Tips for Living with Scrupulosity

Thinking through Religious OCD

Photo by Peter Law on Unsplash

A few weeks ago,

Joseph Harder

asked me to write about “life hacks” I have for living with scrupulosity. If you don’t know, scrupulosity is a subtype of OCD in which you obsessively agonize over a religious or moral (usually religious) doubt or uncertainty and compulsively try to “resolve” the doubt. See this article for a lengthy discussion of what religious scrupulosity is and how ministers can identify it and address it in their congregations. As I describe in that article, living with scrupulosity can be particularly debilitating because you can constantly doubt questions that are so essential to your understanding of yourself: am I saved?, am I forgiven?, am I right before God?, am I sinning?, am I spiritually clean?, is God real?, does God love me?, and so on. If you don’t have scrupulosity, you may have immediately thought of verses that address each of those questions, but for the sufferer, whatever answers you can think of will fall flat. They will find some loophole, some doubt, some “what if?” to poke holes and question the assurance that we have in faith, leaving them spinning in cycles for hours, days, weeks, months, and years. They may visit pastor after pastor, read book after book, post on Reddit, listen to podcasts, or watch YouTube videos seeking reassurance and certainty which never comes. Jobs can be disrupted, family life, or school. Church can become a torturous experience, reminding them of their doubts, rather than a place of rest and communion with God. So what are they to do? As I always warn in articles about OCD, I am not a mental health professional, but I do have lived experience, and I can speak to what I have found to be helpful and wise. And in my experience, the keys are to find professional help, to avoid reassurance seeking, to notice and accept thoughts, and to rest in God’s sovereign love.

Probably the most important pieces of advice I can give is to treat scrupulosity as OCD, not as some special, spiritual doubt. As I’ve heard many mental health experts say, “OCD is OCD is OCD.” No matter what your subtype is, it’s all OCD. I have seen some people treat scrupulosity too much as theological doubts and the result has been that they go down rabbit trails trying to “answer” unanswerable questions (in this life) and feeding the disorder. You have to begin by recognizing that it is a disorder. It’s attacking your faith because your faith is precious to you.

I know it would be nice to hear that there are easy tips for living with scrupulosity that don’t involve treating OCD professionally, but in my experience, if scrupulosity is disrupting your life, it’s time to get treatment. As I recommend in my article on OCD, choosing either ERP (the most well-researched) or I-CBT (newer, but still researched) therapy should be the way to go. Don’t settle for a therapist who says they are “trained” to treat OCD or “can” treat scrupulosity if they aren’t explicitly trained in ERP or I-CBT. OCD is very treatable, but it requires a certain kind of training. One thing to consider with scrupulosity is that ERP (exposure response prevention) requires you to be exposed to your doubts/fears and not respond compulsively. Any good therapist should work with your faith and never ask you to do an exposure that is blasphemous or otherwise against your faith. I-CBT does not ask you to do exposures at all, but instead addresses how the doubts get created in the first place, so some Christians may feel more comfortable with I-CBT, but both methods work well with good therapists. The other thing I would say is that if you have tried therapy for a good amount of time and not seen adequate results, it’s good and appropriate to advocate for yourself and ask for a recommendation to another therapist. Maybe try another methodology. Fight for your recovery.

But my main point here is that treating scrupulosity as primarily a spiritual question that has to be resolved rather than a mental health condition is a part of the mental health condition. You must learn to trust that God works through mental health professionals to heal you. And that includes facing exposures which seem risky or uncertain. Through this your faith is strengthened and your healing happens.

Next, on a day-to-day level, you must stop seeking reassurance for your theological questions. I know this is difficult because they feel like they are of eternal importance, but you must start framing them as part of a disorder and noise and letting them be (more on that in the next paragraph) by not asking people for advice or seeking out answers. It’s counterintuitive, particularly to protestants, to not look to the Bible for answers for our questions, but in Titus 3:9, Paul tells Titus to “avoid foolish controversies,” and I think that’s what OCD questions really are. They aren’t based in here-and-now reality. They are based in our imagination. They are based in “What Ifs?” and hypotheticals and possibilities rather than direct evidence in our senses, even though in the moment they will feel real and important and relevant and urgent. So long as you continue down the path of trying to find answers for what are fundamentally OCD questions, you will never be satisfied, because it will only feed the uncertainty. If you can ask a pastor once and be satisfied with a theological answer, then I think you are in good shape. You aren’t getting reassurance, you’re getting assurance. But once you recognize that cycle of doubt, you have to break it by letting it go. It will only make your OCD stronger.

That letting go process is critical, in my experience, to healing in general. The intrusive thoughts and doubts are going to continue to come (although through ERP eventually they may get quieter and through I-CBT you learn how they are irrelevant and stop caring). But wherever you are in your recovery journey, not giving relevance to thoughts is important. Allowing thoughts to just be there and exist without you having to do something to fix them or solve them or figure them out is key to having peace. Typically, an intrusive thought comes with a terrible spike of anxiety and a feared consequence (“If I don’t do my compulsion, X will happen!” or “If I don’t do my compulsion, it will mean X about me!”). And one of the best things you can do in that moment is just acknowledge that thought (“That’s a thought. I allow that thought to be there. I allow that feeling to be there.”) and return to the present moment and whatever you were doing before you were triggered. Eventually the anxiety will get tired of screaming at you to pay attention to it and it will subside. Don’t fight it. Don’t argue with it. Don’t play tug-of-war with it. Just acknowledge its existence and move on. This is a muscle that takes practice to build up, but it can be exercised.

Finally, the ultimate key in my experience is trusting in the sovereignty of God. Which means when questions come up that feel and even seem legitimate, but you also know that you are ruminating about them inordinately, you allow them to sit there and trust in God’s faithfulness and love for you. If there are theological questions that you need to resolve, you can resolve them after you have sorted out your mental health issues. Or you can work with your therapist and pastor to get them cleared up carefully, without slipping into endless reassurance (you get one good answer and have to live with it). But honestly, wherever you land, it will require you to have faith in the Person of Jesus Christ, in his character, his promises, his love, his relationship to the Father. And that’s where all Christians live. In fact, we all live under the awesome sovereignty of God whether we recognize our contingency upon him or not. It’s just that some of us like to pretend that we’re self-sufficient and some of us know we belong to God. But that knowing is not the kind of Perfect certainty that scrupulosity demands. It’s a reasonable faith, but not the perfect certitude of OCD, which is a standard no one lives by and no one can live by. But as I’ve argued before, I think there is one thing we ought to feel certain about, and that is God’s love for us. Yes, we may have intrusive thoughts that cause us to doubt, but we can be confident that even while we are blown about by doubts, his love never wavers.