While OCD can manifest in various forms, one particularly challenging subtype is scrupulosity. There are two types of scrupulosity. One is more connected to religiosity. Patients with this form of scrupulosity tend to fear going to hell, sinning, or being blasphemous towards God.  The other type of scrupulosity is more connected to morality and ethics. These patients are more concerned with situations being unjust or unfair.  Patients with scrupulosity may engage in many rituals including excessive prayer, confessing, or seeking reassurance, to alleviate their distress and maintain a sense of moral purity.

Not all patients who experience scrupulosity are religious. In fact, someone who identifies as atheist can still have scrupulosity, but they would struggle with the morality type.  In this blog, I will provide some insight about scrupulosity, how it’s manifested, hindrances to treatment, and treatment options.


OCD manifests in three ways: extreme anxiety, disgust (contamination OCD), and guilt. Patients with scrupulosity tend to experience unimaginable feelings of guilt. From a treatment perspective, treating someone with guilt can be a bit more challenging than someone who is experiencing anxiety. Guilt is a powerful influencer. It is difficult for people to not make decisions based on guilt even when they have the insight that the guilt is a manifestation of the OCD.

Treatment Obstacles

People who suffer from scrupulosity OCD tend to be more apprehensive about treatment because they fear exposures that could make them feel blasphemous or immoral. Of course, as providers, we would not have anyone do any exposures that break the law or get anywhere close to overstepping basic ethics. However, the patient will often ask the provider what their religious or moral values are because they want reassurance that the provider will not have them do anything blasphemous or immoral. Treatment is essentially competing against the patient’s perspective on God or their moral compass. Because of this, we would say that those struggling with scrupulosity have a higher likelihood of discontinuing treatment. It is very sad when OCD attacks a patient’s faith or values. Faith and morals are supposed to provide peace, not fear.

Lack of Insight

It has been my experience as an OCD treatment provider that, because guilt is so powerful, those struggling with scrupulosity tend to have lower insight especially as symptoms worsen. Also, scrupulosity is unique. Those struggling with contamination, harm intrusive thoughts, or sexually intrusive thought can know with 100% certainty over time that they are not sick, have not killed anyone, and have not engaged in any sexual behaviors that are contrary to their desires. However, with scrupulosity, there is no 100% certainty on whether there is a God, how God wants you to behave, what is immoral is many situations and so on. In other words, a person cannot gather enough evidence to prove that their beliefs are found to be 100% true. Religion and morality are subjective. Just look at how many religions and belief systems exist. Even within Christianity, there are significant differences in the way in which the faith is practiced. Therefore, a patient’s apprehension or ability to be compliant to treatment is sometimes dependent on their interpretation of the Bible. Again, the treatment is competing against their version of their faith.

Please know that no provider at Anxiety & OCD Treatment Specialists will try to influence your faith or beliefs. We are only here to treat OCD. As scrupulosity symptoms worsen, it can be difficult for the patient to know where the boundary is between their faith and the OCD. Treatment provides the patient with clarity regarding what they truly believe, and it reintroduces peace, instead of fear, in regards to how they practice their faith and moral standings.  Our only goal is to have peace return to your life and in your relationship with God.

Treatment Options for OCD and Scrupulosity

Fortunately, effective treatment options are available for individuals struggling with OCD and scrupulosity. It is essential to seek professional help for accurate diagnosis and personalized treatment. Some common treatment approaches include:

  • Cognitive-Behavioral Therapy (CBT): CBT is the gold standard treatment for OCD and scrupulosity. It involves exposure and response prevention (ERP), which gradually exposes individuals to their feared obsessions while refraining from engaging in the associated compulsions.
  • Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed medications for OCD. They help regulate serotonin levels in the brain and can reduce the frequency and intensity of obsessive thoughts and compulsive behaviors.
  • Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate specific areas of the brain. TMS has shown promise as a treatment option for Obsessive-Compulsive Disorder (OCD).


Living with OCD and scrupulosity can be immensely challenging, but with the right support and treatment, individuals can learn to manage their symptoms and regain control over their lives. Remember, seeking professional help is crucial. If you or someone you know is struggling with OCD, please don’t hesitate to reach out to one of our providers. Each clinician at Anxiety & OCD Treatment Specialists is proud to work with the patients we have. We enjoy seeing our patients get better and regain their lives back.

For more information about OCD, you can visit the International OCD Foundation website:

This blog was written by Natalie Noel, LMHC

Anxiety & OCD Treatment Specialists is located in Tampa, Florida. However, we have providers who are licensed in both Florida and New York. We provide both in-person and virtual sessions. Contact us today! 813-812-4940.

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