Breaking the Scrupulosity Cycle: What Drives Religious OCD

Anna sat in church, heart pounding. A thought flashed through her mind: “What if I just cursed God out loud?” The thought horrified her. She would never dream of doing such a thing. But the more she tried to push it away, the stronger it became. By the end of the service, she had repeated prayers of repentance more times than she could count, trying desperately to neutralise the fear that she had somehow sinned.

This describes many of the key features of scrupulosity, which presents as a cycle of obsession, compulsion, and avoidance. Each step feeds the next, leaving the person trapped in a loop of fear, guilt, and ritual that feels impossible to escape. This cycle often drives them away from the faith they hold most dear. This blog post will look more closely at the Obsessive Compulsive Disorder (OCD) cycle as it presents in scrupulosity, or religious OCD (also known as moral OCD).

Understanding the Cycle

Scrupulosity is a subtype of OCD where the obsessions revolve around morality, sin, religious failure, or other elements of a religious nature. The person’s faith — which might otherwise bring peace — becomes the stage upon which anxiety plays out.

Like all forms of OCD, scrupulosity follows a recognisable cycle that psychologists often describe in five stages:

1. Intrusive thoughts (obsessions)

2. A build-up of distress and anxiety

3. Attempts to neutralise distress through compulsions or avoidance

4. Experience of temporary relief

5. Return of obsessions — often stronger than before

What makes this cycle so distressing is that the very behaviours designed to soothe the anxiety — such as compulsive praying, confessing, seeking reassurance from spiritual leaders, researching to find the correct theological answers, or avoiding certain spiritual practices — actually make the anxiety worse in the long run. Each repetition confirms to the brain that these thoughts must be dangerous, that only ritual or control can make things right. Over time, this pattern becomes deeply entrenched, leading to increased feelings of guilt and self-doubt rather than peace or faithfulness [1,2].

Obsessions in Scrupulosity

Obsessions are intrusive, unwanted thoughts, images, or urges that feel alien — “ego-dystonic” — to the person’s values. Often, they are very much contrary to what the person wants to do. They often involve fears of committing a moral wrong or offending God. Common examples include:

• Fear of having committed an unforgivable sin

• Intrusive blasphemous thoughts or images during prayer

• Doubts about whether prayers, sacraments, or rituals were performed correctly

• Doubts about whether God exists or their faith is real.

• Fear of having offended God without realising it

  
  

These thoughts can feel vivid and alarming. Because they violate deeply held beliefs, they evoke strong shame and guilt. Yet research shows that such intrusive thoughts are universal — most people, even those without OCD, report occasional taboo or blasphemous thoughts [3]. The difference lies not in the content of the thoughts but in how they are interpreted.

In scrupulosity, these thoughts are misinterpreted as significant — as evidence of sin, moral weakness, or spiritual failure. The sufferer may conclude: “If I thought it, it must mean something terrible about me.” This is what psychologists call thought–action fusion — the belief that thinking something bad is as sinful or dangerous as doing it [4].

This misunderstanding turns ordinary mental noise into moral crisis. The mind, desperate to make sense of the anxiety, begins searching for reassurance or certainty — and that’s where compulsions begin.

Compulsions: The Search for Certainty

Compulsions are mental or behavioural rituals performed to reduce distress or prevent feared consequences. In scrupulosity, these rituals often take a religious or moral form. Common compulsions include:

• Repeating prayers until they feel “just right”

• Confessing repeatedly — sometimes multiple times a day

• Seeking reassurance from clergy or friends: “Do you think God forgives me?”. This may include regularly attending confession.

• Analysing past actions for evidence of wrongdoing

• Analysing the bible or compulsively researching to find answers

• Engaging in self-punishing behaviours to “atone” for possible sin

  
  

While these rituals may bring brief relief, they also confirm the idea that the fear was real and dangerous. This is what traps sufferers in the cycle. Each time the person performs a compulsion, the brain learns that the anxiety was justified and that ritual or avoidance is the only way to stay safe [5].

For people of faith, this can be particularly painful. Practices that once felt sacred — prayer, confession, worship, church attendance, or repentance — become hijacked by anxiety. Instead of connecting with God, the person becomes locked in a system of internal policing, endlessly striving for reassurance that never lasts.

