This is the third installment in our ongoing series on Scrupulosity, a sub-type of Obsessive-Compulsive Disorder (OCD) focused on religious or moral perfectionism. This article focuses exclusively on identifying and challenging common cognitive distortions seen in “moral” Scrupulosity.

Moral Scrupulosity

Those struggling with Moral Scrupulosity OCD can
learn to challenge their distorted thinking.

Previous articles in this series have focused on religious Scrupulosity, which is most easily described as a pattern of intrusive, unwanted thoughts related to one’s religious beliefs. These unwanted thoughts are counter to the sufferer’s faith, and lead them to perform compulsive behaviors in an attempt to nullify or extinguish the anxiety they experience related to these thoughts.

Conversely, the obsessions experienced in “moral” Scrupulosity are focused not on matters of faith, but rather on one’s personal sense of morals and ethics. Those suffering with moral Scrupulosity experience commonplace thoughts, feelings and actions that they misinterpret as being evidence that they are ethically flawed or morally bankrupt. As with all sub-types of Obsessive Compulsive Disorder (OCD), those with moral Scrupulosity seek relief from their anxiety through various compulsive and avoidant means in an effort to ensure that their obsessive fears do not come true. In other words, they perform compulsive behaviors that they hope will prevent or eliminate the feeling that they are a “bad” person.

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In the first installment of this series, 35-year-old old Robert told his story of childhood obsessions, teenage compulsions, and his eventual diagnosis with OCD and Bipolar Disorder at age seventeen. He went on to describe suicide attempts and Electroconvulsive Therapy (ECT), as well as his experience with medication and treatment with Exposure and Response Prevention (ERP). In part 2, we focus on the impact of OCD on the family, as told by Robert’s mom, Lisa. 

OCD in the family

When someone is suffering with OCD, it can have a
profound impact on their entire family.

We didn’t suspect anything was wrong until Rob was about fifteen years old. Suddenly, he wanted to change high schools, and though we weren’t excited about the idea, Rob’s father and I decided that if that was what he really wanted, we would let him go for it.  Unfortunately, the problem came when every day for the entire summer, Rob demanded that we review his list of pros and cons of changing schools. We would work on it tirelessly, come to a mutual decision, and then redo it all the next day because of Rob’s uncertainty. He finally confirmed his decision to go to the other school and they hosted a mental health day. Rob came home with a pamphlet on Obsessive Compulsive Disorder and told me he had it. I replied, “That is for really sick people.” I regret that I didn’t listen.

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This is the second installment of a multi-part series on Scrupulosity, a specific variation of Obsessive-Compulsive Disorder (OCD) that focuses on religious and moral perfectionism.  This article focuses on how one can learn to identify and challenge common cognitive distortions seen in Scrupulosity.  Please note that this article will focus exclusively on religiously-focused Scrupulosity, and that future installments will address Moral Scrupulosity.

Scrupulosity in OCD

Cognitive Restructuring can be a valuable component of treatment for Religious Scrupulosity in OCD

Scrupulosity is a type of Obsessive Compulsive Disorder (OCD) rooted in irrational, distorted thoughts (obsessions) related to one’s religious beliefs, morals, or personal ethics.  An individual with Scrupulosity experiences these unwanted thoughts as being at odds with their faith, their relationship with God, or their moral and ethical values.

As with all types of OCD, the individual with Scrupulosity responds to their obsessions with compulsive behaviors that they employ in an effort to reduce, eliminate, or reverse their unwanted thoughts and the anxiety they cause.  Scrupulosity becomes a clinical issue when an individual’s behaviors are motivated by a desire to control anxiety rather than the pursuit of a genuine connection to their faith, morals, or ethics.

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Kimberley Quinlan, MFT, of the OCD Center of Los Angeles discusses the diagnostic overlap between OCD and eating disorders.  Part one of a two-part series.

OCD and Eating Disorders

It can sometimes be difficult to differentiate between the symptoms of OCD and those of an eating disorder.

I was recently asked by a client if there was any functional difference between eating disorders and Obsessive Compulsive Disorder (OCD). After all, if OCD is defined as experiencing obsessive thoughts and compulsive behaviors, wouldn’t an eating disorder be categorized in the same way, given that those with eating disorders have obsessive thoughts about their weight and appearance, and respond to these thoughts with compulsive behaviors?

