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Scrupulosity in OCD: Cognitive Distortions

    

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.

Cognitive Distortions in Religious Scrupulosity

The basic thesis of Cognitive Therapy is that much of our emotional suffering is the direct result of our unrealistic and irrational thoughts, which are called cognitive distortions.  In the case of religious Scrupulosity, these cognitive distortions focus on one’s alleged spiritual  failings.  The most effective tool in treating the cognitive distortions experienced by those with religious Scrupulosity is a specific type of Cognitive Therapy called Cognitive Restructuring.  This technique focuses on helping the client develop three primary skills:

  1. Building awareness of the problematic obsessive thoughts
  2. Identifying how these obsessive thoughts are irrational and distorted
  3. Consistently challenging the distorted thoughts with more objectively realistic thoughts

It is important to note that cognitive distortions are not unique to Scrupulosity, nor even to OCD, but rather are faulty ways in which all people may at times misinterpret thoughts, feelings, situations, and interactions.  Some examples of common cognitive distortions seen in religious Scrupulosity include:

All-or-Nothing Thinking (Black and White Thinking)

    • “I had a passing thought about Satan, so I must secretly be a devil worshipper.”
    • “I mispronounced a few words when I was praying today, so I must have angered God.”

Catastrophizing

    • “Because I had a thought about sex with someone other than my spouse, God will send me to hell.”
    • “I accidentally left out a detail at confession earlier this week, so God will surely judge me as unworthy of heaven.”

Discounting/Minimizing the Positive

    • “Even though I have consistently and earnestly tried to live my life according to my faith, I had that one blasphemous thought, so I must be a terrible person.”
    • “I volunteer at church every week, but I’m a selfish person because I can’t volunteer today.”

Emotional Reasoning

    • “My prayer wasn’t good enough because I didn’t feel totally connected to God.”
    • “I feel like my donation doesn’t count because I don’t have a ‘giver’s heart.’”

Magical Thinking

    • “I had a “bad” thought while praying, so my mother will go to hell unless I repeat my prayers perfectly and without bad thoughts.”
    • “If I’m late to church, God will punish my children.”

Should/Must Thinking (Perfectionism)

    • “I should only have pure thoughts.”
    • “I must follow all religious laws 100% literally.”

Selective Abstraction

    • “I’ve heard The Wizard of Oz is a wonderful family film, but it includes wizards and witches, so we better not watch it or else the kids and I may go to Hell.”
    • “Bob is a wonderful husband and father who treats me and the kids great, but he is from a different denomination, so I might not get into Heaven.”

As these examples illustrate, those with religious Scrupulosity experience distorted thinking in many different ways related to matters of faith and spirituality. For example, with “emotional reasoning”, an individual’s thinking is guided by their feelings rather than rational logic.  A scrupulous person who is going through a difficult relationship breakup may feel depressed or apathetic as an important religious holiday approaches.  As a result, they may come to the irrational conclusion that their lack of spiritual fervor is evidence that they are a bad follower of their faith tradition because they are insufficiently excited about the holiday.

Notice the exaggerated conclusion based on a simple feeling!  Rather than rationally concluding that a significant life stressor is impacting their mood, they obsess that it is evidence of some sort of spiritual failing.  As a result of this faulty logic, they may resort to numerous compulsive behaviors, including:

  • Compulsively praying in an attempt to ensure that they are right with God.
  • Repeatedly going to confession in order to alleviate their perceived guilt.
  • Excessively asking others for reassurance about their alleged transgression and/or what they should do about it.
  • Avoiding the religious holiday altogether in an effort to dodge further triggers and reminders of their obsessive thoughts.

Cognitive Restructuring for Religious Scrupulosity

The first step in cognitive restructuring is to keep a log of the obsessive thoughts that are causing one’s distress. The goal of this log is to develop more awareness of the specific content of one’s irrational and distorted thought patterns.  When the obsessive thoughts are logged, they can then be progressively questioned and challenged.  For example, an individual with religious Scrupulosity may think “I had a sexual thought about my attractive co-worker today, so now I will go to hell”. Once they notice that the thought may be distorted, they can begin to look for the evidence for or against the accuracy or reasonableness of the thought.

