What is Religious (Scrupulosity) OCD

by Foluso Solarin, PhD

Background

*Darrell can’t decide whether he will be able to sit through another church service.  He has already missed several weeks in a row and feels anxious about returning.  However, should he risk connecting with others to sit through another situation where everything is a trigger?

Church was not always like this for Darrell. He used to enjoy connecting with several similar others of a diverse background, especially since he was one of the few people of color in his neighborhood and workplace.  However, he battled intrusive and unwanted thoughts during church, which made him question his faith and have severe worries about his eternal destiny.  Sometimes the rituals he did to deal with these “bad thoughts” took so long he was late for church.  Soon he stopped going altogether.   All the pastors did was provide him with reassurance that he was fine and just “overthinking things,” which temporarily made him feel better but much worse in the long-term.

Because Darrell is isolated from a spiritual community that is supportive of both his culture and faith, he feels less equipped to deal with some of his other stressors, especially those that occur in the workplace.   Darrell feels blindsided.  He has been attending his new church for about a year and feels that it is one of the places he can truly be himself,  He is surprised that he is having OCD symptoms around religion, since until recently, he has never considered himself a devoutly religious person.

Symptoms of Religious (Scrupulosity OCD)

Religious OCD, otherwise known as Religious Scrupulosity OCD, is a subtype of OCD in which the themes of the obsessions and compulsions are religious in nature.  Individuals experiencing this subtype of OCD may have the following symptoms

• Unwanted/intrusive blasphemous thoughts, images or urges
• Fears that they have committed a sin that can never be forgiven (i.e. the unpardonable sin)
• Unwanted/intrusive thoughts about religious figures, saints and icons
• Taboo thoughts and images associated with religion and faith
• Fear of “losing control” while being in a religious setting (i.e., shouting obscenities in church, defacing religious icons)
• Fear of having blasphemous or taboo thoughts while reading Scriptures or engaging in religious activities
• Prayer as a means of escaping anxiety or avoiding catastrophe, instead of meaningful engagement or communication
• Irrational and overwhelming fear of going to hell
• Constantly seeking reassurance from others or Scripture that they are not going to hell
• Avoiding religious activities (i.e. Communion) for fear of not doing them “the right way”
• Overwhelming crippling feelings of guilt and shame for unexplained reasons

The Relationship between OCD and Religion

Faith, religion, and spirituality are abstract concepts.  You cannot observe or measure spiritual concepts such as sin or belief.  It is normal and healthy for those who are religious to try and make sense of these abstract concepts in tangible and meaningful ways, to have questions, and to engage in specific religious rituals that provide deep and meaningful connections with their faith.  However, to those with OCD, the abstract nature of religion can present as overwhelming, and the uncertainty that all people struggle with in religion can be devastating to someone with OCD.  The OCD behaviors initially may start out with the intention of being a devout follower of the faith, but they suck the life, joy and meaning out of what is meant to be a positive relationship with religion.  Dr. Martin Franklin, in his talk on Religious OCD, described OCD was “wearing the cloak of religion.”¹   People who have religious OCD are prone to confusing OCD behavior and their true religion, and may have an especially difficult time accepting that their rituals are not the heart of their religion.  Darrell did not think of himself as a particularly devout person and was surprised by his OCD symptoms.  However, OCD tends to attack what is important to a person at the time.  This is part of the reason why OCD symptoms  can seem to “change themes.”  Darrell’s religious community was an important part of his life and was a prime target for OCD symptoms.

Treatment for Religious OCD

Like many people with Religious OCD, Darrell feels alone and isolated.  Being an immigrant, he has longed to connect with others who share a similar cultural background and church was that place for him. He feels reluctant to seek therapy because he does not want to “other” himself even more by having to identify and work through a mental illness diagnosis.  Darrell’s concerns are understandable and common.  However, the more he delays therapy, the more difficult his OCD symptoms may be to treat.  

ERP (Exposure Response Prevention) is the gold standard, non-medical treatment for OCD.  ERP for Religious (Scrupulosity) OCD will help Darrell address OCD symptoms by teaching him to tolerate the discomfort, anxiety, shame and dread he faces without engaging in compulsions. As Darrell does this, he learns that religious uncertainty he experiences, while very uncomfortable, even terrifying, is not dangerous and will not destroy him.  He will learn ways of tolerating the discomfort and uncertainty without resorting to compulsive behavior.   He will find ways of practicing his religion that is not based on avoiding what triggers his anxiety, but instead, working through those difficult situations, scenarios and triggers. He will learn that absolute certainty in his faith is not essential or helpful as part of his recovery.

Here is what effective therapy for Darrell can look like

1. Finding different ways of praying, that are more meaningful and not compulsive
2. Sitting outside of a church in his car without trying to erase or combat the “bad” thoughts that come into his mind
3. Reading passages of Scripture for increasing lengths of time without seeking reassurance
4. Looking at pictures of religious icons and objects

The right therapist for Darrell will respect his religion, understand and connect with his unique experiences as an immigrant and person of color, and help him reconnect with his religion in a meaningful genuine way that is not based on fear or avoidance.

*Disclaimer: This article is educational in nature and is not intended to be a substitute for professional treatment.   This story in this article is fictional and does not represent any former or current clients or patients of the author.   

REFERENCES and RESOURCES 

1. “Assessment and Treatment of OCD across the developmental spectrum.”  Presentation by Martin E. Franklin, Ph.D. for Rogers Behavioral Health.  November 6, 2020
2. https://accounseling.org/category/mentalhealth/ocd/ (Tedd Witzig’s resources on combating Religious OCD)

Here at ERP Kaleidoscope, you can find a therapist that understands and will be sensitive to your religious beliefs and OCD concerns.  They will approach treatment from a culturally-informed lens and provide ERP therapy in a way that is respectful to your religious beliefs.  

Foluso Solarin, PhD is a licensed psychologist  and owner of Skillset Counseling, LLC a private practice that focuses on the treatment of OCD, Spiritual Abuse, and Cultural Abuse..  The website for the practice is https://skillsetcounseling.com