By Natalie Brei, Ph.D.
Clinical psychologist at the Immaculate Heart of Mary Counseling Center in Lincoln
www.immaculateheartcounseling.org
The season of Lent approaches: a wonderful time to grow nearer to the Lord through additional rituals, sacrifices, traditions, and obligations. But for Catholics dealing with scrupulosity, this time of added penitential focus can create tricky grounds to navigate.
Scrupulosity is a type of OCD, or obsessive-compulsive disorder. OCD involves unwanted, intrusive thoughts or images (the ‘obsession’), with a corresponding thought or action (the ‘compulsion’) meant to offset the obsession. The compulsion is either excessive or not logically connected to the obsession (classic example: repeated handwashing meant to offset feeling contaminated).
When OCD intrudes into the arena of morality or religion, it is called scrupulosity. While scrupulosity is as diverse as the individual, it is often recognized as an excessive fear of sin or wrongdoing, anxious self-doubt about one’s actions, fear of offending God or blasphemy, or fear that one wants ‘bad’ thoughts and is a bad person. While attention to detail helps with proper examination of conscience, religious scrupulosity is much more intense, excessive, distressing, and interfering.
Scrupulosity can develop within the religious practices of any faith tradition, including for non-religious people! Because religion involves ritual, the OCD (which loves creating rules and rituals) takes advantage by piling additions onto existing doctrine. Then it assigns the same moral importance to these new rules that are far above and beyond what the religion actually requires.
For example, people with scrupulosity might fear that turning their back on the tabernacle or crucifix is blasphemous. They might have a rule that reading or hearing a curse word ‘contaminates’ them or makes them evil and in need of confession. They may re-examine every word spoken or written, for fear of telling a lie.
They may consider most sins to be mortal or be so preoccupied with not offending God that they question whether they secretly want to do wrong. This leads to anxiety and compulsions, such as very frequent detailed confessions, praying prayers a certain number of times, re-praying until getting it ‘right,’ trying to correct possible lies, avoiding holy objects for fear of desecrating them, checking for reassurance that one has not sinned, or non-religious compulsions meant to neutralize ‘bad’ thoughts.
While it seems that proper education should rectify scruples, this is not the case. OCD does not respond well to simply being told that it is mistaken, and the physical anxiety experienced in the face of obsessional doubt is hard to overcome. It is hard to describe this effect to someone unfamiliar with OCD. Imagine someone reaching into your brain and turning up the volume on self-doubt, shutting off your ability to tolerate uncertainty, and while they’re at it, labeling everything remotely questionable as a mortal sin. This state makes it nearly impossible to accept reassurance. Scrupulosity insists that, somehow, the criterion of ‘wrong’ has a lower threshold for you. The resulting self-scrutiny points the accusatory finger at totally neutral actions or thoughts.
A heavy guilt may result, along with a need to find moral safety. This is our threat-detection system (which is very powerful physiologically) in overdrive: think of a sensitive smoke detector that is triggered just by making toast! This overactive threat-detector leads to avoidance or rituals that provide relief in the moment, but do nothing to prevent intrusive thoughts from returning, and the cycle continues. Rituals become excessive to the point of being illogical or meaningless. The person’s obsessions create a horrible feeling of uncertainty, and logic does not resonate.
OCD, including scrupulosity, is as much about nature as nurture. It is strongly hereditary, so the predisposition lies in our genes. Life experiences can also factor into developing OCD. Measurable and significant differences in brain structure and activity exist, with an overactive neurological loop that stays stuck on intrusive thoughts. So this is no personal fault or weakness in relationship to God or the desire to trust Him. That said, people with scrupulosity may focus more on God’s judgment than on His mercy – when in fact, the problem does not even lie in the need for mercy, but in a fear that one has done something wrong when one really has not.
OCD has a comfortable spot among the World Health Organization’s top 10 most debilitating conditions. What’s more, it tends to worsen if left untreated. But there is hope, as we know a lot about OCD.
