Individuals experiencing scrupulosity will experience intrusive, unwanted thoughts, images, or urges about violating their religious, moral, or ethical beliefs.
This might include a fear of offending God, committing a sin, praying incorrectly, misinterpreting religious teachings, or going to the “wrong” place of worship.
Key Points
Rationale
Past research on the relationship between religiosity, spirituality and OCD has been mixed, with some studies finding a positive association (e.g., Steketee et al., 1991) and others finding no relationship or even a negative relationship (e.g., Dèttore et al., 2017).
The current study aimed to clarify these relationships using multidimensional measures across a wide range of religious affiliations in both nonclinical and clinical OCD samples.
Understanding these relationships has implications for identifying risk factors for OCD as well as potential treatment targets.
Method
The nonclinical sample included 746 participants recruited from a university and online sources. The clinical sample included 24 participants with a diagnosis of OCD recruited from an anxiety clinic.
Materials
Statistical analysis included correlational analyses to test study hypotheses and moderation analyses to test conditional effects.
Sample
The nonclinical sample included 746 participants aged 17-65 years old. Most were female, white or South/East Asian, and endorsed a variety of religious affiliations including Catholicism, Hinduism, Islam, Judaism, and no religion.
The clinical sample included 24 participants aged 18-61 years with a principal DSM-5 diagnosis of OCD. Most were male and white. Comorbid diagnoses were permitted.
Results
The study found a robust, positive correlation between scrupulosity, defined as pathological fear of sin and divine punishment, and obsessional thinking in participants both with and without a diagnosis of OCD.
Specifically, the degree to which individuals experienced intrusive, unwanted thoughts related to religion and morality was closely linked to their tendency for obsessive rumination and thought suppression attempts. As religious obsessions intensified, so too did urges to mentally review one’s moral purity and actions excessively.
This suggests religious obsessions may directly contribute to broader OCD cognitive patterns like obsessionality.
While the study found that scrupulosity (defined as religious obsessions and compulsions related to excessive concern over sin and God’s punishment) has a robust positive correlation with OCD symptoms, measures of broader religiosity and spirituality did not.
Most indicators of typical religious practices and spiritual experiences did not correlate with heightened OCD symptoms.
For example, religious attendance, prayer frequency, and self-rated religiousness showed trivial or non-significant relationships with obsessional thinking and compulsive behaviors both in nonclinical samples and samples diagnosed with OCD.
Additional findings
Insight
This study clarifies the relationship between religiosity, spirituality and OCD using psychometrically-sound multidimensional measures across diverse religious groups. Results suggest scrupulosity, but not overall religiosity/spirituality, is associated with OCD symptoms.
However, those experiencing religious obsessions may also suffer from religious crisis. For religious individuals with OCD, enhancing spirituality may buffer relationships between religiosity and OCD-relevant cognitive distortions like thought-action fusion and fundamentalism.
Clinically, this highlights potential benefits of incorporating spirituality-focused consultation with religious authorities intoCBT.
Strengths
Limitations
Clinical Implications
These results align with other recent findings that religiosity itself does not constitute a risk factor for developing clinical OCD.
Rather, when religious OCD manifests it takes on a scrupulous flavor, centered around excessive doubt and guilt regarding morality and God’s perception. Whether religious involvement fuels these content-specific obsessions for some subgroups, or they originate from mental rituals gone awry, requires further study.
Regardless, the current study clearly demonstrates the specificity of the link between OCD symptoms and scrupulosity, rather than religion and spirituality at large. This has implications for conceptualizing religion’s role in OCD’s pathology through a narrower lens.
Support for bidirectional relationships means OCD symptoms may negatively impact spirituality. Collaborative treatment incorporating religious authorities merits further study.
References
Primary reference
Henderson, L. C., Stewart, K. E., Koerner, N., Rowa, K., McCabe, R. E., & Antony, M. M. (2022). Religiosity, spirituality, and obsessive-compulsive disorder-related symptoms in clinical and nonclinical samples.Psychology of Religion and Spirituality, 14(2), 208–221.https://doi.org/10.1037/rel0000397
Other references
Siev, J., Huppert, J. D., & Zuckerman, S. E. (2017). Understanding and treating scrupulosity. In J. S. Abramowitz, D. McKay, & E. A. Storch (Eds.),The Wiley handbook of obsessive compulsive disorders(Vol. 2, pp. 527–546). Hoboken, NJ: Wiley and Sons.http://dx.doi.org/10.1002/9781118890233.ch29
Dèttore, D., Berardi, D., & Pozza, A. (2017). Religious affiliation and obsessive cognitions and symptoms: A comparison between Jews, Christians, and Muslims in nonclinical groups in Italy.Psychology of Religion and Spirituality, 9,348–357.http://dx.doi.org/10.1037/rel0000078
Steketee, G., Quay, S., & White, K. (1991). Religion and guilt in OCD patients.Journal of Anxiety Disorders, 5,359–367.http://dx.doi.org/10.1016/0887-6185(91)90035-R
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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.
