religious OCD. We do understand that across all types of OCD (including scrupulosity) there is a relatively low remission rate and pretty good chances that, given the right factors, it will flare up again.

So we work towards full remission — hoping to be within that 12-38% of the fully cured — but we also don’t stress out if we recognize we’ve taken two steps forward and one step back.

But here’s the promise I can make to you: if you learn to manage your symptoms well, you can live a normal, happy life. Despite having gone through raging scrupulosity in my younger years, I do have a “normal” life. I’m happily married, I’m pursuing my second graduate degree, and I get my kitchen cleaned (almost) every day. You can follow your dreams, experience happiness, and have a fulfilling spiritual life.

So let’s talk about your options. What kind of response will help you make it to this goal? What do we mean when we talk about “managing” symptoms? Let’s go now to the section about treatment.

How Can Scrupulosity Be Treated?

Here we are in the bread and butter of this article: how do we treat scrupulosity?

There are tried-and-true methods. There are possibly helpful methods. And there are terribly ineffective methods that are, by misinformation, still recommended (like thought-stopping with a rubber band). In this section we’ll look at treatment methods for scrupulosity in three categories:

1. Clinical Interventions
2. Spiritual Interventions
3. Lifestyle Interventions

Clinical Interventions

A “clinical” intervention is anything you would work on with your psychiatrist or therapist.

Just as a quick review, a psychiatrist is a mental health expert who prescribes medication, while a therapist is a mental health expert who works with you on modifying your thought processes and emotions through talk therapy.

You can imagine a psychiatrist as the one holding a bottle of pills and the therapist as the one holding the clipboard.

Here are some of the most well-known clinical interventions for scrupulosity.

Exposure and Response Prevention Therapy: 5 Stars

As an intervention for OCD, Exposure and Response Prevention (ERP) is the gold standard for clinical treatment.

How does it work?

Your therapist will guide you through the process of first identifying triggering thoughts. Then he or she will help you begin exposing yourself to these terrifying thoughts without reacting to them.

This is why the latter part of the treatment is called “response prevention.” This is the ingredient that makes ERP highly effective yet very scary.

For example, someone with contamination OCD may be asked to touch the doorknob and not sanitize his hands. The therapist will then help him develop the ability to sit through the feelings of anxiety until they gradually recede on their own.

Not acting in the face of our obsessions can be very disturbing (one reason why you should not try ERP alone). But exposing ourselves to our greatest fears and then resisting the compulsion to “solve” them is what helps us break the mental chain that enslaves us.

It’s not comfortable, I can assure you.

But it works. It works very well.

The problem with using ERP to treat scrupulosity is that the religious nature of scrupulosity can pose unique roadblocks. Kevin Foss, a California-based therapist specializing in religious OCD, writes that scrupulosity treatment often “hits a wall” with his clients because they are unwilling to go through with ERP.

ERP can feel like it has deep moral and spiritual implications. Although it is a method that is helping you develop a normal spirituality, it can feel terribly frightening. For example, the woman who prays compulsively, repeating her prayers dozens of times until she feels they are done “right,” might be asked to pray only once and then stop, no matter how she feels.

This can easily feel like a denial of faith. So scrupulous sufferers begin dropping out of treatment when ERP gets more intense.

If you’ve begun treatment for scrupulosity but dropped out because of ERP’s difficulty, you may wish to work in tandem with a spiritual coach and a therapist. A pastor or spiritual mentor can help you frame the therapist’s requests in the context of faithfully seeking total health of spirit, soul, and body (1 Thessalonians 5:23).

Acceptance-Commitment Therapy: 4 Stars

Acceptance-Commitment Therapy (ACT) for scrupulosity can be quite effective. It involves reframing our response to anxious thoughts and feelings by accepting the inevitable presence of anxiety and committing to letting go of the need to act on anxious thoughts.

ACT is different from the cliche “let go and let God” phrase that we often hear in religious circles. With “let go and let God,” there is often spiritual guilt and shame attached to feelings of anxiety. We sometimes hear that Christians must not feel fear or uncertainty.

This is, at its core, an oversimplification of what Scripture says about anxiety.

But anyways, ACT works to break the nervous cycle of always getting stuck in your head trying to “fix” troublesome emotions.

My only word of caution for Christian clients would be to ask their therapist for a spiritually neutral form of ACT. Though its basis can be justified by Scripture, ACT sometimes takes the direction of Eastern mysticism, and about 40% of clinical trials involving ACT include an aspect of meditation, which Christian clients may find objectionable.

Cognitive Behavioral Therapy: 2 Stars

Once upon a time, before I knew I had scrupulosity, I started seeing a therapist for my scrupulosity-induced depression.

