Scrupulosity OCD: Religious & Moral Obsessions

Written by:Elizabeth Keohan, LCSW-C, MSW

Published On: February 3, 2023

Medically reviewed by: Cynthia V. Catchings, LCSW-S

Reviewed On: February 3, 2023

Updated On: July 17, 2023


Scrupulosity OCD is a type of obsessive-compulsive disorder (OCD) that’s rarely discussed. Like all types of OCD, it involves unwanted thoughts and repetitive behaviors. The difference, however, is that the symptoms of s crupulosity OCD involve moral and religious beliefs.

If you’re worried you may be dealing with scrupulosity OCD, it’s important that you know other people experience similar symptoms. You’re not as alone as you think, and there’s help for what you’re going through.

Continue reading to hear more about the impact moral and religious scrupulosity OCD can have on your life and to learn how you can manage your condition.

What Is Scrupulosity OCD?

While only one type of obsessive-compulsive disorder is listed in the DSM-V, experts frequently divide OCD into subtypes based on a person’s symptoms. Scrupulosity OCD is a type of OCD that causes distressing thoughts and urges related to a person’s moral or religious beliefs. The obsessions they experience can cause guilt, shame, and anxiety. In true OCD fashion, these obsessive thoughts often lead to an attempt to break the cycle by engaging in compulsive — unhelpful and often unhealthy — behaviors.

“Scrupulosity is considered a condition or disorder with a persistent, tenacious appetite for moral and religious obsessions. It’s pathological in nature while also compulsive in behavior, particularly obsessive and controlled by intrusive thoughts often ridden with religious driven guilt.”

Licensed Certified Social Worker-Clinical, (LCSW-C), LICSW, MSW Elizabeth Keohan

Some people divide scrupulosity OCD symptoms into two additional categories: moral OCD and religious OCD.

While moral OCD symptoms can be secular in nature, religious OCD involves symptoms related to a person’s spiritual or religious beliefs. Religious OCD symptoms don’t necessarily follow religious laws, and many people have symptoms related to specific fears or practices.

Signs & Symptoms of Scrupulosity OCD

People from all religious backgrounds and beliefs can experience religious scrupulosity. Someone with scrupulous OCD typically holds themself to strict moral or religious standards.

They’ll frequently experience extreme anxiety or shame when they feel they’ve fallen short of those standards. This can result in a variety of obsessions and compulsions.

“Signs of scrupulosity, much like OCD generally, can be identified by compulsive thoughts and behaviors, repetitive manifestations, and ruminating thoughts that aren’t easily dispelled by reframing or sound, rational insight.”

Licensed Certified Social Worker-Clinical, (LCSW-C), LICSW, MSW Elizabeth Keohan


Whether someone experiences moral or religious OCD symptoms, obsessions are typically related to moral belief symptoms. Common obsessive symptoms include:

  • Worrying about mistakes or sinful compulsive behavior in the past
  • Intense fears about engaging in blasphemy
  • Recurring anxiety about sin or immoral behavior
  • Excessive worries about death or the afterlife
  • Distressing, unwanted sexual thoughts, often about religious figures
  • Concerns about what will happen to loved ones in the afterlife
  • Fears of being possessed
  • Obsessing over the moral purity of certain behaviors


While compulsions are intended to relieve the guilt or distress caused by obsessions, they don’t necessarily always align with a person’s belief symptoms. Examples of a compulsive behavior in moral scrupulosity OCD might be:

  • Excessive prayer or confessions
  • Attending all religious services, even when they’re not required
  • Avoiding religious services because of fears about being impure or sinful
  • Constantly asking for reassurance even before ‘sinning’
  • Engaging in purifying or cleansing rituals
  • Repeatedly reading religious texts

“It can be painful or make one feel more vulnerable when trying to influence a change in thought patterns not easily swayed by alternative rationale. Professional support and therapy is always a good idea, especially if a loved one troubled by scrupulosity is particularly fixed or rigid in their ideation.”

