Scrupulosity

Last updated

Scrupulosity is the pathological guilt/anxiety about moral or religious issues. Although it can affect nonreligious people, it is usually related to religious beliefs. It is personally distressing, dysfunctional, and often accompanied by significant impairment in social functioning. [1] [2] It is typically conceptualized as a moral or religious form of obsessive–compulsive disorder (OCD). [3] The term is derived from the Latin scrupus, a sharp stone, implying a stabbing pain on the conscience. [1] Scrupulosity was formerly called scruples in religious contexts, but the word scruple now commonly refers to a troubling of the conscience rather than to the disorder.[ citation needed ]

Contents

As a personality trait, scrupulosity is a recognized diagnostic criterion for obsessive–compulsive personality disorder. [4] It is sometimes called "scrupulousness", but that word properly applies to the positive trait of having scruples. [5]

Presentation

In scrupulosity, a person's obsessions focus on moral or religious fears, such as the fear of being an evil person or the fear of divine retribution for sin. Although it can affect nonreligious people, it is usually related to religious beliefs. Not all obsessive–compulsive behaviors related to religion are instances of scrupulosity: strictly speaking, for example, scrupulosity is not present in people who repeat religious requirements merely to be sure that they were done properly. In addition, while religiosity may affect how OCD is manifested, there is no proven causality between the severity of OCD and religiosity, and only small associations between the latter and scrupulosity. [6]

Treatment

Treatment is similar to that for other forms of obsessive–compulsive disorder. [7] Exposure and response prevention (ERP), a form of behavior therapy, is widely used for OCD in general and may be promising for scrupulosity in particular. [1] [2] ERP is based on the idea that deliberate repeated exposure to obsessional stimuli lessens anxiety, and that avoiding rituals lowers the urge to behave compulsively. For example, with ERP a person obsessed by blasphemous thoughts while reading the Bible would practice reading the Bible. [7] [8] However, ERP is considerably harder to implement than with other disorders, because scrupulosity often involves spiritual issues that are not specific situations and objects. For example, ERP is not appropriate for a man obsessed by feelings that God has rejected and is punishing him.[ citation needed ] Cognitive therapy may be appropriate when ERP is not feasible. [1] Other therapy strategies include noting contradictions between the compulsive behaviors and moral or religious teachings, and informing individuals that for centuries religious figures have suggested strategies similar to ERP. [7] Religious counseling may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety. [1]

Little evidence is available on the use of medications to treat scrupulosity. [1] Although serotonergic medications are often used to treat OCD, [7] studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made. [1]

Treatment of scrupulosity in children has not been investigated to the extent it has been studied in adults, and one of the factors that makes the treatment difficult is the fine line the therapist must walk between engaging and offending the client. [9]

Epidemiology

The prevalence of scrupulosity is speculative. Available data do not permit reliable estimates, and available analyses mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. [1] Available data suggest that the prevalence of obsessive–compulsive disorder does not differ by culture, except where prevalence rates differ for all psychiatric disorders. Associations between OCD and the depth of religious beliefs have been difficult to demonstrate, and data are scarce. [6] There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0–7% in countries like the U.K. and Singapore, to 40–60% in traditional Muslim and orthodox Jewish populations. [10] Characteristics of scrupulosity also tend to vary by religion in relation to traditional practices and beliefs. In Western Christian samples, increased levels of religiosity are associated with an increase in obsessions about controlling thoughts. This phenomenon is thought to be caused by the Biblical explanation that merely thinking of a sin is as bad as committing it. In Jewish communities, scrupulous compulsions tend to include washing, excessive prayer, and consultation with religious leaders, which are closely linked to Jewish customs of removing impurities through hand washing. Similarly, a study of a conservative Muslim population in Saudi Arabia revealed that obsessions about prayer, washing, and contamination dominate, seemingly stemming from the religious practice al-woodo which requires methodical cleansing of the body before prayer. Additionally, Muslims in Pakistan describe a concept called “Nepak” which is a “mix of unpleasant feelings of contamination with strong religious connotations of dirtiness and unholiness.” When suffering Nepak, an individual must cleanse himself thoroughly before participating in religious rituals again. [11]

History

John Moore (shown c. 1691-1703) was the first to describe the disorder, calling it "religious melancholy". JohnMooreBpOfEly.jpg
John Moore (shown c. 1691–1703) was the first to describe the disorder, calling it "religious melancholy".

