Disorder has haunted saints and, especially, sinners

(RNS) Chad’s bout with scrupulosity began earnestly enough. An Idaho health-care worker and devout Mormon, Chad (who asked that his real name not be used) began wondering if he was totally upfront with patients. Soon, he started scrutinizing his past, looking for times he might not have been completely honest. “It started to steamroll on […]

(RNS) Chad’s bout with scrupulosity began earnestly enough.

An Idaho health-care worker and devout Mormon, Chad (who asked that his real name not be used) began wondering if he was totally upfront with patients. Soon, he started scrutinizing his past, looking for times he might not have been completely honest. “It started to steamroll on me,” the 35-year-old man says.

He began phoning and e-mailing past bosses and acquaintances. Did he deliver every paper on the route? What about that Snickers bar he snatched from the discard bin as a teenage bag boy? Or the sod that fell off the landscaping truck he was driving? Or the loaned scrubs he kept in college?


“It included me sending checks to people,” Chad recalls. “I sent the same people the same check over and over again, worried it wasn’t enough.”

Eventually, he began obsessing about his honesty in every new and future encounter. When he finally told his wife he might have to leave The Church of Jesus Christ of Latter-day Saints because every time he went to church he thought of some new evidence of his own dishonesty, it scared her. “She recognized I had a problem and said, `Let’s get help.'”

A year later, Chad now knows he suffers from scrupulosity, an obsessive compulsive disorder (OCD) in which worries of a religious or moral nature consume an individual. The term derives from the Latin word for a small stone, such as an irritating pebble in one’s shoe.

Though it has been described for centuries in Catholic literature and afflicted saints such as Ignatius of Loyola, Alphonsus Liguori and Catherine of Siena, as well as reformer Martin Luther, scrupulosity has been recognized in the field of psychology only in recent decades.

A series of books, beginning with “The Doubting Disease: Help for Scrupulosity and Religious Compulsions” in the mid-1990s helped raise awareness.

Scrupulosity is not in itself a diagnosis, but falls within the OCD family of anxiety disorders, said Jonathan S. Abramowitz, a clinical psychologist and researcher in the field at University of North Carolina in Chapel Hill.

Unlike the normal person who can reject intrusive thoughts, people with OCD get tied in knots by their mistaken ways of thinking and behaving, Abramowitz said. They cannot handle ambiguity, which makes it hard for one who is scrupulous to remain a person of faith.


According to the International OCD Foundation, up to 3 million U.S. adults and about 500,000 children suffer from OCD. Of those, 5 percent to 30 percent have scrupulosity, according to one estimate.

Its sources are biological and likely environmental, but Abramowitz believes OCD manifests itself as scrupulosity mostly in those who care a lot about their faith, whether that is Christianity, Judaism, Islam, Buddhism or Hinduism.

A Catholic woman may repeatedly confess to her priest about intrusive obscene thoughts while gazing on a crucifix, a “sin” she fears is unforgivable. An Orthodox Jew might worry obsessively that he didn’t keep his milk separate from his meat in accord with kosher law.

“Folks with scrupulosity have a pretty harsh view of God. They see him as looking down with a magnifying glass, waiting for people to screw up so he can blast them with lightning,” Abramowitz said. “That runs counter to what most religions teach.”

One problem in identifying scrupulosity is that it can look like virtue, says John Dehlin, a doctoral student in psychology at Utah State University who is researching a new treatment.

For instance, scrupulous Mormons may spend hours every day reading scripture or praying. “It’s easily dismissed as virtuous,” Dehlin said, “and held up as a beautiful thing.”


But what might be a sign of sanctity in a normal person is all about relieving anxiety in the one who is scrupulous.

Dehlin uses a “perfect storm” analogy to answer why scrupulosity strikes some and not others: If a person is prone to OCD and raised in a strict, orthodox home with religious teachings that include high stakes — on Earth as well as the hereafter — he or she may be susceptible.

“You can’t blame the parents, the person, the church, the religion,” he says. But, he adds, “you don’t hear about scrupulosity among Unitarian Universalists.”

Scrupulosity is treated essentially the same way as other types of OCD, with a combination of medication and cognitive-behavior therapy.

But finding therapists who are sensitive to faith can be hard, said William Van Ornum, author of the 1997 book, “A Thousand Frightening Fantasies: Understanding and Healing Scrupulosity and Obsessive Compulsive Disorder.”

“It has to be someone who understands and who doesn’t give off silent contempt or silent disapproval,” he said.


Abramowitz said treating scrupulosity can be difficult because patients may view the remedies as undermining their faith.

“It’s difficult because … what worse thing could you hold over somebody’s head than their eternal salvation?” says Lori Riddle-Walker, a family and marriage therapist in Escondido, Calif., who has patients with scrupulosity.

Chad, the Idaho man obsessed with honesty, has been through Dehlin’s therapy program at Utah State and credits it, as well as medication, with helping him control his compulsion to make amends for perceived mistakes.

“It’s still a fight for me,” he says. “I have to be very cognizant and on alert that I don’t let myself go down that track.”

And though scrupulosity almost cost him his religion, it now is helping him develop greater faith.

“I’ve come to accept I can’t go back and pay all those quarters back. I’m realizing I can’t fix everything. I have to rely on the atonement.”


(Kristen Moulton writes for The Salt Lake Tribune.)

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