There are many versions or subtypes of obsessive compulsive disorder (OCD). One of them is scrupulosity.
The primary anxiety of those with scrupulosity OCD is the fear of being an ethical, moral, or religious failure. They constantly worry that their spiritual efforts either disappoint or offend God.
OCD and Subtypes
All individuals with OCD, whatever the subtype, go through the same thought-behavior cycle. The cycle starts with an unwanted, intrusive thought (an obsession) that triggers intense anxiety. To ease the anxiety a ritual (compulsive behavior) is performed. The experience of relief upon completing the ritual reinforces its use.
What distinguishes one OCD subtype from another is the focus or content of the intrusive thoughts. The focus might be germs, sexual orientation, violence, or catastrophes. The focus, for those with scrupulosity, is tainted virtue.
Scrupulosity
While obsessive thoughts are distressful to people with all types of OCD, the obsessions experienced by those with scrupulosity are linked to their core values and character. Their disturbing thoughts tarnish the person they know themselves to be. This is not true for everyone with OCD.
For instance, a generally compassionate person with OCD who obsesses about harming others will at some point realize the thoughts of harming are out of sync with their character. However, when a believer in God obsesses about avoiding sin, their disturbing thought content is in sync with their religious character, the person they know themselves to be.
Though any spiritual practitioner may be concerned about doing or saying things contrary to their faith, a person with scrupulosity is dogged by perfectionism, or following their faith to the letter. There is a world of difference between living one’s faith with conviction, and having to strictly adhere to specific religious rules or doctrines.
The guilt and anxiety experienced by scrupulosity sufferers are fueled not only by thoughts of violating a religious law or ideal, but by the threat of eternal punishment for doing so. This creates an overwhelming desire to perform the compulsive ritual that calms distress.
Most Effective Treatment
Treating scrupulosity is challenging since sufferers must face fears that are in line with a their character and values. However, as with other types of OCD, mindfulness-based cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are generally effective treatments.
Mindfulness practice helps people observe unwanted thoughts without reacting to them. CBT gives people an opportunity to challenge the truthfulness and significance of their intrusive thoughts. By exposing people to their anxiety triggers, and having them refrain from performing compulsive rituals, ERP breaks the relentless self-reinforcing OCD cycle.
Source: OCDLA
Photo credit: Craig Sunter