She prescribed Cognitive Behavioral Therapy (CBT). Gushing over the benefits of CBT, she told me, “I prescribe CBT for almost everyone, because it’s just so effective. It works wonders for everyone except people with OCD — because for them, it can backfire.”

Famous last words.

I dutifully printed out the CBT worksheets wherein I was supposed to challenge my thoughts and argue them into submission.

I filled out the sheets every. single. day.

And I argued.

Oh, let me tell you, I argued. CBT’s goal is to help you become aware of cognitive distortions and challenge them. So I challenged them till I was red in the face.

I became more anxious, more depressed, and more stuck in my head. I got so bad that I dropped out of therapy for some time. (The story is redeemable, though, because it was that counselor’s random comment about OCD that made me eventually look it up when I realized the activities indeed were backfiring.)

Typically, cognitive challenging is really unhelpful for scrupulosity. Why? Because it’s simply not possible to “solve” OCD’s intrusive thoughts, whether they be about religion, contamination, or sexual orientation.

However, I have still given CBT two stars. Why? Because learning how to identify cognitive distortions — such as all-or-nothing thinking, magnification, heaven’s reward fallacy, or personalization — is still helpful. Those with OCD are statistically more likely to develop depression at some point in life, and having some CBT skills under our belts can ward off the nasty combo of OCD + depression.

So don’t pass by cognitive challenging too quickly — but I wouldn’t recommend it as your first or main line of treatment.

Medication: 1 Star

The last treatment option in our list of clinical interventions is medication. As a spiritual life coach — having spent more than ten years in various ministry roles and Biblical exegesis — I can say that my religious worldview definitely supports the concept of modern medicine.

We have numerous Biblical examples of substances from the plant kingdom being used medicinally (see this, this, and this passage). From a theoretical standpoint, I have no qualms with medication.

However, the relationship between medication and OCD isn’t as simple as popping an aspirin.

Dr. Jonathan Abramowitz, one of today’s leading researchers on scrupulosity and other obsessive-compulsive manifestations, tells us in the video below his view on medication in comparison to the above categories of cognitive therapies: meds just aren’t as effective as therapy.

In recent years, antidepressants (the medication of choice for OCD) have come under increased scrutiny. They often cause side effects which range from unpleasant to suicide-inducing. Once the unpublished drug studies were included in analysis via the Freedom of Information Act, it was also publicized that antidepressants are not statistically more effective than placebos.

And here’s another fact that might surprise you: clinical trials showed that 40% of OCD patients don’t respond to antidepressants at all. Furthermore, individuals with OCD required a much higher dosage to see any clinical response, and a complete recovery from OCD due to medication alone was shown to be a rare occurrence.

So, should you take medication?

It’s your choice.

Sometimes, doctors prescribe antidepressants in cases of backlogged healthcare systems. If you won’t be able to see a therapist for a year, your doctor may feel that it’s better to give you prescription meds rather than give you nothing.

But in the long run, it may not be your most effective treatment option.

Spiritual Interventions

Spiritual interventions are the responses you would work on with a pastor, chaplain, spiritual life coach, or religious mentor.

These solutions don’t come in a bottle and won’t be found in psychological textbooks. Instead, they rely on a careful application of religious beliefs and values to the scrupulous situation. Spiritual interventions answer the question, “what does my faith tradition offer that can help me overcome scrupulosity?”

Spiritual interventions can be extremely helpful, especially when applied in tandem with clinical interventions such as ERP and ACT. The most effective spiritual interventions include the following.

Accepting Uncertainty

I work with my clients to develop a greater tolerance for uncertainty, which decreases symptoms of scrupulosity. We do this by studying Bible passages emphasizing holy Mystery, intellectual pride versus humility, and Biblical characters who were well accepted by God in a state of non-knowing.

For example, one of my favorite narratives is old Job, the Biblical patriarch who went from riches to rags overnight as Satan made a wager with God.

Typical sermons focus on the fact that Job trusted God during loss. But the story doesn’t end there. No, it continues chapter after chapter as Job’s four friends harangue him. They’re all seeking for answers: why has this happened to good ol’ Job?

Job himself puts on sackcloth, sits in a heap of ashes, and scrapes his boils with a broken pot shard. In a state of misery, he ruminates. Much like an obsessive.

Finally, after 37 chapters of rumination, God steps in. He delivers a lofty, elegant speech (time and space prevent me from drawing out all the implications for scrupulosity, but perhaps in another post I will elaborate).

God’s main point is not to tell Job about the cosmic wager.

His main point isn’t to satisfy Job’s cravings for salvific assurance.