When looked at along these lines, it is obvious that OCD and eating disorders indeed have many similarities.  But it is important to consider certain distinctions between these conditions before formulating a diagnosis.

To provide a better understanding of OCD and both its differences and similarities with eating disorders, clinicians rely upon specific diagnostic criteria.  Recently, the American Psychiatric Association (APA) refined these criteria in the newly published Diagnostic and Statistical Manual (fifth edition), also known as the DSM-5.  This manual is used by clinicians to differentiate between various psychological conditions, thus assisting in the development and implementation of appropriate treatment.

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A discussion of Harm OCD and its treatment using Exposure and Response Prevention (ERP).  Part four of a series.

Harm OCD treatment

Exposure and Response Prevention (ERP) is the key component to effective treatment for Harm OCD.

In our three previous articles in this series, we discussed the primary symptoms of Harm OCD, along with how one can use mindfulness and cognitive therapy to address unwanted harming thoughts.  In this installment, we focus on directly challenging the behaviors associated with Harm OCD by using Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

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The impact of OCD and related anxiety based disorders on the family is often overlooked.  In this multi-part series, we present first-hand accounts of the ongoing impact of OCD, BDD, and Bipolar Disorder on one man and his family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

Life with OCD

Those suffering with OCD need
understanding and treatment

My name is Robert and I have Obsessive-Compulsive Disorder (OCD).  I am a thirty-four year old, single man and work as a personal fitness trainer. My story is not typical, but it is the only one I have . . .

I was four years old when I looked at a picture Bible and saw an image of Satan. My thought was, “Satan is cool!” He wore a red cape and was “ripped!”  My obsession was that, since I thought he was cool, I was evil and I would go to hell. I knew that evil people hurt others, and I was terrified of hurting someone. It never occurred to me to tell my parents. I figured all kids thought this way too, but the other kids just seemed to be “managing” it better than I was. They didn’t appear bothered by the eternal consequences of their actions like I was. They were talking back, swearing, being disrespectful and acting cocky, but weren’t worried about going to hell. I figured that thinking Satan was cool and that I was evil was “normal”, and that I just had to be more laid back and figure out how to worry less.

One day when I was fourteen, I had an intrusive thought that I wasn’t funny. I couldn’t shake it and kept a journal of funny quips so I could be “funny” in social situations. I tried to keep up the compulsion of memorizing stuff from the “funny book” so I wouldn’t be “slow”. I wanted to be quick witted, playful and charming.  The irony is people said I was funny – I just didn’t “feel” like I was.  I fought to I remember “my lines” to get rid of the anxiety. At about the same age, I had the obsession that my penis wasn’t the right size. I was pre-pubescent and a “late bloomer.” When in the locker room at school, I compared the boys’ penises to my dad’s penis and thought, ”Wow! They’re tiny!” I even asked my mom one day, “Does size matter?”

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Many people mistakenly think of Obsessive Compulsive Disorder (OCD) solely as a condition in which people wash their hands excessively or check door locks repeatedly.  There are actually many sub-types of OCD.  In this ongoing series, Kevin Foss, MFT of the OCD Center of Los Angeles discusses Scrupulosity, in which an individual’s OCD focuses on issues of religion, morals, and ethics. Part one of a four-part series.

Scrupulosity OCD

Those with Scrupulosity experience profound feelings of anxiety and guilt related to religion, morals, and ethics.

One of the first documented references to Obsessive Compulsive Disorder (OCD) was in a 1691 sermon by Bishop John Moore of Norwich in which he discussed men and women who were overwhelmed with unwanted thoughts, and tormented by feelings of guilt and shame over what he described as “religious melancholy.” Priests had started to notice that some churchgoers were attending confession several times a day, and repeatedly confessing to the same sins and shortcomings that they feared would result in divine judgment and eternal damnation. Their penance and absolution would provide only a fleeting glimpse of peace, and then their fears would come roaring back.

In retrospect, we now know that this obsessive religious fervor is a manifestation of OCD known as Scrupulosity. People of various religions across the world are haunted by feelings of doubt, guilt, and anxiety that torment them by attacking that which they find most dear – their faith. Scrupulosity is a form of OCD in which the sufferer’s primary anxiety is the fear of being guilty of religious, moral, or ethical failure. Those afflicted with Scrupulosity fear that their effort to live according to their spiritual values not only isn’t good enough, but is in direct violation of God.