Avoidance: The Hidden Trap

Avoidance is the quieter twin of compulsion. It often goes unnoticed because it can look like “wisdom” or “prudence” — yet it keeps the cycle alive. Avoidance might involve:

• Staying away from church for fear of “doing it wrong”, or having thoughts or experiences that trigger anxiety.

• Avoiding certain prayers or scriptures because they trigger guilt or intrusive thoughts

• Withdrawing from friends or pastors out of shame

• Avoiding conversations about faith altogether

  
  

Avoidance brings immediate relief, but it reinforces the idea that feared situations are dangerous. Over time, the person’s world becomes smaller. The church service that once brought comfort now feels like a minefield. Scripture reading becomes fraught with fear. Therefore it feels easier to stay way. However, this also tends to lead to feelings of guilt and shame. It may also lead to feeling isolated and depressed.

A 2022 study by Moroń, Biolik-Moroń, and Matuszewski found that scrupulosity operates as a “bridge” between religious struggles and OCD symptoms, with avoidance and obsessing mutually reinforcing one another [6]. This means that avoidance — far from protecting one’s faith — can actually deepen the sense of disconnection and despair.

The following are some examples of scrupulosity cycles:

Schema Therapy explanation of Scrupulosity

Schema Therapy, an integrative approach developed by Jeffrey Young, can be particularly helpful for understanding scrupulosity’s emotional roots. It focuses on schemas — deeply held patterns of thinking, feeling, and behaving that develop early in life — and modes, or emotional states that get activated under stress.

Research (12) has suggested that in scrupulosity, several schemas often appear:

• Unrelenting Standards / Hypercriticalness: The belief that one must meet impossible standards to avoid criticism or failure.

• Punitiveness: The belief that one's mistakes deserve punishment, not understanding.

• Negativity / Pessimism: A bias toward expecting the worst outcomes, especially moral or spiritual catastrophe.

  
  

Schema Therapy would propose that when these schemas are triggered, certain “modes” come online. The Vulnerable part of us feels scared and ashamed, longing for reassurance. The Punitive critic voice declares: “You’ve failed God again. You’ll never be good enough.” Compulsions and avoidance become ways to quiet these inner voices — but only temporarily.

The goal in Schema Therapy is to strengthen the "Healthy Adult" mode: the part of us that can show self-compassion, challenge distorted beliefs, and tolerate uncertainty. This mode can begin to counter messages like “God demands perfection” with “It’s okay to be human. My faith can include doubt and imperfection.”

Scrupulosity occurs across religious settings. Research by Allen et al. (2019) among Latter-Day Saint participants showed that maladaptive perfectionism was strongly linked with scrupulosity, anxiety about God, and avoidance of God, whereas intrinsic spirituality (focus on inner devotion to God) and a secure attachment to God acted as protective factors [7]. Schema work helps address exactly these themes — moving from fear-based striving to a more secure, relational faith.

The Role of Avoidance and Self-Compassion

Avoidance in scrupulosity is rarely about rebellion; it’s about fear of doing harm. For instance, someone may avoid communion because they fear taking it “unworthily,” or stop praying aloud because intrusive blasphemous thoughts arise.

Self-compassion, as defined by Kristin Neff, involves being kind to oneself in suffering, recognising our common humanity, and maintaining mindfulness rather than over-identification with distress [8]. Studies show that people with higher self-compassion report fewer obsessive symptoms and less thought–action fusion [9].

In scrupulosity, self-compassion helps soften the inner critic. A self-compassionate response to the critic voice might be:

“This thought is painful, but it doesn’t define my faith. I can hold it lightly without condemning myself.”

Developing compassion toward oneself — rather than constant moral scrutiny — is not moral laxity; it’s spiritual maturity. As the Healthy Adult mode strengthens, it learns to balance conviction with kindness, responsibility with grace.

Breaking the Cycle: Therapy and Faith

Healing from scrupulosity doesn’t mean abandoning one’s faith; it means disentangling fear from faith. The most effective treatments tend to integrate behavioural, cognitive, and emotional components, such as:

1. Exposure and Response Prevention (ERP)

ERP involves gradually facing feared situations (e.g., praying once instead of ten times) while resisting the urge to perform compulsions. Over time, the brain learns that anxiety can decrease without ritual, and that feared outcomes (such as divine punishment) do not occur [10].

