Understanding OCD and Religious Scrupulosity

With religious scrupulosity, a type of OCD, people experience obsessions, compulsions, and distress related to faith, spirituality, and religion

October 27, 2023

When people have religious scrupulosity, one form of obsessive compulsive disorder, they experience significant doubt, anxiety, and distress about their moral beliefs or religious practices.

For example, people who have scrupulosity may worry if they are performing the rites, observations, prayers, or other obligations of their religion correctly.

They may even place extra demands on themselves that their spirituality or religion does not even ask of them.

The obsessive thoughts of scrupulosity can lead to a never-ending sense of doubt. People who experience such feelings are faced with a relentless desire to make up for their perceived failings.

Despite their best intentions, they become trapped in a vicious cycle of uncertainty and shame.

Fortunately, there is help for religious scrupulosity. Just as with other forms of OCD, treatment is available.

Keep Reading To Learn

  • What religious obsessions and compulsions look like
  • How to recognize if you or a loved one has symptoms of scrupulosity
  • How to treat and manage religion-oriented OCD successfully

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What Is Religious Scrupulosity?

While people with moral scrupulosity fear that their actions won’t match their own sense of what’s right and wrong, people with religious scrupulosity focus on ensuring their actions match their religious or faith-based beliefs.

The difference between faithful observance and religious scrupulosity arises in how someone thinks about their practice.

Most people practice the rituals of their faith and then move on, satisfied they have fulfilled their religious obligations. People with religious scrupulosity, however, fear that what they do is never enough, that they are never enough, or that they have offended their God in some way.

Once scrupulosity takes hold, it can gradually deepen until nothing can soothe a person’s obsessive thoughts that they are bad, unworthy, or blasphemous. When someone has religious scrupulosity, their distress that they have lost touch with God or have let their community down can be difficult to overcome.

Scrupulosity can become severe and take over a person’s life. It can leave them feeling like they have little control over how they feel and act.

Untreated, this form of OCD can eventually degrade relationships, work life, school and family responsibilities, and the ability to find happiness or satisfaction in activities.

What Are the Symptoms of Religious Obsessions and Compulsions?

To understand scrupulosity, it is important to know the difference between obsessions and compulsions.

Obsessions are frequent and intrusive thoughts related to a particular subject.

People fear that an obsession shows that they are purposefully breaking a taboo or willingly entertaining offensive or disgusting thoughts and actions. This leaves them desperate to alleviate the distress their thoughts are causing.

Compulsions are actions one takes to soothe or quiet obsessive thoughts.

Counting, praying, or engaging in cleanliness rituals are all examples of compulsions. These repetitive actions often feel to the person as though they are unavoidable. A person with OCD engages in compulsions because they believe they cannot do anything else until they experience some relief.

Like any manifestation of OCD, religious scrupulosity is characterized by constant, ongoing obsessions and the actions meant to soothe them.

Though there is a wide range depending on the person and their religious community, common symptoms include:

  • Conducting prayers and religious acts repetitively until the person believes they have done them perfectly
  • Using “magical numbers” when performing rites, crossing oneself or saying prayers, only stopping when that magic number is reached, and repeating the entire process again in a short period of time
  • Constantly repenting—either as a prayer or by repeatedly going to confession—even at times when it is not expected
  • Curating religious items and spending undue amounts of time worrying that they will become damaged or tainted
  • Compulsively repeating conversations or prayers back to oneself to look for mistakes that might offend God
  • Endlessly trying to do the right thing as a way of washing away sins
  • Having the ongoing perception of doing the wrong thing
  • Making up for every bad thought with obsessive words, prayers, readings, or actions
  • Questioning religious leaders about the meaning of texts, the requirements of rites or rituals, and the acceptability of words or actions
  • Obsessing about scriptures, compulsively rereading them, parsing them for information, and worrying that one might have misunderstood them (and that there will be consequences for having done so)
  • Punishing oneself for every negative or judgmental thought and making oneself carry out good actions or think good thoughts as a form of repentance
  • Fear of possession by demons or the Devil
  • Fear of being “discovered” for how evil or impure one is
  • Fear of wronging others in a variety of ways, including fear of moral, financial, and sexual transgressions
  • Double-checking every expectation or action

While people with scrupulosity engage in the above behaviors to reassure themselves, these behaviors are never enough to help someone feel okay.

Without treatment, obsessions and compulsions typically do not stop. No amount of trying to think about something the right way or performing a ritual correctly “this time” will succeed.

The obsessive compulsive nature of scrupulosity can drive other people away because they feel their reassurances are never enough. The increasing distance of friends and family may fuel the belief that a person is somehow failing or impure.

Scrupulosity’s effect on relationships can leave a person feeling like they need to do even more or be an even better person to make up for these issues. It is a vicious cycle, and unfortunately, it is not uncommon.

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How Common Is Scrupulosity?

It is estimated that more than 2% of people will experience some form of OCD in their lifetime, and of those, a full third will experience it in the form of scrupulosity. That means that of every 150 people someone encounters, one person is experiencing moral or religious OCD or has experienced it at some point.