If you find yourself troubled by an unwanted thought related to your faith, you would benefit by asking your self some questions about this thought, including:

  • Is the feared outcome of this thought consistent with typical, contemporary teaching of my faith?
  • Would the average person in my synagogue, church, mosque, temple, etc., agree with my conclusions?
  • Is the anticipated outcome or consequence in proportion to my actions?
  • When I have had this thought in the past, have the consequences that I fear actually come true?

If the answers to the above questions are “no”, then it is likely that your unwanted thoughts are significantly distorted.  If that is the case, the next step is to challenge your distorted thought with one that is more reasonable and rational.

For example, you may have the painful, unwanted thought that God will punish your children because you arrived late for church.  But your fellow parishioners would most likely say that this belief is not consistent with your faith’s teachings, and that such a result would be a grossly disproportionate consequence to the simple act of arriving late for church.  And upon reflection, you may realize that you have had this anxiety-provoking thought many times before, and yet there is no evidence that your children are being punished by God.

The long-term goal of cognitive restructuring is to develop the habit of challenging your irrational thoughts rather than just blindly reacting to them.  That said, it is also important to stress here that, though the goal of this exercise is to challenge your irrational thinking, that doesn’t mean you will arrive at a place in which you have absolute certainty about your unwanted thoughts.  Human life is full of uncertainty, and nowhere is that more obvious than in matters of “faith”.

The ultimate goal of therapy for all forms of OCD, including religious Scrupulosity, is for the sufferer to learn that, despite the lack of 100% certainty, they can peacefully co-exist with their unwanted thoughts without doing compulsions.  So while it is most likely an exaggerated and distorted thought, and your children probably are not going to be punished by God merely because you were late for church, you aren’t God and you cannot know for sure what will happen in the hereafter.  Your goal is to accept that uncertainty, and go about the business of life.

In short, our obsessive thoughts are possibilities, not probabilities, or even likelihoods. Once the thought is challenged, and the counterpoint to the automatic negative thought is noted, we take a risk and go forward in life without giving into the urge to do a compulsion. This takes the courage found in the margins between possible and probable, which is forever unknown. At the risk of making the pun, it takes faith to risk the possible outcome when that outcome is possible, though uncertain.

It is also worth noting that, for those desperate to find relief from their spiritual suffering, cognitive restructuring has the potential to become a compulsion in its own right.  It is imperative that individuals with religious Scrupulosity be acutely aware of their excessive desire for certainty, and that they resist the urge to misuse cognitive restructuring as a means of trying to eliminate doubt.  An additional concern is that, while cognitive restructuring is a helpful technique, it is not meant to replace Exposure and Response Prevention (ERP), which is the behavioral component of CBT, and is the most important tool employed in the treatment of all forms of OCD, including religious Scrupulosity.  Future installments of this series will address ERP in-depth.

Also, allow us to note that, before beginning the process of therapy, both the client and therapist should be aware that the result of engaging in CBT for religious Scrupulosity may not be limited to a reduction in distorted thoughts.  An additional result may be that the individual begins to challenge their global interpretation, experience, and practice of their faith. While this does not necessarily mean a loss of faith, it may mean that the individual transitions away from an excessively dogmatic view and practice of faith, and towards a less rigid interpretation.  It may also mean that the individual will develop a lifestyle without some of the specific practices that they previously found so vital to their faith, or even an entirely new perspective towards their faith.

Therapy in general, including CBT treatment for religious Scrupulosity, can dramatically influence one’s life for the better, but that can only happen with acceptance of potentially difficult change. Cognitive Restructuring, coupled with Exposure and Response Prevention, can be extraordinarily helpful in freeing people from the pain of religious Scrupulosity.  We highly encourage doing this work with a trained psychotherapist who understands the process, and is willing to work within the context of your specific religious tradition. That does not mean he/she will always agree with your faith, or conduct therapy in a manner that strictly reinforces its doctrines. However, it does mean that you should take time to explain to your psychotherapist how you experience your faith, your understanding of it, and what you are hoping to get out of treatment.

Lastly, we encourage you to communicate with a trusted spiritual advisor (priest, rabbi, imam, etc.) who is willing to work with you and your therapist on developing appropriate behavioral interventions that honor your religious tradition, while at the same time challenging your distorted approaches to it. With introspection, willingness, and the hard work of therapy, you will be able to more comfortably experience any unwanted thoughts you have on your spiritual journey.

To read part one of this series on Scrupulosity in OCD, click here.

To read part three of this series on Scrupulosity in OCD, click here.

•Kevin Foss, MFT and Tom Corboy, MFT are licensed psychotherapists at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers four weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.

