Religious OCD, or scrupulosity, is a subtype of obsessive-compulsive disorder (OCD) where a person experiences obsessions and compulsions that fixate on religion or morality. Treatment can involve medication, therapy, or a combination of both.
This article explores religious OCD and its symptoms, causes, treatment, and diagnosis. It also provides information on where to find support.
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Religious OCD, also known as scrupulosity, is a form of OCD involving obsessions and compulsions that relate to religion or morality.
These obsessions often fixate on fears or anxieties around a person’s religion, such as the fear of going to hell. Compulsions may also mimic religious behaviors, such as praying, but can take up a significant amount of time and interfere with a person’s life.
According to the International OCD Foundation, symptoms of religious OCD can vary from obsessive thoughts to compulsive behaviors.
Obsessions
Obsessions can be repetitive mental images, thoughts, or urges. They are sometimes referred to as “intrusive thoughts.”
A person’s obsessions may focus on a fear of angering their god or a religious deity, or committing blasphemy. Examples of obsessions may include:
- fear of going to hell or being punished by God
- being overly moral
- fear of having committed a sin
- constantly striving for purity
- fear of the loss of impulse control
- fear of death
- doubting what a person feels or believes
- fear of being possessed
- a need to acquire certainty about religious beliefs
Compulsions
People with religious OCD may feel a need to perform certain behaviors or mental acts to get rid of the distress and anxiety caused by their obsessions. These are known as compulsions or rituals.
These compulsions may mimic behaviors that are part of typical religious practice. However, a person with OCD performs them out of distress or anxiety. The compulsions may become increasingly time consuming and interfere with daily life.
Examples of behavioral or mental compulsions may include:
- excessively praying
- repeatedly seeking reassurance from religious leaders
- making pacts with their religious deity
- excessive confession of perceived sins
- repeatedly performing cleansing rituals
- writing prayers to check they’re done correctly
- making mental efforts to erase or replace “bad” thoughts
- acts of self-sacrifice
- repeating passages from sacred scriptures in their head or out loud
People may also avoid situations that could trigger intrusive thoughts, such as religious services, if they feel they’ve done something wrong.
Learn more about the link between OCD and anxiety.
Grace’s story: Obsessive and compulsive symptoms
“My OCD symptoms started around ages 8 or 9. The big intrusive thought I dealt with was almost always about heaven and hell. There was a lot of fear for me about the afterlife.
“The compulsions were a lot more varied, but the big one for me was praying. I often felt the need to sneak away and pray during the day whenever I felt I might be guilty of some transgression.
“These transgressions consisted of using the wrong tone of voice, feeling I may have looked at someone weirdly, or having swear words pop into my head. These smaller intrusive thoughts [led] me to the conclusion I must be going to hell, which was highly distressing as a child.
“I started praying about twice an hour. Then, when I was about 11, I read some scripture about forgiving people 70 times, and that number stuck with me. Somehow my mind decided I needed to pray 70 times a day, and if I didn’t reach that number, I could kiss any hope of going to heaven goodbye. I only felt relief when I hit 70.
“I’m also from a religion that believes sins must be confessed. My version of this was to apologize constantly. There was a period of time where every hour on the hour I would rattle off quick apologies for anything I might have done wrong.
“I had the insight to know this was not normal, so I would disguise it by saying these things under my breath so quietly that nobody could hear me. I got a reputation for talking to myself.”
Like OCD, the exact causes of religious OCD are unknown. However, experts have several theories about what can influence a person’s risk of developing OCD.
According to the
- Genetics: People with first degree relatives, such as parents, siblings, or children, who have OCD have a higher risk of developing the condition.
- Environment: Some studies have reported an association between childhood trauma and OCD. However, more research is needed to understand this relationship.
- Brain structure: Imaging studies have shown differences between certain brain areas in people with OCD.
Does being religious make you more likely to develop OCD?
The practice of religion often involves a series of rituals and customs that people are expected or encouraged to follow to varying degrees. For example, a person may be encouraged to pray and ask for forgiveness. Or, they may need to perform a bodily cleansing ritual before they can enter a place of worship to pray.
However, just because a person follows these rituals, or follows them more than others, doesn’t mean they have OCD.
According to a
Instead, researchers suggest that OCD can manifest through these rituals for some people, as the rituals lend themselves to the need for perfectionism and obsessive thoughts associated with OCD symptoms.
Some experts believe that OCD latches on to areas of personal importance, so a person for whom religion is important may find themselves more vulnerable to feelings of guilt or intrusive thoughts. Personal factors may also influence the risk of developing obsessions with religion and morality.
Grace’s story: My OCD chose to fixate on religion
“I do not have OCD because of religion. However, my experiences with religion were what my OCD chose to fixate on. A church lesson in which I was told the importance of reading my scriptures every day was one of those experiences.
“Some people’s recovery will take them away from religion, and that’s OK. But for me, my religion is a strength, and the cause of my pain was not religion, just OCD.”
Healthcare professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to diagnose OCD.
