What Is Scrupulosity, and How Is It Treated?

Scrupulosity — sometimes called “religious OCD” or “moral OCD” — is a type of obsessive-compulsive disorder (OCD). Religious OCD causes unwanted and often distressing intrusive thoughts (obsessions) related to moral, religious, or ethical issues. 

Like with other forms of OCD, these intrusive thoughts make you feel driven to perform repetitive actions (compulsions) to manage the anxiety caused by the obsessions. In the U.S., an estimated 2.3% of people will experience OCD in their lifetimes. Of this percentage, as many as 33% will experience scrupulosity specifically. 

In this article, we’ll take a closer look at the intrusive thoughts and compulsions people with scrupulosity may struggle with. Plus, we’ll give you some tips for when to seek professional support and what kinds of therapy and medication can help. 

How is scrupulosity different from other types of intrusive thoughts?

Scrupulosity is a subset of intrusive thoughts due to OCD. Some people with OCD have intrusive thoughts related to contamination, symmetry, or their sexual orientation. People with scrupulosity have intrusive thoughts related to their fear of violating religious, ethical, or moral beliefs. 

Annabella Hagen, a licensed clinical social worker and clinical director of Mindset Family Therapy, provided two common examples of intrusive scrupulosity thoughts:

• Thinking, “My roommate is so sloppy,” leads to the intrusive thought, “Oh no, I’m being judgmental. I need to repent!”

• Thinking, “I didn’t tell mom how I was really feeling,” might cause the obsessive thought, “I just sinned because I lied.”

Other examples of intrusive thoughts people with scrupulosity may experience include: 

• Fear of offending God or a higher power with disrespectful, blasphemous, or sexual thoughts

• Anxiety about being “found out” for perceived misdeeds

• Constant worry about whether you have hurt someone emotionally, physically, or financially

• Fear about not following religious or moral principles perfectly 

• Fear of being possessed by Satan or the devil

• Anxiety about having unwanted “sinful” or “bad” feelings or sensations, like anger or sexual arousal, for example 

Though many people who experience scrupulosity do practice a religion, it’s important to note scrupulosity can impact non-religious, secular individuals, too. One study found 24% of participants with scrupulosity had no religious affiliation at all. 

What are some examples of scrupulosity compulsions?

If you have scrupulosity, you may perform mental or behavioral compulsions to try and lower the distress caused by intrusive thoughts.

Mental compulsions are actions you perform in your head to prevent something you fear from happening or to lessen the anxiety you feel. Some examples of mental compulsions include:

• Praying excessively 

• Trying to make your prayer “perfect” or “sincere enough”

• Combing through past events to determine if you acted sinfully or immorally

• Rehearsing a spiritual text repeatedly

• Making pacts with God or your higher power

Examples of behavioral compulsions — outward actions or rituals you perform to lessen the anxiety caused by intrusive thoughts — include:

• Excessively confessing your sins to others

• Avoiding places, people, or things that trigger obsessive thoughts 

• Seeking constant reassurance from religious leaders or loved ones to make sure you didn’t act immorally

• Repeatedly engaging in cleansing or purifying rituals 

How do you know if you should seek help treating scrupulosity?

On the outside, scrupulosity often looks like — and may be praised for being — total devotion to religious or moral ideals. Because of this, scrupulosity can go undiagnosed for years.

“Genuine religious practice and scrupulous behaviors are sometimes difficult to detangle,” says Kevin Foss, a marriage and family therapist and founder of the California OCD and Anxiety Treatment Center. “However, a clear sign that religious practice is rising to the level of scrupulosity is when religious practices become increasingly urgent and distressing.” 

As a general rule, if you find your intrusive thoughts are impacting your life so much that it’s hard to go about your day, it’s probably time to check in with a mental health professional. Hagen also recommends asking yourself the following questions if you think you may be struggling with scrupulosity.

• Are my moral/religious behaviors a source of spiritual and emotional strength/desire to connect with my higher power? Or am I using them to relieve my anxiety, uncertainty, and guilt?

• Have my religious or moral activities become a checklist?

• Can I participate in religious, spiritual, or moral practices in moderation, or am I often creating time-consuming and rigid rules for myself? 

If you answer these questions and decide your motivations mostly come from your desire to lessen your anxiety or discomfort, that’s another sign it may be time to talk to your provider.

