View original article published in Psych Central here.

Whenever Marian was exposed to religious issues, she felt overwhelmed by doubt, guilt and anxiety. She had been steadfast in her devotion since childhood. Lately, though, she’d try to avoid anything or anyone that triggered her spiritual obsessions. Her loved ones were puzzled because her commitment had been extraordinary. Conflicting worries consumed her mind and she was becoming depressed.

Marian’s example of scrupulosity is one of many variations a sufferer may have with this type of OCD. Sometimes individuals with scrupulosity aren’t religious but feel hyper-responsible to their moral standards. The fact is that once in a while, religious individuals may experience doubts, guilt, remorse and even some anxiety. However, after talking to their church leaders, religious believers are able to come to terms with their challenge, make amends, and move on.

On the other hand, scrupulosity sufferers feel stuck. They need constant reassurance from others and themselves. They feel as if they are going “crazy.” Their thoughts don’t match their values. They feel “impure” and sinful.

Unfortunately, misinformation and misunderstandings may delay their treatment. According to the International OCD Foundation, it can sometimes take between 14 to 17 years from the time OCD begins for individuals to access the right treatment. Quite often, scrupulosity sufferers create their own rituals to decrease their guilt and anxiety. They don’t realize that their incessant need for reassurance and forgiveness are OCD symptoms.

Cognitive-behavioral therapy that includes Exposure and Response Prevention is the preferred mode of treatment for all subtypes of OCD, including scrupulosity. Your treatment provider will teach you the appropriate skills to overcome it. You can also take steps toward change right now, by recognizing your negative thinking patterns and adjusting your daily routines:

• All-or-nothing/black-and-white thinking.This type of thinking may lead you to look at things in absolute and extreme categories. For example, people may believe they need to follow their religion perfectly. Otherwise, they believe themselves to be sinners and unworthy of God’s blessings.
• Intolerance of uncertainty.When individuals suffer from OCD, they are unable to tolerate the uncertainty related to their target obsessions. They are constantly seeking reassurance. They believe that “one day” they’ll have it 100 percent figured out. This goal seems perpetually to elude them.
• Emotional reasoning.People view their emotions as if they were facts. They may use their feelings to prove to themselves that their fears are true or may come true. For instance, a person may feel anxious and guilty every time he attends his church or synagogue. He uses those feelings as evidence that he is a sinner, otherwise why would he feel that way?
• Thought-action fusion.Some individuals believe that having a “bad” thought is the same as acting on the thought, or that their “bad” thought will come true. When their religion teaches individuals that impure thoughts are sinful, their anxiety escalates and they struggle to decrease this thinking pattern.
• Belief that you can control your thoughts.Sometimes sufferers also experience sexual or harm OCD. Once a young woman who agonized over her “impure” thoughts felt triggered during a psychotherapy session. She began to hold her temples while shutting her eyes tightly. The therapist asked what was wrong. She responded, “I can’t let them out. If I do, I’ll have a panic attack!” She wrongly believed she could control her thoughts. Eventually she learned that suppressing her thoughts was actually triggering her panic attacks.
• Inflated sense of responsibility.When individuals experience moral or religious scrupulosity, they express a pure desire to behave in a manner that will be pleasing unto God and beneficial to those around them. They are hypervigilant when it comes to behaving righteously. They believe they are the ones responsible for preventing any harm to those around them.

To help you start making changes, consider the following:

• Are you following the tenets of your religion or are you letting your obsessions and compulsions get in the way of living it? How are you using your God-given talents and gifts? Are you developing skills to bless the lives of others? Cultivate your spirituality by focusing on what matters. Plenty of research confirms that when individuals serve others, their brain chemistry changes and they feel happier. Don’t let OCD get in the way of serving and living your religion.
• Remember to surround yourself with those you love. Anxiety and guilt may get in the way of enjoying your loved ones. At the end of the day, what is it that God will care the most about? Will it be your following your rituals to perfection or your relationships and what you did for your fellow beings?
• Take care of your physical body. Many sufferers get so caught up with their thoughts, worries, and rituals that they forget to take care of their physical well-being. God loves you and desires for you to have self-compassion. The research is clear: appropriate sleep, physical exercise, and healthy eating will help your body feel better and clear up your mind.
• Trust God. Remember God’s love for you and that He knows who you are. He is all-knowing and He knows you need to work on decreasing your rituals to live happier. Trust that He will understand. Ask Him to give you the inner strength to trust and follow your treatment provider’s directions.
• Do you remember what it was like before OCD entered your life? Most likely your religion and faith brought you happiness, peace, and calm. That’s one of its purposes, isn’t it? God doesn’t want you to be anxious and live in perpetual guilt. He doesn’t expect you to be perfect. You are a mortal being!

Dieter F. Uchtdorf, a religious leader, once told his congregation, “please first doubt your doubts before you doubt your faith.” This advice applies to scrupulous sufferers as well. Whenever you have doubts, notice if you are creating negative thinking patterns.

Don’t make assumptions based on your anxiety. Remember that when you are doubting and feeling anxious, it’s most likely OCD. Educate yourself and seek the proper treatment so you can start feeling the love and tranquility your faith is meant to bring into your life.