Scrupulosity is a modern-day psychological problem that echoes a traditional use of the term scruples in a religious context, e.g. by Catholics, to mean obsessive concern with one's own sins and compulsive performance of religious devotion. [13] This use of the term dates to the 12th century. [14] Several historical and religious figures suffered from doubts of sin, and expressed their pains. Ignatius of Loyola, founder of the Jesuits, wrote "After I have trodden upon a cross formed by two straws ... there comes to me from without a thought that I have sinned ... this is probably a scruple and temptation suggested by the enemy." [10] Alphonsus Liguori, the Redemptorists' founder, wrote of it as "groundless fear of sinning that arises from 'erroneous ideas'". [14] Although the condition was lifelong for Loyola and Liguori, [15] [16] Thérèse of Lisieux stated that she recovered from her condition after 18 months, writing "One would have to pass through this martyrdom to understand it well, and for me to express what I experienced for a year and a half would be impossible." [17] Martin Luther also suffered from obsessive doubts; in his mind, his omitting the word enim ("for") during the Eucharist was as horrible as laziness, divorce, or murdering one's parent. [18]

Although historical religious figures such as Loyola, Luther and John Bunyan are commonly cited as examples of scrupulosity in modern self-help books, some of these retrospective diagnoses may be deeply ahistorical: these figures' obsession with salvation may have been excessive by modern standards, but that does not mean that it was pathological. [19]

Scrupulosity's first known public description as a disorder was in 1691, by John Moore, who called it "religious melancholy" and said it made people "fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it". [12] Loyola, Liguori, the French confessor R.P. Duguet, and other religious authorities and figures attempted to develop solutions and coping mechanisms; [1] the monthly newsletter Scrupulous Anonymous , published by the followers of Liguori, has been used as an adjunct to therapy. [13] : 103–12  In the 19th century, Christian spiritual advisors in the U.S. and Britain became worried that scrupulosity was not only a sin in itself, but also led to sin, by attacking the virtues of faith, hope, and charity. Studies in the mid-20th century reported that scrupulosity was a major problem among American Catholics, with up to 25 per cent of high school students affected; commentators at the time asserted that this was an increase over previous levels. [20]

Starting in the 20th century, individuals with scrupulosity in the U.S. and Britain increasingly began looking to psychiatrists, rather than to religious advisors, for help with the condition. [20]

Resources

International OCD Foundation (OCDF) . Non-profit organization dedicated to giving support to individuals with obsessive-compulsive disorder (OCDF), since 1986 raises funds for research; compiles and disseminates the latest treatment information, including scrupulosity [21]

Managing Scrupulosity .  A service from Fr. Thomas M Santa,  C.Ss.R., (A Roman Catholic priest). Fr. Santa has ministered to people with scrupulosity for more than 20 years. [22]

Further reading

Related Research Articles

<span class="mw-page-title-main">Obsessive–compulsive personality disorder</span> Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

Catholic guilt is the reported excess guilt felt by Catholics and lapsed Catholics. Guilt is remorse for having committed some offense or wrong, real or imagined. It is related to, although distinguishable from, "shame", in that the former involves an awareness of causing injury to another, while the latter arises from the consciousness of something dishonorable, improper, or ridiculous, done by oneself. One might feel guilty for having hurt someone, and also ashamed of oneself for having done so. Philip Yancey compares guilt to the sensation of physical pain as an indication that something should not be ignored but attended to.

