Can I really be Certain?

As a licensed mental health counselor, one of the conditions that I regularly treat is obsessive-compulsive disorder (OCD).  There are a number of subtypes of OCD.  One that I regularly encounter especially from the faith community is called Scrupulosity.  Scrupulosity is characterized by excessive concern and guilt over moral or religious matters and can have a significant impact on a person's daily life.  


Individuals with scrupulosity have an intense fear of committing moral or religious sins and constantly worry about their thoughts, actions, and intentions. They may engage in repetitive rituals or seek reassurance from others to alleviate their anxiety.  Common fears include, “Have I committed the unpardonable sin”, “ Am I really saved”.  I have had clients who have spent hours reciting specific scriptures and prayers and affirming certain beliefs over and over.  This constant preoccupation with morality can lead to feelings of guilt, shame, and self-doubt.


Understanding scrupulosity requires recognizing that it is not simply a matter of being overly religious or having a strong moral compass. It is a mental health condition that can cause significant distress and impairment in functioning. It is important to approach scrupulosity with empathy and support, rather than dismissing it as excessive religious devotion.


Treatment for scrupulosity often involves a combination of therapy and at times medication. Cognitive-behavioral therapy (CBT) can help individuals challenge and modify their irrational beliefs. Exposure and response prevention (ERP) therapy, a specific form of CBT, can be particularly effective in treating scrupulosity by helping to break the patterns of behavior and rituals that are perpetuating the problem.  Doing so diminishes and eliminates the intrusive obsessions that cause distress.


Medication, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed to help manage the anxiety and obsessive thoughts associated with scrupulosity.  Many people however are significantly helped with therapy alone. 


It is important for individuals with scrupulosity to seek professional help from a mental health provider experienced in treating OCD and related disorders. Support from family, friends, and religious leaders can also be beneficial in understanding and managing scrupulosity, however it is important they have an understanding of the nature of the condition.  Many well meaning religious leaders and family have offered well meaning direction that is counterproductive and may actually exacerbate  the condition. 


It is important to approach scrupulosity with empathy and understanding, recognizing it as a mental health condition that requires appropriate treatment and support.  In  addiction to seeking a qualified mental health professional specializing in treating OCD using ERP, a good starting place can be found at scrupulosity.com.