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Choosing a Different Route on the Anxiety Highway

Mindfulness for OCD and Anxiety

Mindfulness can greatly enhance Cognitive Behavioral
Therapy (CBT) for the treatment of OCD and Anxiety.

“Mindfulness” seems to be everywhere these days.  In the culture at large, mindfulness is becoming a common practice for many as a means to finding basic peace of mind. And in the field of mental health, mindfulness is quickly coming to be seen as a technique that can help relieve symptoms of OCD, anxiety, and other psychological conditions.

After reading the above paragraph, you may be thinking, “Sign me up!” After all, we live in an era of instant gratification, and most of us usually want a quick fix to our problems. But mindfulness is not something one masters overnight. It is a journey that requires effort, commitment, and dedication. While mindfulness may provide relatively rapid relief to one’s distress in certain situations, it is perhaps better conceptualized as a long-term shift in perspective that allows us to better manage the complexity of human psychological experience. Like learning a new language, mindfulness takes time and patience to master, and ongoing effort to remain fluent.

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Hoarding affects the entire family.  Here is one woman’s story of her struggle as the daughter of multiple generations of hoarders. She has asked to remain anonymous. 

Hoarding affects the entire family

Hoarding and cluttering affect the entire family
(cc image courtesy of puuikibeach)

I am the daughter of a hoarder. I am also the granddaughter of a hoarder. Somewhere amidst the cluttered chaos, I was a child. Competing with nine cats, three large dogs and compulsive shopping sprees was nothing but ordinary. Our 1500 square foot condo was stuffed wall-to-wall with dusty antique furniture, balls of cat fur, and the potent smell of animal urine masked by dozens of cheap burning candles.  Taking in animals and acquiring things were my mother’s attempt to fill the absence of her husband and distract her from her long battle with cancer. She barricaded herself from the real world, consequently shutting down the needs of her only child and leaving no room for a relationship.

An unlikely suspect, my mother is an entrepreneur who dresses sharp, presents with confidence, and is admired and respected by her peers. What many people don’t know about the world of hoarding is that it is often a secret to outsiders. Although some hoarders can be detected by the clutter surrounding their homes, others present the exterior of their homes as well as they present themselves. From the outside world, we went unnoticed, further silencing my cry for help.

Read More »

Thought Action Fusion in OCD

Thought-Action-Fusion is a common
problem for many struggling with OCD.

Virtually everybody experiences unwanted thoughts from time to time, for we human beings are not always in charge of what we think.  But for sufferers of Obsessive Compulsive Disorder (especially Pure Obsessional OCD), the problem is not just the presence of unwanted thoughts, but also the attention and meaning one gives to them.

OCD and Thought-Action Fusion

Obsessive Compulsive Disorder (OCD) not only produces constant mental noise and endless worry, but also often includes a cognitive process known as thought-action-fusion.  The distorted thought at the heart of thought-action-fusion is the irrational assumption that just because a “bad” thought presents itself to your mind, then it is undeniably followed or accompanied by a specific “bad” action.    For some, this fusion is so strong that they believe that their thoughts actually cause actions to occur. Clients who suffer from thought-action fusion often report intense fear because of their belief that their thoughts will come true.  Thought-action fusion is particularly common in the Pure O variant that is colloquially known as Harm OCD.  For example, a teenage girl may worry that if she has a thought of a home invasion happening to her family, then the break-in will undoubtedly occur.  Or a college student might fear that he will wander out of his dorm room and harm someone without knowing it.  If this student is struggling with Harm OCD complicated by thought-action fusion, he might be overcome with a debilitating belief that, because he thinks this thought, then he is almost certainly a sociopath and is likely to act on it. Read More »

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  • My Life with OCD

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  • Scrupulosity: Where OCD Meets Religion, Faith, and Belief

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  • OCD and Thought-Action Fusion

    Thought-Action-Fusion is a frequent problem for those with OCD. This issue is discussed by Laura Yocum, MFT, of the OCD Center of Los Angeles.

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  • Dermatillomania / Skin Picking Disorder Treatment

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