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The ‘Overactive Conscience’ Part 3- Dealing With It

SO WHAT IS SCRUPULOSITY?

Scrupulosity is one subtype of OCD. Other subtypes of OCD include checking, need for symmetry, repeating, contamination/cleaning/washing, and saving/hoarding. Obsessions and compulsions containing religious themes, hypermorality, pathological doubt/worry about sin, and excessive religious behavior are referred to as scrupulosity.

The name “scrupulosity” was derived in the following way: The word ‘scruple’ is derived from the Latin “scrupulus’, a rough or hard pebble that causes discomfort if trodden on; a later meaning was a minute apothecaries’ weight, one twenty-fourth of an ounce, so small as to affect only the most sensitive scales. The term in English acquired a moral interpretation of a thought or circumstance so insignificant as to affect only a very delicate conscience. In religious terminology a scruple is an “unhealthy and morbid kind of meticulousness, which hampers a person’s religious adjustment” (Weisner & Riffel, 1960) (p. 29).

Some ways to distinguish between normal religious practice and scrupulosity

  1. A healthy faith is not associated with debilitating worry and fear.
  1. The more you focus on scrupulosity, the more entangling it is, and the worse it gets. It creates stress.
  1. Scrupulosity is not responsive to spiritual interventions. For example, for the scrupulous person spiritual interventions (e.g., confession) may produce momentary relief, but the symptoms will return.
  1. People enjoy and want to engage in normal religious practices, whereas people with scrupulosity perform the rituals to reduce anxiety/distress due to some feared consequence.
  1. People with scrupulosity often have other symptoms and/or subtypes of OCD.
  1. The individual’s practices far exceed what is required by the particular religious group (e.g., a scrupulous person who is fasting may believe that it is sinful to swallow their own saliva).
  1. Scrupulosity interferes with normal religious practice (e.g., the person does not attend and/or does not partake of communion because of obsessional worries)
  1. The individual’s beliefs and practices become very narrowly focused on “getting it right” and he or she loses sight of deepening their relationship with God (e.g. an individual becomes so consumed with whether or not he could have committed blasphemy without knowing it that he compulsively studies all of the passages on blasphemy and feels that he cannot afford to spend time reading or learning about anything else until his dilemma is solved).
  1. The individual may focus so much time and energy on perfectly performing rituals that he or she overlooks more important aspects of faith (e.g. doing good toward others).
  1. Scrupulosity closely resembles other subtypes of OCD in that there is an overt focus on compulsions (repeating prayers, checking, multiple confessions, reassurance seeking) in response to distressing, intrusive, unwanted and repetitive thoughts, images or impulses.

HOW HELPERS ACCIDENTALLY BECOME PART OF THE PROBLEM

Because of the distress that people with scrupulosity feel, they often turn to others for reassurance and help. While seeking out support and talking to others about our problems is quite healthy in most cases, for a person with OCD/scrupulosity, reassurance seeking is a compulsion and makes the obsessions worse.

Remember how the obsessive-compulsive cycle works: obsessions make anxiety go up (e.g., worrying that one has blasphemed the Holy Spirit) and compulsions (e.g., confessing and seeking reassurance from others) bring anxiety down. Unfortunately, many of the people trying to help scrupulous individuals become part of the problem instead of being part of the cure.

Because, on the surface, scrupulosity looks like a spiritual problem, it is all too easy for Elders/ministers, friends, and family to give advice and recommend Bible verses, prayers, etc. in a way that actually accelerates the OCD/ scrupulosity and causes more distress to the person.

While the scrupulous person may get momentary relief from getting reassurance, in the long run, reassurance makes the obsessions stronger and more distressing. It is very important that people trying to help a scrupulous person be educated about OCD/scrupulosity in order to learn how to best provide support and help to the person.

CONCLUSION

Scrupulosity is a subtype of a mental disorder called Obsessive-Compulsive Disorder. Because the symptoms of scrupulosity involve spiritual concerns, it is often mistaken for a spiritual problem. If you, or someone you know, have symptoms that sound somewhat similar to scrupulosity, it is highly recommended that you seek an evaluation by a mental health professional who understands OCD. Please feel free to call ACCFS for more information on scrupulosity/OCD, a telephone consultation, or counseling.

To view the complete PDF of Understanding the ‘Overactive Conscience’, click here.


RECOMMENDED RESOURCES

OCD-Scrupulosity information from ACCFS
Coping Statements for Christians with OCD-Scrupulosity
Go to www.scrupulosity.org for more information and free downloads.

Adults with OCD:
Hyman, B., & Pedrick, C. (2010). The OCD Workbook (Third Ed.). New Harbinger Publications.
Purdon, C., & Clark, D. (2005). Overcoming Obsessive Thoughts. New Harbinger Publications.
Schwartz, J. (1996). Brain Lock. Regan Books.

Children/Adolescents with OCD:
Chansky, T. (2000). Freeing Your Child from OCD. Time Books.

For Family Members:
Landsman, K, Parrish, K., & Pedrick, C. (2005). Loving Someone With OCD. New Harbinger Publications.
Van Noppen, B., Pato, M., & Rasmussen, S. (2001). Learning to Live with OCD. OCFoundation.

Support Organizations:
International OCD Foundation: www.ocfoundation.org


BIBLIOGRAPHY
  1. Weisner, W. M., & Riffel, P. A. (1960). Scrupulosity: Religion and obsessive-compulsive behavior in children. American Journal of Psychiatry, 117, 314-318.
  2. Greenberg, D., Witztum, E., & Pisante, J. (1987). Scrupulosity: Religious attitudes and clinical presentations. British Journal of Medical Psychology, 60(1), 29-37.
  3. Greenberg, D. (1984). Are religious compulsions religious or compulsive: A phenomenological study. American Journal of Psychotherapy, 38, 524-532.
  4. Abramowitz, J.S., Huppert, J.D., Cohen, A.B., Tolin, D.F., & Cahill, S.P. (2002). Religions obsessions and compulsions in a non-clinical sample: The Penn Inventory of Scrupulosity (PIOS). Behaviour Research & Therapy, 40, 825-838.
  5. Ciarrocchi, J.W. (1998). Religion, scrupulosity, and obsessive-compulsive disorder. In M.A. Jenike, L. Bear, & W. E. Minichiello (Eds.). Obsessive compulsive disorders: Practical management (3rd ed., pp. 555-569). St. Louis: Mosby.