A person must experience the following to receive an OCD diagnosis:
- presence of obsessions, compulsions, or both
- obsessions or compulsions take up much of a person’s time, or cause significant impairment or distress in social, occupational, or other important settings
- obsessive-compulsive symptoms are not caused by a substance or other medical condition
- obsessive-compulsive symptoms are not better explained by another mental health condition
During diagnosis, a doctor may ask a person with suspected OCD to talk about specific obsessions or compulsions they have experienced. It can be helpful for people to keep a journal of thoughts and behaviors to discuss with healthcare professionals.
Religious OCD is a subtype of OCD. Therefore, healthcare professionals may recommend similar treatments for both conditions.
First-line treatments for OCD
Medication
Selective serotonin reuptake inhibitors (SSRIs) are the
SSRIs are a type of antidepressant that alter the levels of serotonin (a mood chemical) in a person’s brain. Experts think that increasing serotonin levels can improve OCD symptoms for some people.
If symptoms do not improve, healthcare professionals
Therapy
Cognitive behavioral therapy (CBT) is another first-line treatment for OCD.
A type of CBT called exposure and response prevention (ERP) may also be effective at reducing compulsive behaviors in people whose OCD does not respond to SSRIs.
With ERP, people are encouraged to face their fears without engaging in compulsive behaviors. So, a person may be encouraged to spend time in a situation that usually triggers a compulsion, but the person is prevented from performing that compulsion.
Other types of therapy for OCD can include:
- interpersonal therapy
- dialectical behavioral therapy
- cognitive analytic therapy
- psychodynamic therapy
- emotional freedom technique
Learn more about the types of psychotherapy for OCD.
Grace’s story: Treatment gave me hope
“The first treatment I did was exposure and response prevention (ERP) therapy with my therapist. ERP consists of slowly exposing yourself to things that trigger obsessions and then not performing the compulsion associated with it.
“You are slowly reteaching your brain that you will be OK and nothing bad will happen. One example of this was my therapist asking me to tell her a lie during our sessions and then not confess to her about the lie.
“Treatment gave me hope. ERP was very hard at first because it meant doing the things I found most uncomfortable. However, once I saw the product of it working, it became much easier.”
Other treatments
Healthcare professionals are exploring other potential treatments for OCD.
One example is eye movement desensitization and reprocessing (EMDR). EMDR involves talking with a therapist about intrusive thoughts while making rapid eye movements. This technique aims to replicate how a person’s brain processes experiences and memories during sleep.
EMDR may be helpful in situations where ERP is unsuitable. For example, if a person experiences intrusive thoughts about having sexual relations outside of marriage, it would not be appropriate to expose a person to that situation in order to desensitize them.
A 2017 randomized controlled trial comparing EMDR to CBT for the treatment of OCD found that both treatments had similar clinical outcomes. However, the study had a small sample size with only 55 participants. More research is needed to establish the effectiveness of EMDR as a treatment for OCD.
Other potential treatments
Grace’s story: EDMR helped me the most
“ERP was incredibly helpful for many of my symptoms, but some were untouchable until I found EMDR. EMDR helped to desensitize me to disturbing intrusive thoughts, just like you would memories.
“After doing EMDR processing of my early religious experiences, I found that the obsessions lost their bite and I inherently understood that imperfection was OK.”
Anyone experiencing symptoms of OCD should consider talking with a healthcare professional as soon as possible. A healthcare professional can provide information on treatment and refer people to mental health professionals with experience treating OCD.
The International OCD Foundation also has a dedicated OCD and faith resource center that provides information on coping with OCD in relation to different religions.
Some people may also find it helpful to talk with religious leaders or fellow members of their religion. However, not everyone will be aware of how OCD works or how it can relate to religion. This is why it’s important to also seek clinical advice from professionals.
If a person experiences stigma from religious figures due to expressing their experiences with religious OCD, or is made to feel like their feelings are not valid, then this may not be an appropriate support network.
Learn more about overcoming OCD.
Grace’s story: Advice to others
“You aren’t going to hell for questioning this. Your problem isn’t that you’re a bad person, it’s that you have OCD. Some people feel like questioning their scrupulosity is questioning God, and it’s simply not.
“If I could do it over again, I would have immediately found a group or a forum or some way to connect with others with religious OCD. Having someone else go through the same things I did made me feel seen.
“Try to find a therapist who has a background in OCD and trauma treatment. I actually found a therapist who was a member of my church. I also spoke to my congregation leader.
“While therapy was essential to my recovery, my clergy and my therapist together helped me realize that God was very loving and didn’t want me to rot in hell.”
Religious OCD is a subtype of OCD, which is a mental health condition involving obsessive thoughts and compulsive behaviors.
With religious OCD, a person’s obsessions and compulsions are related to religion and morality. Although these symptoms may mimic religious fears or behaviors that are part of religious practice, they can cause severe emotional distress and disrupt a person’s life.
Anyone experiencing symptoms of OCD should consider talking with a healthcare professional as soon as possible. A healthcare professional can provide information on appropriate treatments and refer people to mental health professionals.