God doesn’t even bother answering a single one of Job’s questions!

Instead, God’s powerful monologue buries Job under an onslaught of mystery.

“Where were you when I laid the foundations of the earth? Tell me, if you have understanding. Who determined its measurements? Surely you know! …Have you entered the springs of the sea? Or have you walked in search of the depths? Have the gates of death been revealed to you? Or have you seen the doors of the shadow of death? Have you comprehended the breadth of the earth? Tell Me, if you know all this.”

–God, Job 38:4-5, 16-18

At the climax of God’s speech in chapter 41, God’s summary is that there will always be things in the natural world that we cannot understand. How much more will there be things in the spiritual world that are beyond our ken?

Job’s response is to “repent in dust and ashes” for his presumption (Job 42:1-6). There is no more seeking for answers. No more rumination. No more trying to “solve” his uncertainties.

He lets go of the need for certainty.

And this is exactly the process that scrupulous individuals must experience, too. Accepting the inevitable presence of uncertainties is key to developing both spiritual and mental health.

Fully assimilating this single concept will probably be the most impactful step you can take in beating scrupulosity. I work with my clients through passages like this one to overcome the “certainty addiction” that lies at the root of scrupulosity.

Setting Spiritual Boundaries

If there’s something that scrupulous folks don’t do well, it’s setting boundaries.

Researchers have discovered that the part of the brain that signals obsessive-compulsives to “stop” activities is underactive.

Let me try to illustrate this.

One of my favorite fitness channels on YouTube is FitnessBlender, a husband-wife couple who have made hundreds of workout videos. At the end of every video, they flash a smile and say, “this workout is complete.”

Over the years, they’ve gained a cult-like fitness following. Fans can purchase posters, t-shirts, and even pillows with the slogan, “workout complete.”

After an intense workout, it feels so good to hear those words: workout complete.

But with religious OCD, there is no “complete” message. No point at which we have done enough. The part of the brain responsible for sending the “complete” signal is not working, so we are left with a feeling that we simply must keep going.

It’s like leaving the YouTube “autoplay” function on and doing workout videos until YouTube makes you stop. It won’t make you stop, and neither will the obsessive-compulsive brain.

Thankfully, the Bible doesn’t support this kind of excessive behavior. Built into Scripture’s portrayal of spirituality are natural checks and balances that help us create healthy boundaries.

Take a look at King Solomon, who wrote cryptically at the end of his life,

Do not be overly righteous,
Nor be overly wise:
Why should you destroy yourself?
Do not be overly wicked,
Nor be foolish:
Why should you die before your time?
It is good that you grasp this,
And also not remove your hand from the other;
For he who fears God will escape them all.

Ecclesiastes 7:15-18

It’s insightful that Solomon says we should not be “overly righteous.”

Might Solomon have had scrupulosity? We are too far removed in history to know for sure, but I can’t stop thinking about that story of young Solomon offering a thousand sacrifices, then getting to the end of his life and telling us to take it easy with spiritual things. Don’t go overboard. Don’t study too much. Don’t be “overly righteous.”

Healthy spirituality involves boundaries: knowing when enough is enough. Viewing God as satisfied rather than hungry.

Jennifer Traig, a scrupulous American Jew, didn’t begin to experience a decrease of symptoms until her family wrote a list of boundaries: praying for no more than an hour per day, no supervising her mother’s cooking to make sure it kept kosher, no forcing others to keep Shabbat, and so on.

She writes in her memoir that these parental boundaries stopped her scrupulous activities (though she later relapsed as an adult).

How much better if we develop our own internal boundary-drawing mechanism?

Easier said than done, but doable.

Scrupulosity coaching with your pastor, priest, or mentor involves studying the Bible to determine Biblical standards of behavior, and being held accountable to not go beyond what is written. This can be tricky, because most scrupulous individuals can find verses that seem to support their aggressive proselytism or hyperactive attention to purity.

But scrupulosity must be analyzed from the perspective of the whole life, recognizing the net effect of compulsions on one’s quality of life, and asking whether or not this is truly what God intended.

If you have a spiritual leader who understands scrupulosity, ask him or her to guide you through the process of listing your spiritual compulsions and creating healthy boundaries.

Reassessing God’s Character and Mode of Salvation

Thousands of years ago, God said, “My people are destroyed for lack of knowledge” (Hosea 4:6). Crucial misunderstandings of God’s character can lead us to erratic, sinful, fanatic, or overly cautious behavior.

That’s been the story of human behavior since the dawn of time.

We humans fear God, we detest His “restrictions,” we pass Him off as a do-gooder marshmallow guy-in-the-sky, or we shelve Him as a fairy tale.

