Religious Obsessions in OCD

Obsessive-compulsive disorder can cause a crisis of faith.

Ghazel Tellawi, Ph.D.

OCD Overview

Obsessive-compulsive disorder (OCD) is a anxiety-related condition that involves recurring, unwanted obsessions and repetitive compulsions. Obsessions are intrusive thoughts that cause severe distress, despite the fact that the individual realizes that the obsessions represent exaggerated fears that are not likely to occur. These obsessions are worries that reach beyond anxiety about everyday problems. So upsetting are the obsessions that the individual attempts to counteract them with a specific behavior or neutralizing thought called a compulsion. The individual feels as though their compulsions must be performed in response to the obsessions. Compulsions are performed strictly to reduce anxiety or prevent a feared outcome.

Religious OCD Subtype

Common Obsessions About Religion

• Concerns with sacrilege or blasphemy
• Accidentally omitting any loved ones from their prayers
• Worries about inadvertently offending God
• Worries about accidentally worshipping the devil
• Performing a religious task or ritual in the wrong way
• Having committed a sin
• Thinking too much about purity
• Going to hell
• Praying in the wrong way
• Perfectly following scripture or other religious doctrines
• Death

Religious thoughts can become intrusive and distressing in individuals with OCD. These thoughts can involve intrusive religious blasphemous thoughts, compulsive prayers, hypermorality, unwarranted concern about committing a sin, and cleaning/washing rituals (Himle, Chatters, Taylor & Nguyen, 2001). These thoughts sometimes become problematic and are referred to as "scrupulosity." Scrupulosity describes the relationship between religiosity and the symptoms of OCD, and individuals with these obsessions often focus on certain details of their religion while ignoring others.

One large study found that scrupulous obsessions in OCD were ranked as the fifth most common obsession, with 6% of participants endorsing it as their primary obsession. Additionally, it has been estimated that religious obsessions occur in 25% of individuals with OCD (Antony, Dowie, & Swinson, 1998). One study showed that OCD symptoms presentation can be influenced by one's religion and culture (Sica, Novara, Sanavio, Dorz & Coradeschi, 2002). Abramowitz and colleagues (2004) highlighted this point by finding that Protestant individuals with high levels of religiosity had the highest severity of OCD symptoms.

Individuals with scrupulous obsessions may have anxiety related to their religion, sinning, and guilt, which can cause religious practices and rituals to become compulsive (Deacon & Nelson, 2008; Gonsalvez et al., 2009). Also, these individuals are often more religious and more likely to seek out religious counseling and less likely to receive medical treatment (Siev, Baer, & Minichiello, 2011). It was also found that a negative concept of God was associated with higher symptom severity, and that one in five did not subscribe to a particular religious affiliation. In line with the negative God concept, those that believe that their God is punitive will likely engage in more severe compulsions to make up for minor sins, even though the clergy is aware that their sins are minor and do not need compulsive actions (Gonsalvez et al., 2010). One in five think that their OCD symptoms help them in observing their religion.

While it may be easy to assume that people with these types of worries are from very religious or strict traditions, these worries can strike the very orthodox, non-religious people, or even atheists. Scrupulosity should not be confused with appreciating religion or being very devout. People with this type of OCD do not feel more spiritual or fulfilled by performance of OCD-related rituals, which may include repeating prayers, seeking reassurance, or mental rituals. In actuality, the OCD interferes with carrying out proper religious duties.

Treatment for Religious-Themed OCD

The most effective treatment for religious-themed OCD is Exposure and Ritual Prevention (ERP or ExRP) from a skilled therapist. Elliott and Radomsky (2008) suggest that through collaboration with clergy, counselors, and members of the religious community, psychologists can provide good support for individuals suffering from scrupulous obsessions. Religious leaders can determine within their doctrine which rituals are extreme and which are appropriate, and they may be able to offer guidance and treatment. Additionally, highly religious individuals often consult their religious leaders rather than clinicians for help (Miller et al., 2008), so providing OCD education and specialized treatment trainings in religious settings could be beneficial to bringing therapies that have been shown to be effective to more people suffering from these obsessions.

Common Obsessions About Morality

People with religious obsessions are also usually worried about morality, but people with morality worries might or might not be religious. For example, someone with this sort of OCD may worry excessively about receiving extra change from a cashier, even its just a few cents. Common obsessions about morality include:

• Excess concern with right and wrong and morality
• Worry about always doing the morally right thing in every circumstance
• Having made a moral error
• Breaking an unimportant rule
• Behaving immorally
• A loss of control over urges
• Wondering if a person is "good enough"

Recommended Reading About Religious OCD

Scrupulosity: Blackmailed by OCD in the Name of God by Laurie Krau

Religious & Traditional Healers for OCD: Helpful or Hurtful? Psychology Today.