<span class="mw-page-title-main">Intrusive thought</span> Unwelcome involuntary thought, image or idea

An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), Tourette's syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive–compulsive disorder (OCD) symptoms.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

Jeffrey M. Schwartz is an American psychiatrist and researcher in the field of neuroplasticity and its application to obsessive-compulsive disorder (OCD). He is a proponent of mind/body dualism and appeared in the 2008 film Expelled: No Intelligence Allowed

Sexual obsessions are persistent and unrelenting thoughts about sexual activity. In the context of obsessive-compulsive disorder (OCD), these are extremely common, and can become extremely debilitating, making the person ashamed of the symptoms and reluctant to seek help. A preoccupation with sexual matters, however, does not only occur as a symptom of OCD, they may be enjoyable in other contexts.

<span class="mw-page-title-main">Compulsive behavior</span> Habit and impulse disorder

Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders.

Primarily obsessional obsessive–compulsive disorder, also known as purely obsessional obsessive–compulsive disorder, is a lesser-known form or manifestation of OCD. It is not a diagnosis in the DSM-5. For people with primarily obsessional OCD, there are fewer observable compulsions, compared to those commonly seen with the typical form of OCD. While ritualizing and neutralizing behaviors do take place, they are mostly cognitive in nature, involving mental avoidance and excessive rumination. Primarily obsessional OCD takes the form of intrusive thoughts often of a distressing, sexual, or violent nature.

<span class="mw-page-title-main">Obsessive–compulsive disorder</span> Mental and behavioral disorder

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

Stanley Jack Rachman was a South African-born psychologist who worked primarily with obsessive-compulsive disorder (OCD) and other anxiety disorders. He spent much of his career based in the UK and Canada.

The biology of obsessive–compulsive disorder (OCD) refers biologically based theories about the mechanism of OCD. Cognitive models generally fall into the category of executive dysfunction or modulatory control. Neuroanatomically, functional and structural neuroimaging studies implicate the prefrontal cortex (PFC), basal ganglia (BG), insula, and posterior cingulate cortex (PCC). Genetic and neurochemical studies implicate glutamate and monoamine neurotransmitters, especially serotonin and dopamine.

Scrupulous Anonymous is a Catholic monthly newsletter and website published by Liguori Publications, written primarily for individuals who suffer with scrupulosity. It is a ministry of the Redemptorists founded by St. Alphonsus Liguori. The newsletter is run by Thomas Santa, a Redemptorist priest who specializes ministering to those with scrupulosity.

In psychology, relationship obsessive–compulsive disorder (ROCD) is a form of obsessive–compulsive disorder focusing on close or intimate relationships. Such obsessions can become extremely distressing and debilitating, having negative impacts on relationships functioning.

The delayed-maturation theory of obsessive–compulsive disorder suggests that obsessive–compulsive disorder (OCD) can be caused by delayed maturation of the frontal striatal circuitry or parts of the brain that make up the frontal cortex, striatum, or integrating circuits. Some researchers suspect that variations in the volume of specific brain structures can be observed in children that have OCD. It has not been determined if delayed-maturation of this frontal circuitry contributes to the development of OCD or if OCD is the ailment that inhibits normal growth of structures in the frontal striatal, frontal cortex, or striatum. However, the use of neuroimaging has equipped researchers with evidence of some brain structures that are consistently less adequate and less matured in patients diagnosed with OCD in comparison to brains without OCD. More specifically, structures such as the caudate nucleus, volumes of gray matter, white matter, and the cingulate have been identified as being less developed in people with OCD in comparison to individuals that do not have OCD. However, the cortex volume of the operculum (brain) is larger and OCD patients are also reported to have larger temporal lobe volumes; which has been identified in some women patients with OCD. Further research is needed to determine the effect of these structural size differences on the onset and degree of OCD and the maturation of specific brain structures.