Licensed Certified Social Worker-Clinical, (LCSW-C), LICSW, MSW Elizabeth Keohan

Causes of Scrupulosity OCD

We don’t know exactly what causes OCD. That said, we do understand that several things can contribute to the condition. Experts believe there’s likely a neurobiological cause. Research shows that many people with OCD have similar brain abnormalities. Other elements, including genetics and environmental factors, may play a role as well.

Why do some people experience religious OCD symptoms? Religion and spirituality don’t cause OCD, but some related beliefs can influence certain obsessions and compulsions people develop. For people with a strongly-held religious belief, the obsessions that OCD can trigger can be very distressing.

How to Overcome OCD Scrupulosity: 4 Treatment Options

Many evidence-based OCD treatments have been helpful for people with obsessive-compulsive disorder. However, while some types of therapy can treat any form of OCD, a religious scrupulous treatment will likely be tailored to a person’s obsessions and beliefs. Below, you’ll find some of the most effective treatments for moral and religious OCD.

1. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy used to treat many mental health conditions, including OCD. This type of therapy for OCD is often focused on exposure and ritual prevention.

Exposure therapy for OCD involves purposefully exposing people to objects or situations that trigger symptoms. It also involves strategies for avoiding compulsions and relieving distress caused by symptoms. Exposure to OCD triggers in a safe environment can help some people develop effective coping strategies.

Another treatment approach used for OCD is mindfulness-based cognitive behavioral therapy. This style of therapy combines CBT with mindfulness practices that can help people with OCD change their relationship with the symptoms they experience. Mindfulness is all about focusing on the present and accepting obsessive thoughts without judgment.

2. Rational emotive behavior therapy

Rational emotive behavior therapy (REBT) is designed to help people identify and cope with irrational beliefs. When used to treat OCD, treatment generally focuses on teaching someone to recognize and accept the symptoms of their condition. It uses emotive, cognitive, and behavioral techniques to manage and improve symptoms.

While REBT is similar to CBT, it’s client-directed, which means that patients take a direct role in managing their OCD symptoms. Like CBT, it’s often used alongside exposure and response prevention. A significant benefit of REBT is that treatment can teach people to tolerate the anxiety caused by their obsessions. This, in turn, can help them avoid using compulsions to try and alleviate their intrusive thought patterns.

3. Medication

OCD treatment may also include psychiatric medications. While OCD medications can be used alone, most often, it’s used alongside therapy. Certain medications can reduce the severity of OCD symptoms, making patients more responsive to treatment.

A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are typically used as a first-line treatment for OCD. Clomipramine, a tricyclic antidepressant, is another medication frequently prescribed. In addition, patients with co-existing conditions may be prescribed medication to help manage their other symptoms.

4. Transcranial magnetic stimulation

While a large percentage of people with OCD respond well to first-line, combined treatments like CBT therapy and medication, they aren’t effective for everyone. In these cases, transcranial magnetic stimulation (TMS) might be an effective option. TMS is a non-invasive brain stimulation technique that uses magnetic fields to reach parts of the brain linked to OCD.

This treatment is FDA-approved, and studies show it’s highly effective at improving symptoms in people with treatment-resistant OCD. Although it is considered safe, it’s important to note that TMS can cause adverse symptoms and physical discomfort. This is why other treatments are typically explored first.

Finding Help For Scrupulosity OCD With Talkspace

The distress scrupulosity OCD causes can be severe, and the condition can interfere with daily functioning. So, what should you do if you have symptoms of moral scrupulosity OCD?

If you think that you may have scrupulosity OCD, reach out to Talkspace. Our online therapy platform makes it easy to connect with a mental health professional with experience treating various forms of OCD.

Talkspace offers online therapy that makes getting mental health help convenient, affordable, and more accessible than ever. Get started with an OCD test today if you think you are experiencing symptoms.

See References

Elizabeth Keohan, LCSW-C, MSW

Licensed Talkspace Therapist, Elizabeth Keohan has enjoyed working with clients in communities from Washington DC through rural Maine over the course of her career. While she has worked extensively with those experiencing anxiety and depression, she embodies a unique comfort working with the bereaved. Elizabeth combines a compassionate, holistic approach with Cognitive Behavioral Theory (CBT), to help clients counter their somatic response to stress, anxiety, mood, grief and loss.

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