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Religious Obsessions and Compulsions
Carol E. Watkins, MD
Religious belief, and membership in a faith community are important factors
in the lives of many individuals. In addition to moral and spiritual guidance,
they can provide a sense of purpose, structure and community. For a certain
individuals, religious beliefs become compulsive, joyless behaviors. The
individual may constantly worry that he or she might say or do something
blasphemous. He may fear that he has committed sin, forgotten it and then
neglected to repent for the sin. He may spend long hours searching his mind to
try to ferret out evidence of un-confessed sins. He is unable to feel forgiven.
Specific obsessions and compulsions vary according to the individual’s
religion. An Orthodox Jew might worry that he did not perform a particular
ritual correctly. He might obsess about this for hours. A Roman Catholic might
go to confession several times a day. Another individual could believe that
anything he does might be sinful. This individual might become so paralyzed
with doubt, that he or she becomes afraid to do or say anything at all.
Scrupulosity and OCD
Religious faith and religious education are not
generally the causes of Scrupulosity. Actually, Scrupulosity is a form of
Obsessive-Compulsive Disorder. (OCD) OCD appears to be a biologically based
disorder with severe psychological consequences. The disorder occurs in 2-3% of
the population (5-7 million sufferers in the U.S.). About 10% of the
first-degree relatives of affected persons also have OCD.
Obsessions are recurrent
thoughts or impulses that make the person anxious (such as the fear that using
a public toilet will make one sick) The obsessions persist despite efforts to
control or suppress them. They feel intrusive and disturbing even though the
person knows that they come from his own mind. Obsessions may include fear of
harming someone, contamination or of doing something embarrassing.
Compulsions are repetitive
behaviors or mental acts the person feels driven to perform, often with
ritualistic rigidity, to prevent the anxiety connected with the obsessions.
These may include urges to wash, count, check or repeat phrases to oneself.
OCD can occur in different forms. There are a
variety of different types of obsessions and compulsions. The nature of
intensity of these symptoms may vary over time. Aggressive, sexual and
religious obsessions sometimes occur together in the same individual.
Differentiating Scrupulosity from Devout
Religious Faith and Practice
Because these obsessions and compulsions are
intertwined in the individual’s religious life, it may be difficult for him
or her to recognize that he or she has a psychiatric condition. An individual
with religious obsessions often may focus excessively on one particular concern
about sin while neglecting other aspects of his or her religion. Most religions
place a high priority on compassion and being a good neighbor. The scrupulous
individual while focusing excessively on a few specific rules may neglect this
more general dictum.
Religious leaders within the Roman Catholic and
Jewish community have addressed these issues. Commentators in both of these
groups have writings that label scrupulosity as a sin. One rabbi called it
idolatry because the excessive devotion to a specific ritual (to the detriment
of good acts toward other people) elevated the ritual to a god-like status. In
his book, The Doubting Disease, JW Ciarrocchi reviews Roman Catholic
pastoral writings over past centuries. He feels that some of the things that
priests did to help scrupulous individuals anticipated current treatments for
Treatment of Scrupulosity
Like other forms of OCD, scrupulosity responds
to medication and cognitive-behavioral therapy. Prior to studies in the 1980's,
the usual view of OCD was that it was a relatively rare disorder with a poor
prognosis. However, in addition to it being now recognized as much more common
(2-3% prevalence rate), it is generally considered treatable. About 60%–80%
of patients show some degree of response to treatment.
The serotonin system in the brain seems to be
involved in the pathology of OCD, since the medications that have been shown to
be help treat OCD increase the availability of this neurotransmitter. These
medications include the serotonin re-uptake inhibitors: clomipramine,
fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram.
Cognitive-Behavioral therapy—specifically ERP
[Exposure and Response Prevention]—has been successfully used for the
treatment of OCD. The idea behind ERP is that compulsions provide only a
temporary reduction of the anxiety produced by obsessions. Furthermore, the
only way to experience more permanent relief is to habituate (grow tolerant
of…"get used to") the anxiety caused by the obsession--without
performing the compulsion. Habituation is the key factor, and clinicians start
by identifying triggers that bring on obsessional thoughts and compulsive
behaviors. Then they develop a graduated hierarchy of anxiety based on the
patient's report. The patient "challenges" him or herself by
gradually moving up the hierarchy. In addition to exposure, the patient
is instructed to refrain from carrying out the associated rituals or at least
to delay the rituals by several minutes. .
This treatment can be adapted to religious
obsessions and compulsions. However, the therapist must proceed with
sensitivity to the individual’s cultural and religious beliefs. If this is
not done, the therapy may actually increase anxiety and resistance.
Coordination Between Psychiatrist and Clergy
It is often useful for the psychiatrist and the
individual’s religious leader to work together. In some cases, with
permission, the psychiatrist and the religious leader may speak directly. In
many other cases, the individual in treatment can be the communication bridge.
The religious leader can help the individual distinguish legitimate concerns
about faith and guilt from stereotyped religious obsessions. As the person with
scrupulosity begins to face his fears, he may experience a temporary increase
in anxiety. The religious leader can then be a source of support and
encouragement. In some cases, clergy will give the individual permission to
visualize things that would usually be considered sinful thoughts if it is part
of the treatment for this condition. If an individual is compulsively repeating
a ritual until it is perfect, the clergy may need to give the individual
special permission to perform a ritual in a less than perfect manner.
Although the psychiatrist may coordinate with
clergy, the psychiatrist usually remains neutral about the individual’s
particular religious beliefs. Psychotherapy and religious conversion are
different things. However, within the context of psychiatric treatment, the
individual is often able to gain control of his or her OCD and Scrupulosity.
This can lead to freedom from excessive guilt and stereotyped religious
obsessions. Ultimately, the individual is freed to experience a richer life in
his or her family and faith community.
Obsessions may often
involve thoughts which seem unacceptable to the individual, so that he or she
feels ashamed. Because of this, many people keep their thoughts a secret and
suffer silently. In the past decade, there have been advances in the behavioral
and pharmacological treatment of Obsessive Compulsive Disorder. For helpful
mental health links, please see our web page www.baltimorepsych.com/Consumer.htm
Links related to OCD
Foundation This organization is by and for individuals with OCD. The
site contains information on medication, psychotherapy and support for
individuals with OCD. There is a chat room and a message board.
American Anxiety Disorders Association An
organization for individuals who experience the spectrum of anxiety
disorders. This is a link to a
self administered test for Obsessive Compulsive Disorder.
- 16829 York Road/PO Box 544/Monkton, MD 21111
Suite 223, 2360 West Joppa Rd. Lutherville, MD 21093
- Email: [email protected]
( Please use telephone for appointments and emergencies)
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Copyright © 2008 Northern County Psychiatric Associates
January 20, 2008