Rarely do we get our picture of God right.

The devil is gleeful, of course. If he can’t freeze us ice of indifference, he’ll burn us in the fire of fanaticism. Just as long as we don’t get it right. Just as long as we don’t catch a glimpse of who God really is in His benevolent love and paternal protection.

Speaking of the devil — do I believe scrupulosity is demonic possession or direct satanic harassment? No. But insofar as we can trace all of earth’s sickness, woes, and sorrows back to Satan, the arch-deceiver and destroyer of all life and happiness, I blame scrupulosity squarely on him.

All things in this fallen world reach out to blind our eyes to the true character of God. Perhaps scrupulous individuals are somewhat more vulnerable to these deceptions, but we are also the ones who, like Martin Luther, will grasp the flame of truth with glowing ardor once we understand it.

An important spiritual intervention for scrupulosity is to develop a biblical understanding of the character of God and His mode of salvation.

Especially for those who have struggled with scrupulosity for years, this can demand an entire worldview transformation. Although scrupulosity has roots in biological predispositions, we have spent years and years strengthening neural networks in the wrong direction.

We went down the wrong mental path so many times that our behavior has created highways towards faulty views of God.

Breaking faulty understandings of God’s character often occurs in stages. There is the initial “aha” moment, full of beauty and excitement, when we see God with new eyes.

But those neural pathways are still so strong.

In our everyday relationship with God, long-established habit struggles against new truths gained from God’s word. We still feel a sense of hyper-responsibility, we fear God’s wrath, we feel a false sense of His displeasure. Thus, many of us may go through a somewhat lengthy stage of learning to apply biblical truths to our faith experience.

And that’s totally ok. God is patient. Is is His patience and longsuffering that is responsible for saving us at the end of the day (2 Peter 3:9).

I work with my clients to root out faulty assumptions about God’s character. We go through scripture and learn how to accept God’s promises by faith, not by feeling or demonstration.

When we look at the history of scrupulosity, this is the step that ultimately helped key figures like Martin Luther to finally come to terms with his religious OCD.

And it will work for you, too.

Lifestyle Interventions

We’ve discussed clinical and spiritual interventions for scrupulosity, but it’s also important to remember lifestyle factors.

God created us as whole beings — body, mind, and spirit. The brain is connected to the rest of the body, so what we do in the body will affect our mental health.

Without going into too much detail, I’ll remind you of brain-healthy lifestyle habits that you probably already knew about. Stringent adherence to a lifestyle that supports mental health can give you a head start in beating scrupulosity.

Try to implement as many of the following habits as possible:

• Regular physical activity
• Consistent sleep cycles
• Avoidance of alcohol and nicotine
• Relaxation techniques (nature exposure, deep breathing, creating a relaxing home environment, massage, etc.)
• Healthy diet

Think these lifestyle interventions sound unrelated to mental health? Let me challenge that assumption with my story.

When I went into treatment for severe depression, I attended a depression and anxiety recovery program in California. The entire 10-day experience forced attendees into the above lifestyle standards — boot camp style. It also included hydrotherapy sessions (alternating hot and cold water immersion) and cognitive behavioral therapy.

It sounds simple. So. Simple.

Exercise, sleep right, and eat healthy? Yeah, right. As if that can have an impact on mental health.

Let me assure you — I’m a prime witness to the effects of lifestyle on mental health. With three hours of daily exercise in open nature, plant-based food, 8 hours of sleep (circadian rhythm reinforced with a medical-grade blue light), hydrotherapy, and counseling — my depression was cured in ten days.

I’ve been depression-free in the years since.

I don’t maintain a 3-hour daily exercise regimen, but I’ve done my best to continue as much of these lifestyle interventions as possible.

(This video will get you excited to exercise as soon as possible!) ” />

I’m not a scientist; my expertise is in spirituality, so I will not attempt to explain correlations between diet and mental health, nor will I try to explain what happens to your neurotransmitters when you exercise. What I know is that it works, and in our journey with scrupulosity, we need every single bit of help we can get.

Are There Other Disorders Commonly Experienced Alongside Scrupulosity?

Unfortunately, research has discovered that people with obsessive-compulsive disorder are at a higher risk for developing other mental health complications.

For example, individuals with OCD are 10 times more likely to suffer from major depressive disorder and 10 times more likely to die from suicide. There’s a 15-35% overlap between OCD and bipolar disorder, and up to 56% of OCD patients may also have panic disorder (source).