<span class="mw-page-title-main">Jonathan Abramowitz</span> American clinical psychologist

Jonathan Stuart Abramowitz is an American clinical psychologist and Professor in the Department of Psychology and Neuroscience at the University of North Carolina at Chapel Hill (UNC-CH). He is an expert on obsessive-compulsive disorder (OCD) and anxiety disorders whose work is highly cited. He maintains a research lab and currently serves as the Director of the UNC-CH Clinical Psychology PhD Program. Abramowitz approaches the understanding and treatment of psychological problems from a cognitive-behavioral perspective.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a 20-item self-report instrument that assesses the severity of Obsessive-Compulsive Disorder (OCD) symptoms along four empirically supported theme-based dimensions: (a) contamination, (b) responsibility for harm and mistakes, (c) incompleteness/symmetry, and (d) unacceptable (taboo) thoughts. The scale was developed in 2010 by a team of experts on OCD led by Jonathan Abramowitz, PhD to improve upon existing OCD measures and advance the assessment and understanding of OCD. The DOCS contains four subscales that have been shown to have good reliability, validity, diagnostic sensitivity, and sensitivity to treatment effects in a variety of settings cross-culturally and in different languages. As such, the DOCS meets the needs of clinicians and researchers who wish to measure current OCD symptoms or assess changes in symptoms over time.

Inference-based therapy (IBT), also known as inference-based cognitive behavioral therapy (I-CBT), originated as a form of cognitive therapy developed for treating obsessive-compulsive disorder. IBT followed the observation that people with OCD often inferred danger on the basis of inverse inference. Later the model was extended to inferential confusion, where inverse inference leads to distrust of the senses and investment in remote possibility. In this model, individuals with obsessive-compulsive disorder are hypothesized to put a greater emphasis on an imagined possibility than on what can be perceived with the senses, and to confuse the imagined possibility with reality. According to inference-based therapy, obsessional thinking occurs when the person replaces reality and real probabilities with imagined possibilities; the obsession is hypothesized to concern a doubt about a possible state of affairs.

Inferential confusion is a meta-cognitive state of confusion that becomes pathological when an individual fails to interpret reality correctly and considers an obsessional belief or subjective reality as an actual probability. It causes an individual to mistrust their senses and rely on self-created narratives ignoring evidence and the objectivity of events. These self-created narratives come from memories, information, and associations that aren't related- therefore, it deals with the fictional nature of obsessions. It causes the individual to overestimate the threat.