40 Comments

  • Excellent post with a comprehensive,detailed description of how to challenge scrupulosity. I appreciate your stressing that cognitive restructuring is not a replacement for ERP therapy, but rather a complement to it. Looking forward to more of your articles!

    Reply
    • Hi Janet – Thanks for your comments.

      You are absolutely right – while cognitive restructuring is a helpful tool, the most important aspect of treatment for Scrupulosity (and all forms of OCD) is Exposure and Response Prevention (ERP). It is only through changing behavioral responses to unwanted thoughts that one will make real progress.

      Reply
  • thank you for this post, I still have problems with scrupulosity, the blasphemous thoughts still scare me. You hit the nail right in the head about religious holidays or important church dates being a stress, we just passed a very important day for my faith and I did not go because I was afraid of the thoughts and I did not want to go to church to have the thought. Actually I haven’t really been able to FREELY go to church without being anxious and on edge, I want to relax as I use to, pray, sing and don’t worry about the stupid thoughts! sigh…thank you thou

    Reply
    • Hi Nica,

      Glad the article was helpful for you. Keep in mind that when you avoid your spiritual practice due to Scrupulosity fears, you are only making the Scrupulosity worse. Avoidance is one of the main ways people with OCD do compulsions, and it is virtually guaranteed to worsen your symptoms. A more effective approach would be to attend whatever services you want to attend, despite your anxiety. You can pray and sing and worship, even when anxious.

      Reply
      • Thank you so much for these articles. My 35-year-old son is currently in a mental health hospital dealing with this very thing. I was at a loss for how he would ever be able to embrace going to church again since that is one of the triggers. You have explained very well what one needs to do in order to for a person to work through Religious OCD. I thank you so much for that! It’s going to take a lot of work from my son, but I am now more hopeful that he will once again find some joy from his relationship with God.

        Reply
        • Andrea,

          Thank you for your comment. We are glad to hear that our article has helped you, and hope that it can be of service to your son as well. Take care.

          Reply
  • I have had a problem with OCD for years. It is a form of scrupulosity. Unfortunately I cannot attend the seminar on 4/5 and 4/6 but would desperately like information on more seminars here is Southern California. Also, if there are any books you can recommend would be helpful.

    Thanks so much

    Reply
    • Hi Kathleen,

      Thanks for your comments. We do not have any other mindfulness workshops planned, but we will certainly have more in the future. In the meantime, if mindfulness for OCD is of interest to you, you may want to get our book, The Mindfulness Workbook for OCD

      Reply
  • I have recently had the worst week of my life. I have OCD, but have never really been a true Christian. I live a life that Christians don’t and take many advantages of the forgiveness and freedom that God allows. I have been seeing a doctor. Despite, CBT, I seem to be getting worse. The thing is, I am not motivated nor keen to fix the religious aspect of this. I am happy to think and say these horrible and abusive thoughts against God and all that is holy. I feel that answers may be available from the church, but I don’t want to go there. I also, cannot motivate myself to do the right thing in any situation. As soon as becomes a God issue, I want to rebel and move away and abuse God again.

    It goes from small issues all the way to big ones! Can anybody help me?

    Reply
  • Greg, Thank you for the comment, but I am uncertain how to help you based on what you wrote. On one hand, you ask for help and reference your spiritual life as being a focus of your pain, yet on the other you say you are “not motivated” to address any religious issues that may be involved.

    Taking a guess based on some experience, I’m wondering if some of your discomfort exists specifically because you have no motivation to change. In other words, you would like to have the feeling of motivation, but because it’s not there, you feel like you are unable to change, and therefore feel like you are intentionally abusing and rebelling against God? Again, just a guess.

    Based on your statement about not making progress with your current CBT therapist, you may want to consider finding someone who specializes in OCD using a mindfulness based approach to CBT. Perhaps the fresh perspective will help you get the help for which you are asking.

    Reply
  • Tom, you say in response to Janet that the only way to get over scrupulosity is ERP, but the problem with that for religious OCD, is that we can’t expose ourself to the fear of Hell, not even once.

    Reply
    • Hi TangoGirl,

      Thanks for commenting.

      Actually, what I wrote in my reply to Janet was that “cognitive restructuring is a helpful tool, (but) the most important aspect of treatment for Scrupulosity (and all forms of OCD) is Exposure and Response Prevention (ERP).” I further wrote that “It is only through changing behavioral responses to unwanted thoughts that one will make real progress”, and I stand by that position.