Research has also shown a strong connection between OCD and the following conditions:

• ADHD
• Parkinson’s Disease
• Epilepsy
• Tourette’s Syndrome (tic disorders)
• Anxiety Disorders
• Eating Disorders
• Trichotillomania (hair-pulling)
• Excoriation (skin-picking)

Sudden onset of obsessive-compulsive symptoms has also been observed after suffering a stroke, or in the case of young children, after contracting strep throat.

Scrupulosity, as a subcategory of OCD, is not invulnerable to these statistics. We need to understand that if we have scrupulosity, we are at risk for other mental health vulnerabilities. Dealing with our obsessive-compulsive trends is a top priority.

It should also be noted that in most cases of depression seen in OCD patients, the OCD predated the depression. That is, when we ask the question about whether the chicken or the egg came first, it is almost always OCD. Depression arises out of the emotional suffering of trying to deal with the obsessive-compulsive spiral.

Scrupulosity OCD is not something to take lightly, as if it’s just a mere personality quirk.

It is a real mental health vulnerability.

This doesn’t mean that it’s the end of the world, but if you’ve been diagnosed with OCD of any kind, it should alert you to the fact that you will need to prioritize mental health self-care more than others in the general population.

This is important for family members and loved ones to understand, as well. Before I was diagnosed with scrupulosity, I hid most of my symptoms (as is quite common with OCD). When the symptoms worsened and began interfering with daily life — taking up hours of my time each day, causing depression and severe distraction — it was like the tip of an iceberg peeking through.

My husband thought I was just stressed out.

But the iceberg was much bigger than it appeared on the surface.

To this day, I still don’t tell my husband all the weird, unhelpful, intrusive thoughts that scrupulosity throws my way.

What I do tell my husband on a regular basis is my emotional status. This is the part of the iceberg that is a good idea to share. Our family members need to know whether we’re feeling anxious, depressed, or calm. They can support us and keep their eyes out for more urgent issues like burnout, panic attacks, or suicidal ideations.

The bottom line: if we have scrupulosity, we belong to a somewhat more vulnerable mental health category. Simply put, let’s take care.

Let’s get out priorities straight. Let’s communicate what we need to communicate to our loved ones. No matter how well we are able to manage our OCD or even go into complete remission, the same vulnerabilities will be there, and we need to take these statistics seriously.

How Long Does It Take for Religious OCD to Get Better?

The improvement rate for scrupulosity depends on a lot of factors.

• Quality of healthcare provider
• Frequency and type of therapy sessions
• Personal effort and dedication
• Environmental stressors
• Family support

Research also suggests that a full remission of OCD is more likely for those who have had symptoms for less amount of time — that is, if you catch it and treat it sooner, you’re more likely to kiss it goodbye for good. However, some people may be willing or unwilling to go through with treatment (like the much-hated, highly effective ERP therapy).

But what about an estimated timeline? How long should it take for scrupulosity to begin getting better?

Dr. Jonathan Abramowitz suggests that in about 16 to 20 ERP sessions, a patient can begin seeing significant improvement of OCD symptoms.

If you work on attacking from every possible angle — including spiritual coaching and lifestyle interventions — you’ll build an even stronger strategy. It’s possible to see your major scrupulosity symptoms disappear or reach a minimal level in just 4 to 6 months.

But if you can’t attack your scrupulosity from all angles — clinical, spiritual, and lifestyle — start with just one. Start with the easiest and most convenient intervention, budget a longer recovery time, and start plugging away.

Conclusion

Scrupulosity OCD is a combination of learned and biological factors that make religion seem like a tyrant. But it doesn’t need to be like that forever. Now is your time to revolt — not against religion, but against this imposter, scrupulosity.

Jesus said we will know the truth, and the truth will set us free (John 8:32). Do you honestly feel “free” within the compulsive demands of scrupulosity?

No!

Christ’s promise of freedom comes through knowing truth. We must take a merciless, truthful look at ourselves and vow to root out every last shred of the “learned” behavior of OCD. We must believe the truth that some parts of scrupulosity are biological and will require long, arduous efforts to bend our brains new ways. We must accept the biblical truth that we are not omniscient and cannot remain addicted to certainty any longer.

Life is short. Every day that ticks by is a day you can either spend in freedom or in bondage. Don’t wait. Don’t think that scrupulosity will go away on its own — it probably won’t. Take action today to gain freedom from religious OCD:

• Take a scrupulosity quiz to find out your likelihood of having religious OCD
• Schedule a consultation to see if scrupulosity coaching is right for you
• Find more articles on my blog to support your scrupulosity journey

As a survivor of scrupulosity, I can tell you that it does get better. But don’t wait. Don’t spend your entire life worshipping God in fear and trembling. Take action today, and learn how to worship Him in spirit and in truth.

What’s holding you back from conquering your scrupulosity?