References

  1. 1 2 3 4 5 6 7 8 9 Miller CH, Hedges DW (August 2008). "Scrupulosity disorder: an overview and introductory analysis". Journal of Anxiety Disorders. 22 (6): 1042–58. doi:10.1016/j.janxdis.2007.11.004. PMID   18226490.
  2. 1 2 Abramowitz JS, Jacoby RJ (2014). "Scrupulosity: A cognitive–behavioral analysis and implications for treatment". Journal of Obsessive-Compulsive and Related Disorders. 3 (2): 140–149. doi:10.1016/j.jocrd.2013.12.007.
  3. ↑ Deacon B, Nelson EA (2008). "On the nature and treatment of scrupulosity" (PDF). Pragmatic Case Studies in Psychotherapy. 4 (2): 39–53. doi: 10.14713/pcsp.v4i2.932 .
  4. ↑ American Psychiatric Association (2000). "Diagnostic criteria for 301.4 Obsessive–compulsive personality disorder". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). American Psychiatric Association. ISBN   0-89042-025-4.
  5. ↑ "Scrupulous". Dictionary.com. Retrieved 17 September 2018.
  6. 1 2 Huppert JD, Siev J, Kushner ES (October 2007). "When religion and obsessive-compulsive disorder collide: treating scrupulosity in Ultra-Orthodox Jews". Journal of Clinical Psychology. 63 (10): 925–41. doi:10.1002/jclp.20404. PMID   17828763.
  7. 1 2 3 4 Abramowitz JS (2008). "Scrupulosity". In Abramowitz JS, McKay D, Taylor S (eds.). Clinical Handbook of Obsessive–Compulsive Disorder and Related Problems. Johns Hopkins University Press. pp. 156–72. ISBN   978-0-8018-8697-3.
  8. ↑ Abramowitz, Jonathan S.; Deacon, Brett J.; Whiteside, Stephen P. H. (2011-03-14). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN   9781609180171.
  9. ↑ McKay D, Storch EA, Nelson B, Morales M, Moretz MW (2009). "Obsessive–compulsive disorder in children and adolescents: treating difficult cases". In McKay D, Storch EA (eds.). Cognitive Behavior Therapy for Children: Treating Complex and Refractory Cases. Springer. pp. 81–114. ISBN   978-0-8261-1686-4.
  10. 1 2 van Megen HJ, den Boer-Wolters D, Verhagen PJ (2010). "Obsessive compulsive disorder and religion: a reconnaissance". In Verhagen P, Van Praag HM, López-Ibor JJ Jr, Cox J, Moussaoui D (eds.). Religion and Psychiatry: Beyond Boundaries. Wiley. pp. 271–82. ISBN   978-0-470-69471-8.
  11. ↑ Williams, M.T.; Chapman, L.K.; Simms, J.V.; Tellawi, G. (2017). "Chapter 4: Cross-Cultural Phenomenology of Obsessive-Compulsive Disorders". In Abramowitz, J.S.; McKay, D.; Storch, E.A. (eds.). The Wiley Handbook of Obsessive Compulsive Disorders. pp. 56–61.
  12. 1 2 López-Ibor JJ Jr, López-Ibor Alcocer MI (2010). "Religious experience and psychopathology" (PDF). In Verhagen P, Van Praag HM, López-Ibor JJ Jr, Cox J, Moussaoui D (eds.). Religion and Psychiatry: Beyond Boundaries. Wiley. pp. 211–33. ISBN   978-0-470-69471-8.
  13. 1 2 Ciarrocchi JW (1995). The Doubting Disease: Help for Scrupulosity and Religious Compulsions. Mahwah, NJ: Paulist Press. ISBN   0-8091-3553-1. Scruples: common and uncommon. p. 32–47.
  14. 1 2 Taylor CZ (2002). "Religious addiction: obsession with spirituality". Pastoral Psych. 50 (4): 291–315. doi:10.1023/A:1014074130084. S2CID   147184112.
  15. ↑ Rose S (2007). "Manresa—the spiritual exercises—1523". St. Ignatius Loyola And The Early Jesuits. Read Books. pp. 45–71. ISBN   978-1-4086-2255-1.
  16. ↑ de Liguori A (1999). "Peace for scrupulous souls". In Jones FM (ed.). Selected Writings. Mahwah, NJ: Paulist Press. pp. 209–18. ISBN   0-8091-3771-2.
  17. ↑ Monahan J (2003). Thérèse of Lisieux . Paulist Press. p.  45. ISBN   0-8091-6710-7.
  18. ↑ Aho JA (2005). "Martin Luther and scrupulosity". Confession and Bookkeeping: the Religious, Moral, and Rhetorical Roots of Modern Accounting. Albany: State University of New York Press. pp. 95–8. ISBN   0-7914-6545-4.
  19. ↑ Cefalu P (June 2010). "The doubting disease: religious scrupulosity and obsessive-compulsive disorder in historical context". The Journal of Medical Humanities. 31 (2): 111–25. doi:10.1007/s10912-010-9107-3. PMID   20127153. S2CID   207195185.
  20. 1 2 Bourke J (2009). "Divine madness: the dilemma of religious scruples in twentieth-century America and Britain" (PDF). J Soc Hist. 42 (3): 581–603. doi:10.1353/jsh.0.0152. S2CID   144063854.
  21. ↑ "What is OCD & Scrupulosity". International OCD Foundation. Retrieved 2023-05-07.
  22. ↑ "Managing Scrupulosity – Scrupulosity is a life-long commitment to healing and integration" . Retrieved 2023-05-06.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.