Scrupulosity (also known as religious obsessive compulsive disorder) is a specific form of obsessive compulsive disorder in which the individual becomes overly concerned with religious or moral issues. Obsessive thoughts concerning religious pureness or the appropriateness of actions in accordance with religious guidelines generally leads to intense anxiety. In an effort to cope, the individual often turns to a number of physical or mental compulsions to help reduce or rid the anxious feeling. Unlike general obsessive compulsive disorder, those suffering from scrupulosity are generally unaware of the inappropriateness of their actions and often believe the obsessive-compulsive thoughts and actions are the core of their relationship with a chosen higher power.
Scrupulosity was first described in 1691 by John Moore; however, he termed the condition religious melancholy and claimed it caused individuals to fear their actions to such an extent that they felt unfit for acceptance from a higher power. Although this condition has been described throughout history, it has only come to be recognized by the medical profession in recent years. Due to the recent recognition, the prevalence rate is currently unknown.
Diagnosis: A physician may perform an extensive medical history and laboratory tests to rule out drugs, medications, or a general medical condition as the cause of such symptoms; however there is no specific set of diagnostic criteria for scrupulosity. In most cases, physicians rely on the DSM IV criteria for obsessive compulsive disorder paired with religious obsessive-compulsive specificity to make a diagnosis. The DSM IV criteria for obsessive compulsive disorder include:
- Recurrent and persistent thoughts, impulses, or images are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety and distress. Persons with this disorder recognize the pathologic quality of these unwanted thoughts (such as fears of hurting their children) and would not act on them, but the thoughts are very disturbing and difficult to discuss with others
- The thoughts, impulses, or images are not simply excessive worries about real-life problems.
- The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without, as in thought insertion).
- The disturbance is not due to the direct physiological effect of drugs, medications, or a general medical condition.
It is important to note that because scrupulosity can be difficult to distinguish from a strong yet rational religious relationship from scrupulosity, the physician may need to make multiple contacts with the patient to confirm the diagnosis.
Symptoms: Scrupulosity is a form of religious form of obsessive compulsive disorder; therefore, the symptoms include both obsessions and compulsions. It is important to note that the obsession and compulsions are unique to each individual.
Obsessions may include:
- Recurring blasphemous thoughts or fear of saying a blasphemous expression
- Fear of committing a sin
- Recurrent thoughts regarding behaving morally
- Recurrent thoughts regarding purity
- Persistent fear of going to hell
- Intrusive thoughts about wickedness, religious figures, or a higher power
- Fear of being possessed by an evil spirit
Compulsions can include:
- Excessive trips to confession
- Repeated cleansing and purifying rituals
- Acts of self-sacrifice
- Avoidance of situations that would lead to religious or moral error
- Excessive praying
- Repeatedly imagining religious images or saying religious phrases
- Repeatedly making pacts with a higher power
- Attempting to cancel potentially blasphemous thoughts with pure thoughts
Treatment: Scrupulosity is also treated following the same guidelines for obsessive compulsive disorder. Exposure response and prevention, a form of cognitive-behavioral therapy, is generally the most effective and most prescribed form of treatment. This type of therapy requires that the patient confront the fears causing the anxiety while making a conscious effort to prevent themselves from performing the obsessive or compulsive escape actions. In addition, medications known as Selective Serotonin Reuptake Inhibitors (SSRIs) may be prescribed to help reduce symptoms. Finally, because scrupulosity has a religious basis, it may also be helpful for the individual to meet with religious leaders to discuss the source of their obsessions and compulsions and develop a healthier relationship with their higher power.
Additional Information: Although the prevalence rate of scrupulosity is unknown, there are large regional differences in the percentage of patients who suffer from general obsessive compulsive disorder couples with religious obsessions or compulsions. Rates are reported to range from less than 7% in the U.K and Singapore to 40-60% in traditional Muslim and orthodox Jewish populations.
Scrupulosity is thought to have a Roman Catholic origin but it is seen in a variety of religious affiliations.
Some sufferers of scrupulosity believe they suffer from obsession without compulsion; however, some compulsions can be entirely mental (e.g. attempting to cancel potentially blasphemous thoughts with pure thoughts).
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