Religious OCD, also known as scrupulosity OCD, is a common form of obsessive-compulsive disorder (OCD) in which someone experiences unwanted intrusive thoughts, images, or urges about violating their religious beliefs. Typically, people worry that they are committing blasphemy and will be punished and go to Hell, or that they are evil or bad.
The hallmark of this OCD subtype is uncertainty — people with religious OCD want to be absolutely certain that they are good and will not be condemned to Hell. However, because no one can be sure about something of that nature, uncertainty breeds fear and anxiety that results in compulsions to alleviate the distress. With religious OCD, the compulsions may look like excessive prayer, confession, reassurance seeking, avoidance of certain actions or people and more.
How is religious OCD treated?
The good news about religious OCD is that it is highly treatable. The most effective treatment option for all types of OCD is a form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy. ERP is continuously recognized as the gold-standard treatment option for OCD because it effectively leads patients, over time, to a life free of compulsions.
When you begin ERP therapy, you can expect your therapist and you to identify what triggers your religious OCD and work together to expose you to those triggers in a safe and controlled environment. As you are repetitively exposed to your triggers and begin experiencing your intrusive thoughts in the presence of your therapist, they can help you to resist enacting your compulsions. Eventually, you will be able to better endure your intrusive thoughts and not feel as strong of an urge to engage in compulsions.
What are religious OCD exposures?
Exposures for religious OCD depend on the religion of the person and may look different across patients. Typically, exposures cannot be done in real life or “in vivo”, and your therapist will instead have you complete imaginal exposures where you lean into uncertainty around what God thinks of you or if you are going to Hell. An example of an imaginal exposure might look like this:
“Last week when Sally asked me to lead the prayer group, I had the thought ‘Hail Satan’ go through my mind. It scared me so badly and I wanted to believe that the thought wasn’t mine. I prayed to God so I wouldn’t be sent to Hell. No matter how many times I pray to God, I can never know if I will be damned to Hell. I can live my life virtuously, in His image and still not know if at the end of my life I will be able to join my loved ones in heaven. Nothing I do will ever convince me that I will be saved. I can never know for sure. For now, I must put my faith in God that He will do whatever is right, including damning me to Hell.”
By allowing this uncertainty to come up in a safe environment, you can learn to tolerate it without feeling the need to enact your compulsions.
Other exposures include:
- writing or saying the words “666,” “Satan” or “Hell”
- drawing pentagrams
- saying things such as “hail Satan”
- praying to the devil
- wishing harm to others
- not paying attention during religious services
- exploring doubts about religious doctrines
- destroying holy objects
- cursing at God or other religious figures
- praying “incorrectly”
- not confessing
It’s understandable that if you are particularly religious and faithful, you might have strong reactions to these exposures. However, it is likely that you are even more devout or strict than others of the same religion. In other words, you may take your religious doctrines to a higher (and potentially unhealthy) level. However, your therapist will never ask you to do things that others in your religion would agree is not right — you can still find exposures that work for you.
Overall, exposures will vary from person to person and are only a part of the process. Outside of your ERP therapy sessions, it’s important to continue being aware of your triggers and to resist enacting your compulsions. Response prevention — or the continual resistance of compulsions — is key in seeing real and lasting results from your exposure work.
How can I begin treatment?
If you’re ready to begin ERP therapy, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD clinical team. All NOCD therapists specialize in the treatment of OCD and receive training specifically in ERP therapy to offer you the most effective treatment options.
While exposures may seem overwhelming, they are imperative to living a life free of your compulsions — and your therapist will be with you every step of the way. You can also join our Religious & Scrupulosity OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.
