Understanding and Treating Scrupulosity

Individuals with scrupulosity prototypically have excessive religious fears or doubts about sin; however, individuals may have secular moral scrupulosity, fearing being immoral, bad, or evil without any religious component. It is worth acknowledging that others have argued that scrupulosity is distinct from obsessive-compulsive disorder (OCD) and warrants a unique diagnostic category. Abramowitz and Jacoby propose a cognitive-behavioral model of scrupulosity that stresses the significance of dysfunctional and intrusive beliefs, the uncertain nature of many facets of religion, and the role of compulsive behaviors in the development and maintenance of scrupulosity. There are actually several reasons to tailor standard exposure and response (ritual) prevention (ERP) protocols for individuals with scrupulosity. This chapter elaborates on these issues and reviews important modifications with respect to assessment, the therapeutic stance, psychoeducation, working with clergy, exposure work, and prayer. At its core, ERP for scrupulosity is the same as for other forms of OCD.