Scrupulosity (religious OCD): Symptoms and treatment

Religious OCD, also known as scrupulosity, is a form of obsessive-compulsive disorder (OCD) that involves intrusive thoughts about sin, morality, or breaking religious rules. Experts who study OCD have discovered that peoples’ obsessions and compulsions often revolve around some common themes. One of these themes is religion, and there’s an unofficial subtype of OCD called religious or scrupulosity OCD.

People living with this form of OCD live in fear of breaking the rules of their religion, disappointing God, or not practicing their faith the “right” way. Left untreated, this form of OCD can negatively impact many areas of a person’s life. Fortunately, like other forms of OCD, it can be managed with the right support.

What is religious scrupulosity OCD?

All people living with obsessive-compulsive disorder (OCD) experience disturbing, intrusive thoughts called obsessions. In an attempt to quiet or control these upsetting thoughts, they then engage in ritualistic behaviors called compulsions.

For people with religious scrupulosity OCD, these obsessions and compulsions center around faith, sin, and morality. They may constantly worry about sinning, offending God, or violating religious rules in some way. Even small mistakes or moral “imperfections” can trigger intense fear, guilt, or shame, along with deep anxiety about what those thoughts or actions mean about their character or spiritual worth.

People with religious OCD may experience distressing, intrusive thoughts like:

• Blasphemous thoughts or images that go against their beliefs

• Fear of sin or hell, even when they haven’t done anything wrong

• Prayer repetition, feeling they must pray “perfectly” or start over until it feels “right”

• Doubting their faith or worrying that they don’t truly believe

• Intrusive urges to say or do something offensive during worship or prayer

• Fear of moral failure, such as lying, cheating, or hurting others

• Anxiety about salvation, fearing they can never be forgiven

In response to these distressing thoughts, people with religious OCD engage in ritualistic behaviors to reduce their anxiety. These behaviors might include:

• Repeatedly touching sacred objects

• Viewing holy imagery

• Praying for hours

• Or making intense mental efforts to cleanse their minds from “bad” or sinful thoughts

While these behaviors may offer temporary relief, they tend to strengthen the obsessive-compulsive cycle over time. A key part of recovery involves learning to tolerate uncertainty — accepting that intrusive thoughts don’t define your faith or morality, and that spiritual peace doesn’t come from constant reassurance.

What’s the difference between scrupulosity OCD and being religious?

Being a devout person or someone who practices frequent faith-based rituals does not mean that you have a mental health condition. Perhaps you’re a person who prays at certain times each day or regularly attends religious services. Maybe you use this time to contemplate, reflect, and feel connected to your higher power. These experiences might bring you a sense of peace or help you navigate life’s daily stressors and uncertainties.

By contrast, a person living with scrupulosity OCD will have a different relationship with their religious practices. For example, they might feel extremely anxious if they don’t say their nightly prayers “correctly.” If they stumble over a word or make some other error, they feel like they have to start the process over again. They can’t relax or fall asleep until their prayers feel “perfect.”

These compulsive rituals are very different from everyday expressions of faith. In fact, religious scrupulosity OCD has very little to do with religious beliefs. Just like germs aren’t the cause of contamination OCD, religious beliefs are not the cause of religious OCD.

Symptoms of religious scrupulosity OCD

Religious scrupulosity OCD can take many forms, depending on the individual. But some of the common signs and symptoms to be aware of include:

• Having constant fears of sinning

• Avoiding anything that could lead you to feel impure or immoral

• Striving for religious perfection

• Worrying that your thoughts or behaviors might signal that you’re a bad person

• Being afraid of going to hell or being punished by your higher power

• Seeking constant reassurance about your level of religiosity or commitment to your faith

• Doubting whether you’re religious enough

• Fearing things like demons or becoming possessed

• Feeling anxiety about losing control and straying from righteousness

• Feeling compelled to confess every sin, even the smallest mistakes

• Seeing religious practices (such as attending services) as mandatory or obligatory even when they aren’t

• Engaging in acts of self-sacrifice that could compromise your health or well-being

• Spending excessive amounts of time on cleansing or purification rituals

• Seeking constant reassurance from clergy, religious leaders, or loved ones

What causes religious scrupulosity OCD?

Genetics, brain circuits, and stress or trauma are believed to play important roles in the development of religious scrupulosity OCD, just as they do with other forms of OCD. While the exact cause isn’t fully understood, research suggests that OCD involves both biological and environmental factors working together.

In the past, some experts thought religious scrupulosity was caused by being highly religious or belonging to a specific faith tradition, but those ideas haven’t been supported by evidence. Instead, studies show that when religious people develop OCD, their symptoms are more likely to take on religious or moral themes, such as fear of sinning or disappointing God.

Most effective treatment options for religious scrupulosity OCD

All forms of OCD, including religious scrupulosity OCD, can be managed with the right support. The most common forms of treatment for OCD include:

• Cognitive-behavioral therapy (CBT): This form of treatment helps interrupt irrational, unhelpful, or distressing thoughts, like obsessions related to religion. Learning to manage these thoughts through CBT can help you respond to stressful situations differently.

• Exposure and response prevention (ERP): Considered the “gold standard” for OCD treatment, ERP is a form of CBT that can help reduce the distress you experience due to your obsessive thoughts. It can be effectively conducted over teletherapy and involves a slow, gradual exposure to stressors under the supervision of a trained therapist.

• Medications: Certain medications may be used to reduce OCD symptoms. You can talk with your therapist about getting referred to a psychiatric provider to see if medications are the right option for you.

Can therapy respect my faith?

Yes — therapy for OCD can fully respect your faith. A good therapist won’t ask you to change or give up your beliefs. Instead, they’ll help you find a healthy balance between your faith and your mental health. Many therapists who treat religious scrupulosity OCD understand the importance of religion and will work with you to keep your values part of the process. The goal is to help you worry less, feel more peace, and reconnect with your faith in a healthy way.

Clinician’s take

You don’t have to choose between your faith and your mental health. The right therapist will respect your beliefs while helping you find peace, balance, and freedom from the fears that hold you back.

Brandy Chalmers, LPC

Clinical reviewer