      As for your statement that those with Scrupulosity cannot expose themselves to their fear of hell, I disagree, and would go one step further and say that, if they want to move past Scrupulosity, they must expose themselves to their fears of hell.

      Everybody thinks their particular fear is somehow different or special, but they are mistaken. For example those with HOCD and Harm OCD often think that there is no way that they could directly confront their obsessions. Fears of hell are no different than any other OCD fears, and respond to the same treatment. We have helped many people with Scrupulosity to directly face their fears of hell. Yes, like all forms of OCD, facing your fears will entail some discomfort, but that doesn’t mean it cannot be done.

      Reply
  • Yes, but my point remains, if people do certain things, and certain people are right, people can go to Hell. As long as that could be true, people can’t get over their fear of Hell. You are basically saying unless you send yourself to Hell, you won’t get better.

    Reply
    • Hi Tangogirl,

      Your position seems to be:

      1) Certain behaviors may send a person to hell.

      2) Therefore, people cannot get over their fear of hell, because the only way to treat Scrupulosity is to do behaviors that will send you to hell.

      I think you perhaps have a misunderstanding of what ERP is. We do not ask people to do anything that is against their beliefs. We merely ask them to stop doing compulsive behaviors. So for example, if someone compulsively reads the Bible after having unwanted sexual thoughts, we would suggest that they would benefit from not using the Bible as a compulsion. We would not ask them to act sexually in a manner that is against their beliefs. Likewise, if someone compulsively avoids church because they have unwanted thoughts about Satan when they go to church, we would suggest that they instead go to church (which is actually more in keeping with their faith, not less).

      Allow me to make a comparison. When we have clients with Harm OCD or HOCD (gay obsessions), we do not ask them to commit acts that are agianst their beliefs. We do not ask them to commit harmful acts or to have gay sex. We merely ask them stop acting compulsively in response to their unwanted thoughts. That might mean eating with their family instead of avoiding their family (for fear of having thoughts of killing them) or it might mean watching a movie with gay characters instead of avoiding that movie. The same principles apply to Scrupulosity.

      Ultimately, we do not ask people with obsessional variants of OCD (i.e., Scrupulosity, Harm OCD, HOCD, etc.) to do what they are afraid of – we merely ask them to expose themselves to their fearful thoughts (which they are having anyway), but without doing compulsions. Stay tuned as we will soon have an article specifically on ERP for Scrupulosity. In the meantime, I encouarge you to read our article on ERP for Harm OCD to get a better idea of how ERP is applied to unwanted thoughts. I also encourage you to seek treatment with a therapist who specializes in ERP for OCD.

      Reply
  • It’s been a rough week for me. I find myself mentally repeating blasphemous phrases of the most vulgar nature. For some reason I feel compelled to curse and insult God. I’ve gone over and over again possible reasons for this. I have to blurt out phrases or shake my head vigorously when it seems that my thoughts are going down that path. It’s like having a lion trying to bread ore it’s way into your house. I want to believe that it is due to some mental illness but tat seems like an excuse. I’m so frustrated and that just seems to make it worse.

    Reply
  • Hi,
    Am an indian and in the adolescent age group. I was diagnosed with ocd when i was 10 yrs old. The theme is always religious . Am from india and i follow a religion having many gods. Ur posts are very helpful though i find few difficult to relate .am undergoing cbt and in a stressful period as of now.i always fear that god will never help me if i dont go to temples very often. I can never say no in any religious issues even the day before my exam. And guilt does play z very significant role in my story. Kindly help

    Reply
  • Hi Eric,

    Thanks for your comment. You mentioned that thinking that these thoughts may be the result of some mental illness feels to you like an excuse, but you didn’t mention if you have sought professional help or guidance with regard to your thoughts. If you have not done so already, consider a consultation session with a therapist who understands OCD/ Scrupulosity to see if perhaps this is playing a role in your frustration and pain. Further, you may want to speak with a pastor, or other religious leader, to get clarification on what is and is not a blasphemous thought. Keep pushing through, and remember that you are more than your thoughts, and thoughts do not define us. Thanks again for the comment.

    Reply
  • Hi Anu,

    Regardless of what God or gods you worship, your story still plays out the OCD cycle, and a fear of punishment based on your action or inaction. Before moving forward, you may want to consider speaking with a religious leader who can help you get a clearer understanding of the consequences to not going to temple, and what saying “no” means in your religious context.