First, let me normalize scrupulous thoughts: we’ve all had them, but the attention and merit we assign determines whether they stick. Often, a scrupulous person feels that special circumstances make their thoughts sinful or somehow meaningful compared to others who have the same thoughts. Ignoring them requires labeling thoughts as scrupulous and therefore reducing their credibility and the need to address them. I tell scrupulous clients that if there is an “I’m-not-sure” component, the thought is nearly always OCD. Just because thoughts or images occur does not mean we desire them, and the more we push them away, the more we are actually thinking about them!
Cognitive and physiological coping skills must become the focus rather than ‘getting rid of’ the obsession, and this is admittedly a very uncomfortable process. Nobody wants to let these thoughts just sit there while anxiety rises. But the status quo – managing the obsession by engaging in a compulsion – does not work.
Scrupulosity can be successfully treated in a variety of ways, with the most effective modes involving what is called exposure. Exposure and Response Prevention (ERP) involves gradually facing feared—but still moral—situations while using more effective coping strategies mentally and physically. For example, a person usually creates an ‘exposure ladder’ and works from less to more challenging situations. Items may include increasing time between confessions, saying prayers the ‘wrong’ way, eliminating mental rituals, gradually returning to the Eucharist, or even writing/saying feared words that are not actually spiritually harmful.
The individual learns to decrease reassurance-seeking and ‘safety behaviors,’ which really just magnify the obsession as a threat. This is done within the bounds of Church teaching, and it involves re-orienting to what is true versus what is personally believed.
Another approach, Acceptance and Commitment Therapy, incorporates gradual exposure/tolerance of feared situations, focuses on one’s values, and uses ‘cognitive defusion’ from the thoughts (recognizing that the thought is a sort of brain glitch, not me). Defusion helps a person not take obsessive thoughts seriously by minimizing them or even adding humor—imagining the OCD as something annoying like a commercial jingle, computer pop-up, or yapping chihuahua. This helps a person separate from the scrupulous thoughts and see that they do not actually point to reality.
For a person of faith, spiritual coping strategies are also critical—e.g., prayer, seeking spiritual guidance, bringing the roots of the fear into the open, and making a goal to adhere to actual Church teaching. One can also seek the intercession of saints who were known to struggle with scrupulosity—St. Thérèse of Lisieux, St. Ignatius of Loyola, or St. Alphonsus Liguori.
What can family and friends do to help? Know that it is often very hard for a person with scrupulosity to trust a therapist or even a priest’s counsel. The scrupulosity will always interject with “but what if this doesn’t apply to me because....” For this reason, diving deeper into the scrupulous rituals can be a counterproductive rabbit hole because people with OCD have brains that are excellent problem-solvers, and the OCD will always find an excuse to complete a ritual. Constant reassurance can even become a problematic ritual.
It is best to focus on gradual, planned exposures (often with the help of a therapist), non-ritualistic coping (deep breathing, valued action, distraction, defusion, seeing the scrupulosity as excess ‘chatter’). This helps a person resist rituals, diminishes doubt, and refocuses on evidence that can be seen. It is then easier to trust others who try to help.
Going through treatment for scrupulosity is truly an act of faith, because in OCD the mind constantly tries to avoid and fix uncertainty. Once we accumulate evidence beyond what we simply feel, we shift toward insight. While God’s providence may allow for the burden of scrupulosity, He wants to provide accompaniment during the healing process: this is not a solitary battle.
Self-compassion is critical: scrupulosity is just trying to keep a person safe from wrongdoing. However, the definition of ‘safe’ is too sensitive and the definition of ‘wrong’ is too broad. One must learn to encounter and move through the anxiety because the body must re-learn that there is no danger to the soul in these situations, that one’s relationship to God is still intact, and that one is still in God’s grace. With every attempt at resisting rituals, a person grows in the ability to trust, and these small steps lead to progress that breaks the hold of scrupulosity.
Recommended resources: Scrupulous Anonymous - a Catholic newsletter (scrupulousanonymous.org), and ‘The OCD Workbook’ by Hyman and Pedrick.
