What is Scrupulosity OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by cycles of unwanted thoughts, anxiety and compulsive behaviors. But there are many different sub-types of OCD.

For example, individuals who typically worry about cleanliness and getting others sick may have Contamination OCD, and those who fret about hurting others or themselves may have Harm OCD.

But what is Scrupulosity OCD? In this blog, we’ll cover everything you need to know, from what it is and how it works to the best ways to approach healing and recovery.

The OCD cycle

In order to understand Scrupulosity OCD, the first step is to understand the OCD cycle, which is what is used to differentiate those who have persistent worries and anxiety from those who have OCD. It consists of the following four steps:

1. Intrusive thought: An unwanted thought that, for the OCD sufferer, is very difficult to let go of/stop thinking about. 

2. Anxiety: A spike in anxiety generally follows the intrusive thought. This could look like heart palpitations, shortness of breath, tingling in the fingers, etc.

3. Compulsive behavior: The OCD sufferer completes an action that they believe will solve or answer their intrusive thought and therefore make their anxiety go away. Examples include tapping, researching, counting, praying, confessing and more.

4. Temporary reduction in anxiety: As a result of the compulsion, the anxiety spike resolves. However, it’s important to note that this relief does not last long, and soon, the cycle restarts – either with the same exact intrusive thought or a different one.

The OCD cycle with Scrupulosity OCD

For those with Scrupulosity OCD, this cycle revolves primarily around morality and/or religiosity. For instance:

1. The individual gets the intrusive thought, “My faith is not strong enough.”

2. Their heart begins to race.

3. They open their journal and make a list of things they do and do not believe about their religion.

4. They feel at ease about having a plan for gaining faith in the “things they do not believe” list.

Or:

1. After a social event, a person gets the intrusive thought, “Alex was acting off when I said goodbye. I probably said something to offend her.”

2. Their fingers begin to tingle.

3. They call a friend who was at the event with them and ask if they think an apology to Alex is warranted.

4. After the friend says no, their fingers stop tingling.

Or, finally:

1. On the drive home from work, the OCD sufferer turns on the radio. The song that plays feels inappropriate, but they don’t immediately change the station.

2. They get a tension headache.

3. Once they arrive home, they can’t stop thinking about their sin, and they don’t feel any better after they say a prayer to repent. They make an appointment to talk with a religious leader to confess.

4. After the confession, the OCD sufferer feels relieved.

Scrupulosity OCD treatment

Because OCD is characterized by this repetitive loop and a chronic intolerance of doubt, its treatment is focused on breaking the cycle and building comfortability with uncertainty. 

The gold standard treatment for OCD is Exposure and Response Prevention Therapy (ERP), which helps the OCD sufferer refrain from doing compulsions, even in the presence of intense anxiety. 

In addition to ERP, Inferential Cognitive-Behaviorial Therapy (I-CBT) can also be very helpful for Scrupulosity OCD sufferers. It focuses on helping individuals identify and become more comfortable with their intrusive thoughts so they can stop the cycle before it even starts.

Healing from Scrupulosity OCD is possible

Scrupulosity OCD recovery can be extremely difficult and nuanced because sufferers may be asked to sit with anxiety and doubt surrounding the state of their eternal salvation.

That’s why it’s so important that those with Scrupulosity OCD are met with compassion and understanding, not judgement, confusion and fear. Because ultimately, healing comes from sitting in that uncertainty – and the good news is that healing is possible.