Clinical features of scrupulosity: Associated symptoms and comorbidity

Abstract

Objective: Scrupulosity is a manifestation of obsessivecompulsive disorder (OCD) characterized by religious or moral core fears. Clinicians often struggle to treat scrupulosity, which may be associated with several features known to predict poor treatment outcome. The purpose of this study was to examine these features in participants with scrupulous OCD, contamination OCD, and healthy controls. Method: A total of 68 participants (57.4% women, age mean = 34.01) completed diagnostic interviews, and measures of symptoms and quality-of-life. Results: Relative to comparison groups, scrupulous participants had higher rates of obsessive-compulsive personality disorder, more severe schizotypal symptoms, and more severe symptoms of depression. In addition, OCD severity was strongly associated with poor insight in the scrupulous group. Both OCD groups reported poorer quality of life than did healthy controls.

Scrupulosity in the Network of Obsessive-Compulsive Symptoms, Religious Struggles, and Self-Compassion: A Study in a Non-Clinical Sample

“…Contrary to expectations, religiosity did not correlate with scrupulosity (see Abramowitz and Buchholtz 2020). Although a number of studies demonstrated positive associations between religiosity and religious scruples (Siev et al 2021), some previous studies did not show significant associations between these variables (Nelson et al 2006). The associations between religiosity and scrupulosity, therefore, seem to be complex and could depend on the particular cultural context (Abramowitz and Jcoby 2014).…”

“…Mental health professionals, and also patients, have problems with differentiating between the normative religious struggle and pathological symptoms of scrupulosity. Religious doubts and rituals may appear to be similar to compulsive rituals and obsessions present in a mental disorder (e.g., OCD; Siev et al 2021). The question of how religious individuals become scrupulous is similarly under-studied (Siev et al 2017b).…”

“…Religion has been identified as one of the most common themes of obsessions (McKay et al 2004) with prevalence among patients suffering from OCD, ranging from 0% to an even 93% (Foa et al 1995;Greenberg and Huppert 2010;Huppert and Fradkin 2016;Siev et al 2021). Among religious obsessions, the most frequently observed are recurrent fears that one has committed a sin, blasphemous thoughts of an intrusive nature, concerns about being not faithful or moral enough, fears that one didn't perform a religious prayer or ceremony properly, and worries about being punished by God (Abramowitz and Buchholtz 2020).…”

“…According to the network approach, investigation of dynamic and mutual associations between symptoms could be clinically more relevant than an approach that was focused on latent processes that underlie the symptoms (Borsboom and Cramer 2013). Since scrupulosity is understudied in its position in the context of normative religious experiences and psychopathological symptoms (Siev et al 2021), we used network analysis to exploratively analyze the position of scrupulosity in a network consisting of OCD symptomatology, religious and spiritual struggle, self-compassion, and religiosity. We also compared this approach with the usual approach based on latent variables in order to detect advantages and limitations of each approach in studying scrupulosity.…”

How Do I Care for those Burdened by Religious Scrupulosity?

“…Scrupulosity is a sub-type of obsessive-compulsive disorder (OCD) that involves moral and religious anxieties and rigidity. Characteristics associated with scrupulosity include perfectionism, self-doubts, discomfort with uncertainty, persistent and tormenting thoughts interpreted as “immoral” or sacrilegious, poor insight, and depression (Besharat & Kamali, 2016; Siev et al, 2021). For example, a scrupulous person likely will feel anxiety about not having enough faith or not being saved, or not being pure or pious enough.…”