They may engage in repetitive religious rituals, seek reassurance about their moral conduct, or have intrusive blasphemous thoughts. Scrupulosity is often considered a presentation of obsessive-compulsive disorder (OCD) with a religious or moral focus.
Key Points
Rationale
However, the dimensionality of scrupulosity and its associations with OCD symptoms remains unclear.
Scrupulosity dimensionality refers to the number and nature of distinct factors or dimensions that underlie the symptoms of scrupulosity. In other words, it concerns the question of whether scrupulosity is a unitary construct or if it comprises multiple, separate dimensions.
Previous studies have found both unifactorial (Gallegos et al., 2018) and two-factorial structures (Abramowitz et al., 2002) of the Penn Inventory of Scrupulosity (PIOS), a commonly used measure of scrupulosity.
Additionally, scrupulosity has been associated with various OCD symptoms such ascontamination(Nelson et al., 2006), obsessing, and hoarding (Olatunji et al., 2007).
The present study aimed to investigate the dimensionality of scrupulosity and its associations with OCD symptoms using network analysis, a novel approach that examines dynamic interactions between symptoms (Borsboom, 2017).
Understanding the central symptoms of scrupulosity and its links to OCD can inform targeted interventions for individuals with religious scruples.
Method
The study employed network analysis to examine the dimensionality of scrupulosity symptoms and their associations with OCD symptoms in a non-clinical sample of religious individuals from Poland.
Procedure
Participants completed online measures assessing scrupulosity (PIOS) and OCD symptoms (Obsessive-Compulsive Inventory-Revised; OCI-R). They also reported on their religious affiliation, importance of religion for identity, and frequency of participation in religious ceremonies.
Sample
The final sample consisted of 322 individuals (227 women, 95 men) aged 18-79 (M=38.3, SD=14.05), predominantly Roman Catholic (96.9%) and with higher education (67.7%).
Measures
Statistical measures
Network analysis using graphic LASSO regularization was employed to estimate networks of scrupulosity symptoms and their associations with OCD symptoms.
Community detection algorithms (Walktrap, Louvain) were used to identify dimensions within the networks. Centrality indices (strength, closeness, betweenness, expected influence) were computed to determine the most influential symptoms.
Results
Insight
This study provides valuable insights into the nature of scrupulosity and its relationship with OCD symptoms.
The central symptoms revolve around fears of having thoughts and behaviors unacceptable to God, immoral thoughts, and disobeying religious rules.
Obsessing symptoms appear to be the link between scrupulosity and OCD.
The association between the frequency of religious ceremony attendance and the severity of scrupulosity symptoms highlights the potential role of religious context in the development of scruples.
These findings can guide therapeutic interventions for scrupulosity, focusing on addressing the central symptoms and the underlying religious beliefs and practices that may contribute to their severity.
Future research could explore the causal relationships between religious factors and scrupulosity, as well as examine scrupulosity in diverse religious and cultural contexts.
Strengths
Limitations
Clinical Implications
The results of this study have significant implications for the understanding and treatment of scrupulosity.
Identifying the central symptoms of scrupulosity (i.e., fears of thoughts and behaviors unacceptable to God, immoral thoughts, disobedience of rules) can guide targeted interventions addressing these core concerns.
Therapeutic approachesmay need to incorporate discussions about the individual’s religious beliefs, their image of God, and the moral standards of their religious denomination.
The link between obsessing symptoms and both scrupulosity and OCD suggests that interventions targeting obsessiveness could be beneficial for individuals with religious scruples.
Additionally, the association between frequency of religious ceremony attendance and scrupulosity severity highlights the importance of considering the individual’s religious context and practices in understanding and treating scrupulosity.
Mental health professionals may need to collaborate with religious leaders or incorporate pastoral counseling to address the religious aspects of scrupulosity effectively.
References
Abramowitz, J. S., & Hellberg, S. N. (2019). Scrupulosity. In E. Storch, D. Mckey, & J. Abramowitz (Eds.),Advanced casebook of obsessive–compulsive and related disorders. Conceptualizations and treatment(pp. 71–87). Academic Press.
Abramowitz, J. S., Huppert, J. D., Cohen, A. B., Tolin, D. F., & Cahill, S. P. (2002). Religious obsessions and compulsions in a non-clinical sample: The Penn Inventory of Scrupulosity (PIOS).Behavior Research and Therapy, 40(7), 825–838.https://doi.org/10.1016/S0005-7967(01)00070-5
Borsboom, D. (2017). A network theory of mental disorders.World Psychiatry, 16(1), 5–13.https://doi.org/10.1002/wps.20375
Gallegos, J., Sánchez-Jauregui, G., Hidalgo, J., Davila-de Gárate, S. M., Támez-Díaz, O. G., & Fisak, B. (2018). The validation of a Spanish version of the Pennsylvania Inventory of Scrupulosity—Revised.Mental Health, Religion & Culture, 21(2), 194–203.https://doi.org/10.1080/13674676.2018.1432582
Nelson, E. A., Abramowitz, J. S., Whiteside, S. P., & Deacon, B. J. (2006). Scrupulosity in patients with obsessive–compulsive disorder: Relationship to clinical and cognitive phenomena.Journal of Anxiety Disorders, 20(8), 1071–1086.https://doi.org/10.1016/j.janxdis.2006.02.001
Olatunji, B. O., Abramowitz, J. S., Williams, N. L., Connolly, K. M., & Lohr, J. M. (2007). Scrupulosity and obsessive–compulsive symptoms: Confirmatory factor analysis and validity of the Penn Inventory of Scrupulosity.Journal of Anxiety Disorders, 21(6), 771–787.https://doi.org/10.1016/j.janxdis.2006.12.002
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
