Obsessions & Compulsions Common to Scrupulosity
Prayer is an important part of the Christian faith, but it can also function as a compulsion.
Only licensed mental health professionals can diagnose OCD. But if trusted leaders in the church are aware of common manifestations of scrupulosity, this increases the likelihood that people in the church will find the correct treatment.
Last week, I wrote about my framework for understanding scrupulosity. This week, my goal is to discuss specific manifestations of scrupulosity within the Christian tradition, for the purpose of self-knowledge, but also to educate those in the faith community (pastors, deacons, pastoral counselors, etc.) about some specific ways people in their flock may be showing signs of scrupulosity. This is not for the purpose of diagnosis. This is purely to put scrupulosity/religious OCD on the radar for those who might not be aware of it.
Only licensed mental health professionals can diagnose OCD (preferably one who specializes in OCD, as misdiagnosis is common due to the number of subtypes that can present). But if trusted leaders in the church are aware of it, this increases the likelihood that people in the church will find the correct treatment. In addition, not everyone who shows signs of these specific obsessions and compulsions below will have a scrupulosity diagnosis; nor will everyone with a scrupulosity diagnosis relate to these particular examples.
Regardless of the subtype, Obsessive Compulsive Disorder is made up of both obsessions and compulsions. Obsessions can be intrusive thoughts, doubts, unexplained urges, and even images, and can not be understood in light of the common cultural understanding of an obsession; it is not a general preoccupation, and it is definitely not enjoyable. There will be some overlap between obsessions in the scrupulosity sense, and common concerns parishioners bring to their pastors and church counselors.
One common obsession is perceived lack of assurance of salvation and eternal security. This can be anything from “How do I know that I am truly ‘saved?” to “How do I know that I have not blasphemed the Holy Spirit accidentally?” When Christians with scrupulosity struggle with assurance of salvation in the scrupulosity sense, there is often an underlying expectation that belief and emotional experience should match. But our emotional experience is not always trustworthy. Intrusive OCD doubt is no measure of eternal security.
Scrupulosity can also transform trivialities like going to the mailbox or brushing one’s teeth, for example, into a false sense of spiritual conviction and condemnation. There can, and often is, knowledge that these trivialities are not deeply meaningful spiritual acts, but it feels otherwise. The other side of the coin is that scrupulosity can turn actual conviction into a false sense of condemnation. Not everything is trivial, and there are many times that we do actually need to make changes in our lives. People with scrupulosity are not without need for repentance. This is why I believe it is essential to enlist the help of a specialist who also shares your spiritual convictions: if a therapist’s own beliefs are not within the bounds of Christian orthodoxy, they may be quick to categorize theological truths in matters of ethics and morality as intrusive thoughts, leading to a reduction in OCD discomfort but resulting in spiritual harm.
When the symptoms of scrupulosity are controlled through Exposure and Response Prevention, we can more freely commune with God in a way that is desired and intentional, rather than solely to relieve discomfort.
The habituation that takes place within ERP should be to the OCD discomfort itself, not to a departure from the Christian belief system.
For every intrusive thought and doubt, there will usually be a corresponding compulsion. A compulsion is something done behaviorally or mentally to reduce the distress that results from the intrusive thoughts, doubts, or images. Understanding common compulsions in scrupulosity is of great importance, because pastors can unintentionally recommend tasks to people that are generally helpful, but serve as compulsions within the scrupulosity context. And compulsions will always make OCD worse. Common compulsions include avoiding the Eucharist, praying multiple times, confessing repeatedly, reassurance seeking, rumination, and even requesting to be “re-baptized,” which is outside the bounds of Christian orthodoxy.
The answer to the discomfort caused by obsessions is not more reassurance from a pastor. It is not scripture memorization, and it is not repetitive prayer, although those things are good and healthy when used intentionally and free from the direct influence of OCD. The answer is good, theologically sound Exposure and Response Prevention (ERP). Good exposure exercises will be consistent with the morals and ethics of the Christian faith. Good ERP for scrupulosity will never require sin, and will not have the result of searing one’s conscience. The habituation that takes place within ERP should be to the OCD discomfort itself, not to a departure from the Christian belief system. When the symptoms of scrupulosity are controlled through Exposure and Response Prevention, we can more freely commune with God in a way that is desired and intentional, rather than solely to relieve discomfort.