People do not need to practice a religion to experience religious scrupulosity.

Studies have found that of those who experienced scrupulosity, nearly a quarter had no religious affiliation.

Many individuals who identify as spiritual, faith-based, agnostic, or even atheists can experience scrupulosity. Because scrupulosity is not about religion or faith—it is OCD guised in the theme of religion and God.

The cause of scrupulosity is not known. Hard empirical evidence is lacking. However, anecdotal research shows that the condition stems from the same factors as broader OCD and other mental health conditions: genetic and environmental influences, and nature versus nurture.

Risk factors vary by person. Given the different brain development and socialization of children and adults, scrupulosity also presents differently depending on age.

OCD, Religion, and Scrupulosity in Kids and Teens

One of the defining characteristics of children and teens is that they are not yet old enough to make many of their own decisions. Because of this, scrupulosity in this age group frequently takes on the overtones of the religion practiced in the home.

Whether or not parents or guardians attend a religious gathering regularly, a child or teen may believe they are not meeting the requirements of the family’s religion.

As with anyone who experiences scrupulosity, children and teens worry that their thoughts are impure. They may feel anxious that they are not good enough and that their thoughts will have negative consequences.

Children already face a lot of correction in life as they learn to function in society. Additional internal pressures of trying to be perfectly good can have devastating consequences for young people.

Children’s fears often center on their parents. Some kids fear their parents will not love them. They may worry that God will strike their parents down in retaliation for unworthy thoughts. Consequently, children with scrupulosity try to make up for their failings but never feel they succeed.

Another factor that affects scrupulosity in children is their lack of autonomy. For example, they are unlikely to attend religious services on their own or connect with spiritual leaders of their choice. On the other hand, they may be forced to interact with leaders or attend services that do not resonate with them. These factors can increase feelings of inadequacy and doubt in young people.

In the case of children and teens, it is important to remember that concerns about pleasing authority figures and parents need to be addressed along with scrupulosity.

OCD, Religion, and Scrupulosity in Adults

Compared to children with scrupulosity, adults have more access to resources as well as more self-governed time.

Adults with religion-oriented OCD are more likely to go repeatedly to their place of worship to pray or confess. They may seek out spiritual leaders and make desperate bids to receive assurances they cannot find within themselves. They may repeatedly perform cleansing rituals, acts of repentance, or sacrifice for others.

Because adults have more autonomy, they are also better able to avoid situations they might find triggering. People with scrupulosity may actually avoid their place of worship, religious texts, or gathering with members of their congregation. Such settings may spark obsessive thoughts of moral failings and doubt.

Scrupulosity may also lead people to focus excessively on one aspect of religion while ignoring others. This shift has real-world repercussions. Avoiding services, for instance, could lead to disapproval from one’s religious community. This would likely lead to more feelings of inadequacy and fear.

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How Do I Know If It’s Scrupulosity?

There is a difference between being exacting about one’s religious observance and having religion-oriented OCD. The main factor is whether or not a person has constant, intrusive thoughts and feels the need to do something about them. This difference can take many forms.

Spiritual practices are one example. A deeply religious Catholic might make sure to say the rosary every day, light a candle to the Virgin Mary, read a certain amount of scripture, and pray at designated times. Once they have completed these steps, they feel secure that they are maintaining their relationship with God. They can proceed with their day, and their conscience is clear.

A Catholic person with scrupulosity, however, likely would not find these practices to be enough. For example, they might worry while performing them that they are not doing them right.

They could fear missteps and cringe as they worship. Once completed, they would possibly review every action for errors and judge their thoughts harshly. They might complete actions more frequently than necessary or at times not designated for them.

The actions would not bring peace and would not change intrusive and fearful feelings.

When OCD is in charge, the purpose of the religious practice is not to connect with one’s faith or develop a stronger relationship with their God. The goal is to stop anxiety and avoid the wrath of God.

The following thoughts and behaviors are signs of scrupulosity:

  • Constantly reviewing thoughts and actions related to religion
  • A strong belief in one’s own unworthiness, immodesty, or impurity
  • A belief that bad things are just around the corner because of how a person thinks and acts
  • Intrusive thoughts that never leave, even during prayer and meditation
  • A brief sense of relief after performing actions, followed by a return to intrusive thoughts
  • Seeking excessive reassurance from others to calm one’s anxiety about not being good enough
  • Endlessly repeating actions in an effort to “get them right”
  • Feeling possessed or worrying about being possessed

Is Scrupulosity a Mental Illness?

Yes, scrupulosity is a type of OCD, which is recognized as a mental health condition. When untreated, OCD can disrupt work and relationships and can make every aspect of life more challenging.

It is important to understand that the symptoms of religious scrupulosity are not indicators of a strong religious faith. They are hallmarks of OCD and should be treated as such.

People who are experiencing symptoms of scrupulosity deserve to have their overwhelming feelings taken seriously, especially if aspects of their life are starting to suffer.