    Oftentimes, our fear is rooted in a misunderstanding, exaggeration, or minimizing of specific religious dogma or tradition. Learning a more reasonable view may help you proceed with more confidence and freedom. That said, there is such a thing as asking too many questions, especially when it stops us from taking any action. Treatment for anxiety will always come down to taking a risk, or at least a perceived risk, following more reasonable, rational, and evidence-based thinking.

    Best of luck, and thank you for the comment.

    Reply
  • hi, i have always a fear that i bow down before the devil but actually i never. the thought keeps on repeating, i know at the core of my heart i have to ignore…and really ignore also which helped me to have relief but when this thought repeats in my head ….there is the doubt whether i bow down before the devil or not….what if i bowed down….then it causes me so much anxiety…

    Reply
  • Hi
    Working with my daughter who has a diagnosis of Scrupulosity

    She tried E&RP with a psychologist specializing in Scrupulosity but it was to difficult for her. She is off all her meds and is slowly improving but does have some setback days.

    My biggest issue with her is trying to have her use the logical part of her brain and realize that these intrusive thoughts are only a brain lie. She thinks that these thoughts are a spiritual attack on her.

    If you have any ideas on how she could make that leap, the E &RP would be so much easier

    Brian

    Reply
  • Parveen,

    Doubt is the main tool that Scrupulosity (and OCD in general) uses to attack and influence your thoughts and actions. But just because we think something doesn’t mean it’s true, and just because we feel something doesn’t mean it’s fact.

    Try to challenge your thoughts and fears by striving to see the more reasonable and objective facts of the situation. Furthermore, trying to suppress the thought will only cement its presence in your mind, but tolerating its presence and habituating to the discomfort has proven effective in treatment. I encourage you to click here to read our article on the futility of Thought Suppression. Good luck, and thank you for the comment.

    Reply
  • Hi Brian,

    Thank you for the comment.

    I first want to advise you against taking on the role of a therapist to the detriment of being her father. Treating your daughter’s OCD should be left to a professional therapist for two important reasons. 1) therapists go through years of training in order to handle the intricacies of treatment while taking into account the overall context in which the symptoms exist, and; 2) your role as a father is to cheer-lead her progress, lament her pain, empathize with her struggle, and help her develop as a person. Mixing these two roles interferes with the responsibilities of both.

    Understanding that your daughter’s recovery from OCD is not your responsibility, but solely that of your daughter, is a hard truth that family members (and therapists) must accept. You cannot make your daughter think logically, nor can any therapist. For clients who are resistant to engaging in their own treatment, we work with the family to identify and stop accommodating the OCD, which makes the sufferer face the natural consequences of giving into the OCD. Your daughter will need to decide for herself whether or not she is ready to face her fears.

    I strongly advise you seek the counseling and guidance of a trained therapist who understands OCD and will work with the rest of the family on a plan to disengage from struggling with OCD. You can also consult with a therapist at our center, or set up sessions with a staff therapist, through our website at http://www.ocdla.com.

    Thank you again for your comment, and best of luck with your daughter.

    Reply
  • Hi. I’m 14 and have OCD. It seems to be mostly from Scrupolosity. I have strange thoughts that seem very disrespectful towards God, curses towards him that just happen to cross my mind very often. Sometimes I have to do certain compulsions until I feel “pure”.I don’t know why they appear, I thought I believed in God, but these thoughts are starting to convince me otherwise. My parents know I have OCD, but I don’t think they’re aware I have it this bad. I’m just confused and I don’t know if I need to tell my parents if I need a therapist or not? Should I be able to stop these thoughts with your methods on my own? Any advice?

    Reply
    • Hi Jessy,

      Thanks for your comment.

      While our articles can be helpful, we do not encourage you to use them as an alternative to therapy. We strongly encourage you to discuss this matter with your parents, and to seek treatment with a therapist who specializes in treating OCD.

