scrupulosity

Scrupulosity, also known as religious OCD, is a form of obsessive-compulsive disorder in which obsessions and compulsions revolve around religious or moral themes. Individuals experience persistent, distressing thoughts about sin, guilt, or failing to meet divine standards, accompanied by rituals intended to reduce anxiety or prevent perceived wrongdoing.

Common symptoms include intrusive religious or moral thoughts, compulsive prayer, confession, ritualized mental reviews, excessive seeking of reassurance, and avoidance of situations perceived as morally dangerous. Behaviour may be time-consuming and impair daily functioning, relationships, work, or study.

Scrupulosity is considered a manifestation of OCD rather than a distinct religious condition. It is associated with cognitive distortions such as inflated personal responsibility, moral absolutism, dichotomous thinking, and overvaluation of thoughts as morally decisive. Neurobiological factors and family history can contribute, and symptoms often begin in adolescence or early adulthood.

Diagnosis follows standard OCD criteria, with the religious content serving as the primary obsessional theme. The condition is distinguished from ordinary religious devotion by the level of distress, impairment, and the compulsive nature of the rituals.

Treatment typically involves evidence-based OCD therapies. Cognitive-behavioral therapy with exposure and response prevention tailored to religious concerns is commonly used. Serotonergic medications, such as SSRIs (for example fluoxetine, sertraline), may be effective, sometimes in combination with psychotherapy. Education, supportive counseling, and collaboration with trusted religious advisers can help, provided they respect the patient’s autonomy and avoid enabling compulsions.

Prognosis improves with appropriate treatment; without it, scrupulosity can be chronic and incapacitating. Prevalence is not precisely known but is estimated to comprise a notable minority of OCD cases.