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How Religious Obsessions and Compulsions Are Diagnosed

Scrupulosity and other forms of OCD are diagnosed by trained mental health clinicians. A primary care physician can also diagnose the condition and refer you to a mental health provider for confirmation of the diagnosis and treatment.

Scrupulosity is determined by the symptoms a person has. A person does not need to have all the symptoms associated with the condition to qualify for a diagnosis. Even a combination of some symptoms is enough to point to a diagnosis.

When performing an assessment, a therapist will look for the following indicators of scrupulosity:

  • Intrusive thoughts a person cannot control and finds disturbing
  • Compulsive behavior someone feels they must engage in to control their thoughts

When meeting with patients, clinicians will also likely ask the following questions:

  • Are your observances in line with your faith, or are they excessive?
  • Do you practice your faith the way others in your community do?
  • How much of your time do your religious practices take up?
  • What is the nature of your thoughts? Do they feel intrusive or disruptive?
  • How do you respond to your thoughts, in words and actions?

Therapists will likely also try to get a sense of how patients practice their faith compared to how others in the patient’s faith community worship.

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Management of OCD and Religious Scrupulosity

The main methods of controlling obsessive compulsive behaviors, in general, and scrupulosity in particular, are exposure and response prevention (ERP) therapy and medication.

ERP Therapy

In exposure and response prevention (ERP) therapy, a therapist will gradually encourage a patient to come into closer and closer contact with situations the patient finds uncomfortable.

For instance, patients might be asked to read or listen to material they find nonreligious or attend services they might otherwise avoid. They might be asked to experiment with not doing compulsive behaviors in response to their obsessions and see what happens.

Early treatment planning and exposure work should include a trusted religious leader/elder/confidant that is relevant in the person’s life, ideally someone they have a pre-existing relationship with in their religious community.

These steps will likely feel difficult at first. However, over time, many patients find they have less of a reaction to circumstances they once found very triggering.

ACT Therapy

Acceptance and commitment therapy (ACT) is another treatment approach that can be effective in treating people with scrupulosity. With ACT, patients practice mindfulness and learn how to accept thoughts and feelings without responding to them with compulsive behaviors.

At the same time, they learn ways to give distressing thoughts and feelings less power. Treatment involves exercises, discussions of patients’ responses to their thought processes, and weekly homework assignments.

In a 2013 study, five participants diagnosed with scrupulosity received eight sessions of ACT. The participants were assessed for the severity of their compulsions. They were also assessed for how frequently they avoided activities they valued (for example, attending church or praying) out of fear of triggering obsessions and compulsions.

At a three-month follow-up, the participants reported an 80% reduction in compulsions and an 87% decrease in avoidance behaviors. The study’s authors noted that ACT may be especially useful for the treatment of scrupulosity because there is a strong emphasis on helping patients make choices to re-align with their religious values in a way that is personally meaningful.


Sometimes behavioral techniques alone cannot effectively treat the symptoms of scrupulosity. If this is the case, clinicians can help patients find the right medication.

Usually, the medication used to treat scrupulosity falls in the class of selective serotonin reuptake inhibitors. Many people who take SSRIs for OCD find that their obsessions decrease and become less intense.

Finding Joy in Spirituality: Recovery From Scrupulosity

With the help of a trained professional, people with scrupulosity can learn to manage uncertainty. They become better at questioning triggering thoughts and accepting them without engaging in compulsive behavior.

At first, people recovering from scrupulosity may try to convince themselves that managing symptoms is just one more “bad” thing they are doing.

For example, they may believe that stopping their obsessions and compulsions will take them further from God. Instead, managing symptoms frees people to experience a healthier relationship with religion.

With treatment, people can heal from scrupulosity. Over time, they notice that they can embrace their moral and spiritual beliefs—without giving weight to the intrusive thoughts and engaging in compulsive behaviors.

Learning to change your response to obsessions and compulsions takes time. However, starting the process of recovery can give people reassurance and lead to a healthy and fulfilling life.

McLean offers world-class mental health care for people who struggle with OCD and related disorders. Let us help you find the treatment option that’s right for you or your loved one. Contact us today.

Want More Information?

Looking for even more information about scrupulosity? You may find these resources helpful.

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Helpful Links

These organizations may also have useful information:

International OCD Foundation
The mission of the International OCD Foundation is to help people affected by obsessive compulsive disorder and related disorders to live full and productive lives. The IOCDF aims to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight stigma surrounding mental health issues.

OCD Massachusetts
As a non-profit affiliate of the IOCDF, OCD Massachusetts aims to provide public and professional education about OCD to raise awareness and improve the quality of treatment provided in Massachusetts. They also work to improve access to resources for those with OCD and their families and advocate and lobby for the OCD community in Massachusetts.

Peace of Mind
Now part of the International OCD Foundation, Peace of Mind provides educational resources and access to self-help tools, offers scholarship opportunities, supports professional training programs, and spreads awareness about OCD and related disorders.