      Reply
  • Hi Kevin,
    I am Mormon and think I am struggling with OCD – my problem is I keep doubting that it’s OCD. I have a history of obsessive thinking, ever since I was about 6 years old, but nothing has hung on or been so frightening as this. I’ve been on Paxil for 15 years to deal with my obsessions and anxiety. I go around in circles, trying to convince myself it IS OCD, but then my mind pops up saying something like, “No, this is real. Your doubts are real and you need to do something about it!” It’s like a record that plays in my head all day, every day.
    In the past few weeks these doubts have resurfaced with a vengeance, following a policy change by the church with which I disagree. My thoughts have run wild, along the lines of, “If I don’t agree with this policy or this stance, I must be destined to leave the church. I’ll have to find something else.” That thought makes me sick to my stomach. I don’t want to leave my church. I’ve been a dedicated member my entire life. My family members are all active in the religion. I’ve always enjoyed going to church and have found real truth and peace there. It’s an enormous part of my identity. I feel like I’m running out of hope.

    Reply
  • Hi Kelly,

    Wrestling with the “is this or is this not OCD” question is very common. While in treatment, a rule of thumb is “if it feels like it could be OCD, then treat it like it is.”

    If you are not already in treatment, please consider meeting with a psychotherapist who specializes in treating OCD, even if only to get an accurate diagnosis. Until then, it will be hard to make any recommendations for moving forward.

    Your “leaving the church” question easily fits into the “all or nothing thinking” distortion listed in the above article. This distortion leads you to believe that, unless you agree with everything the church says or does, you must fully abandon it. In life, however, we rarely if ever agree 100% with anything, and yet we tolerate the grey area between “everything” and “nothing.”

    Working with a qualified therapist can help you make a clearer decision based on a possible OCD diagnosis and your personal values. Thank you for your comment.

    Reply
  • hi
    i am a 24 years old girl living in india.i think i am having Scrupolosity. i have a history of anxiety and stress since childhood.
    i get intrusive thoughts and negativity about everything very often.four years back i visited a psychiatrist and i was on medication for a while.them the doctor slowly stopped medication as i was doing quit well.but now since a month i have started getting very discomforting thoughts about god and religion. i pray and apologies repeatedly to feel better.but it is all very much exhausting and feels depressing. i request you to please help me out with some queries
    1 i am engaged and will get married in couple of months.i really worry about it given my OCD situation .what is your advise about it?
    2 i am a well educated and mature person working at a MNC as software engineer.still why cant i control these thoughts even if i know it is a mental disorder .
    3 please help me out for overcoming this situation.

    Reply
    • Thanks for the comment Trisha. Simply knowing you have a mental disorder doesn’t mean you can control your thoughts, just like seeing dark clouds doesn’t mean you can predict and control when and how much it will rain. In the case of rain, it means you know you should get an umbrella, and with OCD, it means you should seek out a therapist who specializes in Cognitive Behavioral Therapy (CBT) and begin working through the process to manage your obsessions. Even the smartest, most mature people cannot control their thoughts, but they can develop the discipline of accepting and mindfully responding to their thoughts, which is the goal of Mindfulness Based Cognitive Behavioral Therapy.

      Unfortunately, without more information I’m unable to give any meaningful guidance regarding your upcoming marriage, but again I advise you to speak with a therapist who can help you process your thoughts and worries in a meaningful and results-oriented way. Good luck.

      Reply
  • Here you talk about a specific subtype of OCD called scrupulosity, ok. But, are there people with moral or religious scruples whose origin is, say, more “spiritual”, not caused by OCD? Or does OCD cause ALL forms/cases of religious scruples?

    Reply
    • Margaret,

      I think you are splitting hairs here and focusing on the wrong issue in the process. Your question is akin to someone asking if all handwashing is due to OCD (to which the answer is “of course not”). The real issue is whether the person’s scruples are excessive, and whether their scruples are interfering with their life and their faith. If so, then OCD is the likely culprit.

      Reply
  • I keep worrying because I had a thought about God crashing my plane to prove He exists that it will really happen. How do I work through this. Even getting reassurance (which I shouldn’t be doing) hasn’t helped. The thought keeps playing over and over in my head.

    Reply
    • Jennifer,

      A few thoughts…

      1) Just because you have a thought doesn’t mean it will happen. And the fact that you had a certain thought doesn’t mean that your thought can make the feared event occur. I encourage you to read our article “OCD and Thought-Action Fusion”, which addresses this issue.

      2) The fact that you have repeatedly had this thought, and you have not yet been on a plane that has crashed is evidence of this.

      3) What kind of God would kill you for having a thought just to prove his existence?

      4) Yes, you shouldn’t be seeking reassurance, as it only makes OCD worse.

      5) The thought keeps playing over and over in your head because that is what OCD does.

