Scrupulosity

This article is about mental disorder. For other uses, see Scruple (disambiguation). "Doubting disease" redirects here. For the French film, see La Folie du doute.

Those with scrupulosity struggle with intense feelings of guilt, sometimes leading to excessive participation in religious rites such as confession. (The Confession by Giuseppe Molteni, 1838)

Scrupulosity, also known as religious obsessive–compulsive disorder or scrupulous–compulsive disorder (SCD), is a mental disorder defined by intrusive thoughts about moral or religious ideas, pathological feelings of guilt, and compulsions which attempt to mitigate such thoughts. It is widely understood as a subtype of obsessive–compulsive disorder (OCD).

Common obsessions include fears about having blasphemous thoughts, unwittingly committing immoral actions, being condemned to hell, or improperly performing religious obligations. Compulsions often take the form of excessive prayers, obsessive study of religious doctrine, or avoidance of religious obligations and objects. Individuals with scrupulosity often exhibit paralyzing doubt about whether they fully understand their moral principles, leading to rumination. They often have difficulty acknowledging that their thoughts and behaviors are irrationally motivated and may have difficulty interpreting exaggerated language in religious contexts.

Scrupulosity is generally treated with psychotherapy; cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are both common approaches in treatment. Psychopharmacological treatments, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed to those with OCD if symptoms are severe enough, though effectiveness with scrupulosity appears to be lower. Clinicians often collaborate with appropriate clergy to help bolster patient trust in the process, fortify the patient's understanding that their thoughts are disordered, and prepare clergy to support treatment in ecclesiastical settings. Clergy also help clinicians disentangle normative religious practices from disordered ones.

Prognosis for scrupulosity is generally worse than other forms of obsessive–compulsive spectrum disorders, being more resistant to treatment overall. The mental energy cost of obsessions and compulsions can lead to increased comorbidity, especially depressive and other anxiety disorders. People with scrupulosity are at a higher risk of depression, low self-esteem, self-harm, and suicide.