Treating scrupulosity with therapy

There are a number of therapy treatments that can be effective for treating scrupulosity and OCD. These include exposure and response prevention (ERP) and acceptance and commitment therapy (ACT).

Exposure and response prevention (ERP)

ERP is a type of cognitive behavioral therapy (CBT) where a mental health professional gradually exposes you to the trigger of your anxiety (exposure). Then they help you resist using a compulsion (response prevention) so you learn that your intrusive thoughts are just thoughts. This helps reduce your anxiety and OCD symptoms.

For example, you may fear that experiencing attraction or sexual arousal makes you a sinful person. Anytime you find yourself attracted to someone, you have incredible anxiety about being sinful. To reduce the anxiety, you seek reassurance from your religious leader by asking if it’s a sin for you to feel sexual attraction. Asking your religious leader for reassurance is the compulsion. 

To help you lessen your dependence on this compulsion, an ERP therapist might have you think about a time when you felt attracted to someone in your life (exposure). They’ll then help you cope with the distress of this memory without seeking reassurance or confessing (response prevention). 

Over time, you will learn to cope with the intrusive thoughts related to attraction without repeatedly confessing to a religious leader. And, your anxiety related to sexual attraction will also lessen with ongoing exposure and response prevention exercises. 

Acceptance and commitment therapy (ACT)

The goal of acceptance and commitment therapy (ACT) is to increase your psychological flexibility — the ability to “go with the flow” when difficult thoughts, feelings, or circumstances come up. In the case of OCD and scrupulosity-related obsessions, ACT teaches you to notice your thoughts without giving them special significance or meaning. 

For example, let’s say your scrupulosity causes intrusive thoughts like, “I’m being possessed by the devil.” Instead of believing this thought is true or trying to change it, ACT helps you accept it as just a passing thought (acceptance). You’ll then choose to keep doing what you’re doing without stopping to use a compulsion (commitment).  

Preliminary studies have found ACT can be effective in treating people with OCD, including scrupulosity-based OCD. Foss says acceptance-based treatment can be particularly helpful to people who are hesitant about traditional exposure therapy. 

Medications to treat scrupulosity

If you’ve been diagnosed with OCD or are experiencing OCD-based scrupulosity, you may also benefit from taking medication. Medication can take the edge off the anxiety you feel, which can make exposure treatment more tolerable and effective, Foss says. 

People who benefit from medication as part of their OCD treatment may experience up to 60% fewer OCD symptoms. Medication may also help if you have other conditions like clinical anxiety or depression as well.

The following are FDA-approved psychiatric medications for OCD:

• Clomipramine (Anafranil)

• Fluoxetine (Prozac)

• Fluvoxamine (Luvox)

• Paroxetine (Paxil)

• Sertraline (Zoloft)

Depending on your symptoms, your healthcare provider may recommend other medications. Together, you and your provider will decide on a treatment plan that works best for you.

How can I deal with scrupulosity at home?

If you’re struggling with scrupulosity and OCD, you’ll want to work with your healthcare provider to develop a treatment plan that might include therapy, medication, or both. In addition, your provider can help you learn techniques to manage distress caused by intrusive thoughts when you’re on your own.

You could also consider a support group to connect with others who “get it.” This can help validate your experience as well as help you learn new coping skills and resources. To find a group, the International OCD Foundation (IOCDF) maintains a list on its website. There, you can find free or low-cost groups in your community or online.

Faith and spirituality can be a source of strength for your mental health, even if you’re struggling with scrupulosity. If you are part of a faith or spiritual community, try speaking to a religious leader or community member. They may be able to help you brainstorm new ways to connect with your faith. IOCDF also has resources specifically for religion and OCD. 

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Written by:

Juliette Timmins

Juliette Timmins, MSW, recently completed her social work internship at the Los Angeles Department of Mental Health. She now volunteers as a crisis line counselor at Didi Hirsch's Suicide Prevention Center in Los Angeles.

Edited by:

Renée Fabian, MA

Renée Fabian is the senior pet health editor at GoodRx. She’s worked for nearly 10 years as a journalist and editor across a wide range of health and well-being topics.

Reviewed by:

India B. Gomez, PhD

India B. Gomez, PhD, is a licensed clinical psychologist with a certificate in Latin American Family Therapy. She completed her doctoral education at the California School of Professional Psychology/Alliant International University.

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