      Reply
  • I have been battling with ocd for about a year now. It started has hocd and morphed into something worse, but I just continually spent time with my friends despite the anxiety and that served as my own ERP and help me get over it. I did the same with the other types of ocd that I began to have. With my scrupilosity it has been harder. I am worried that if I follow an ERP program for this aspect, I will become numb to the sins that I am reacting to or fearing that I am commiting. Especially when you mention it will cause me to have a less strict view on my faith. Is there a way to go through ERP but still maintain my strong viewpoints of right and wrong? Example, my current ocd has me being scrupulous about viewing porn. I believe strongly that it is wrong, but because of the disorder I find myself attaching that title to things that sent considered real porn, making me feel like I want to confess for any image that pops up in media that displays an attractive women, foe fear that I knew it would come up and should have avoided the site. But I am afraid doing ERP will make me comfortable with viewing those things, is there a happy medium?

    Reply
    • Hi J,

      You bring up a common concern, namely the fear that ERP will make someone care less about their relationship with God, sin more, and hold lax convictions.

      The intention of Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) is to help you resist compulsive behavior and live in accordance with your intended values, whatever they may be. Assuming your personal and/or religious convictions are against the viewing of pornography, the treatment goal would be to resist compulsive rituals, routines, and avoidances with images that are not explicitly pornographic, and when your intentions are not directed at seeking out pornographic images. In short, you will need to accept and deal with images that the average person would see in the course of living life, and treat them as if they are not pornographic by resisting compulsions and tolerating any level of discomfort from this perceived (but not actual) sin.

      Reply
  • I was a christian, I used to go to the church and I was guilty of doing most of these things you described, but not constantly. I have overcome my religion and now I am an agnostic atheist, so I don’t believe in god, but I’m not really sure if he does or not exist, so I still kind of fear I might offend him, considering the possibility he exists. That is, I don’t think about it all the time, I do make some “dark jokes” that some might consider blasphemy and it doesn’t really bother me, but I still wouldn’t for example praise satan or make any serious blasphemy. I still have this issue of “Inordinate focus on religious, moral, and/or ethical perfection” with my morals and ethic. I didn’t really ever think about having OCD or anything like it and I still don’t think I do, but lately some thoughts have been seriously haunting me. I’m not even sure what I am thinking about, but I imagine it is the devil or something like it and I fear god might be real and it might be an actual temptation and just to be sure, I respond it like “No, get out of here, you’re not welcome, I will never give in to you” or stuff like that, in fear that I would actually sell my soul. Once these thoughts start, they just won’t stop and they are driving me crazy. Any thoughts?

    Reply
    • Thanks for the comment Jonatas.

      For an agnostic atheist, you are giving supernatural forces and beings a lot of attention. Though saying you don’t believe in God, the effort spent to prevent the devil from impacting you in any way is giving the thought a lot of credit, especially given that you aren’t certain about if God does or does not exist, and I imagine also don’t know the impact devil will have (if he exists).

      The next time you notice the thought, acknowledge it as being just words in your mind, and let them gently float out in their own time like any other nonsense thought would. Best of luck and keep it up!

      Reply
  • Hiya. I’ve got it badly at the minute. Can’t think straight and confession is a big worry at the moment. I remember looking at a 5 year old and saying she is pretty, and now I’m in panic thinking I’m looking at a child or something. Help.

    Reply
    • Michael,

      A few thoughts…

      1) Looking at a child and noticing that he or she is pretty is not even remotely the same as doing something inappropriate with a child. Every day since the beginning of time, people all over the world have looked at children while noticing that they are pretty or cute or adorable or whatever.

      2) Confessing is a compulsion that will only make your OCD worse.

      3) I encourage you to see treatment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT).

      Reply
  • Would love to hear more about scrupulosity for non-believers. My atheist teenager keeps detailed lists on all his so-called “crimes” (very minor offenses). Would this be non-religious scrupulosity or Harm OCD or ?

    Reply
    • Jean,

      Don’t get caught up trying to distinguish between variants of OCD. Terms such as “Harm OCD” and “Scrupulosity” are just slang terms for variations of OCD in which the primary obsession focuses on certain issues. The bottom line is this: it’s all OCD.

      Also, religious folks do not have a corner on Scrupulosity. I encourage you to read our article “Moral Scrupulosity in OCD: Cognitive Distortions“.

      Reply

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