Scrupulosity could be considered the over-religious type of obsessive-compulsive disorder (OCD). In most forms of OCD, painful ideas or obsessions lead to repetitive behaviors or compulsions, creating misery for those afflicted. When people have the scrupulosity type of the disorder, their obsessive thoughts focus on sins, breaking religious rules, or being impure. These thoughts create compulsive behaviors like constantly obtaining spiritual counsel, going to confession frequently, praying constantly, or harsher activities like self-flagellation. This condition’s treatment, a combination of therapy and medication, is often effective, but it takes hard work.
Many definitions of scrupulosity begin with listing famous individuals who appear to have had this disorder. A number of saints and other religious leaders are mentioned. Most of these lists are conjecture, and they tend to be inaccurate because the people named lead full and functional lives. For people with true scrupulosity or any other form of OCD, the illness can severely impair function in many aspects of life. Patients with extremely severe scrupulosity may have little in life beyond suffering painful obsessive thoughts and repeating actions to try to lessen these thoughts or the anxiety they produce.
From a diagnostic standpoint, scrupulosity includes obsessive focus on any religion. A person may view himself as greatly sinful, bound for hell, liable to offend a deity, or constantly impure in thought and deed. Additionally, the individual increases various forms of religious practice like prayer, confession, or seeking spiritual advice.
The illness could also feature a variety of ritualistic behaviors that are undertaken much more often than is called for by the religion. Alternately, behaviors, like self-injury, may even be discouraged by an individual’s religion. It is common for patients with this condition to have grave misunderstandings concerning spiritual dogma and doctrine. This disorder is further characterized by significant anxiety because people live in constant fear of erring in major spiritual ways.
Present treatments, such as talk and drug therapy, have a good chance of success. Therapists may draw on various techniques like existential therapy, cognitive behavioral therapy, or exposure and response prevention. These take work on the part of the client, and it can be very difficult at first because clients may fear they are at all times acting in sinful ways. Sometimes, therapists enlist local religious leaders to help explain spiritual misunderstandings, which may promote greater comfort.
Another part of treatment is drug therapy. Some medications, like selective serotonin reuptake inhibitors (SSRIs), may help to reduce symptoms. Anxiety medications, such as benzodiazepines, could also be tried to reduce apprehension and compulsivity. Generally, the most improvement is made when a combination of medication and therapy are used. Therapy of any type is difficult and requires significant client commitment, but that effort may be repaid with improvement or, in many cases, total cessation of the disorder.