2. Cognitive–Behavioural Therapy (CBT)

CBT helps people identify distorted thoughts — such as “If I doubt, it means my faith is weak” — and replace them with more balanced beliefs.

3. Schema Therapy

Schema work brings deeper change by addressing underlying emotional themes: perfectionism, guilt, fear of rejection, and unmet needs for love and safety.

4. Acceptance and Commitment Therapy (ACT)

ACT teaches clients to notice intrusive thoughts without getting caught in them, to live in alignment with values rather than fear, and to make peace with uncertainty.

5. Faith-Sensitive Integration

Recent research shows that integrating religious and cultural context enhances outcomes for people with scrupulosity. A systematic review by Toprak and Özçelik (2024) found that culturally and spiritually sensitive CBT and ERP approaches are highly effective, particularly when therapists respect clients’ faith boundaries while challenging compulsive fear [11].

Closing Thoughts

Scrupulosity can feel relentless, like there is a battle between conscience and anxiety, between devotion and dread. But this cycle of obsession, compulsion, and avoidance is not unbreakable. With compassion, structured therapy, and a faith-affirming approach, people can reclaim a spirituality rooted not in fear, but in trust and grace.

An Invitation

If you or someone you love feels caught in the cycle of scrupulosity, know that help is available. I offer online psychology sessions across Australia, integrating Schema Therapy, CBT/ERP, and ACT in a faith-sensitive, compassionate way. Together, we can work towards breaking free of this cycle and finding a healthier relationship with your faith and yourself.

You can book an appointment with me at Refuge Psychology.

Immediate Support

If you are experiencing distress and need immediate support, please call Lifeline on 13 11 14 for 24/7 crisis support in Australia.

Disclaimer

Any stories or examples provided are an example only and do not describe a specific client, person or event. Some of the information we provide on our website may be information related to health and medical issues, but it's not meant to be health and medical "advice". We provide this information for your general use only. While we try to provide accurate information, it may be historical, incomplete information or based on opinions that aren't widely held. Your personal situation has not been considered when providing the information, so any reliance on this information is at your sole risk. We recommend seeking independent professional advice before relying on the information we provide. Find the full terms of service here: Terms of Service | Curated Mind Psych.

References

1. Abramowitz, J. S. (2001). Treatment of scrupulosity with exposure and response prevention: A case report. Cognitive and Behavioral Practice.

2. Abramowitz, J. S., & Jacoby, R. J. (2014). Scrupulosity: A cognitive-behavioural analysis and implications for treatment. Journal of Obsessive-Compulsive and Related Disorders.

3. Rachman, S. (2006). The Evolution of Obsessions. Oxford University Press.

4. Shafran, R., & Rachman, S. (2004). Thought–action fusion: A review. Journal of Behavior Therapy and Experimental Psychiatry.

5. Miller, C. H., & Hedges, D. W. (2008). Scrupulosity disorder: An overview and introductory analysis. Journal of Anxiety Disorders.

6. Moroń, M., Biolik-Moroń, M., & Matuszewski, K. (2022). Scrupulosity in the network of obsessive-compulsive symptoms, religious struggles, and self-compassion. Religions, 13(10), 879.

7. Allen, G. E. K., Norton, A., Pulsipher, S., Johnson, D., & Bunker, B. (2019). I worry that I am almost perfect: Perfectionism, scrupulosity, intrinsic spirituality, and attachment to God. Brigham Young University.

8. Neff, K. (2003). Self-compassion: An alternative conceptualisation of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.

9. Brodar, K. E., Cross, R. T., & McMinn, M. R. (2015). Self-compassion and perceptions of God’s support and forgiveness. Journal of Psychology and Christianity, 34(3), 231–241.

10. Koran, L. M., et al. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Psychiatric Association.

11. Toprak, T. B., & Özçelik, H. N. (2024). Psychotherapies for the treatment of scrupulosity: A systematic review. Current Psychology, 43, 22361–22375.

12. Soltanmohammadlou, N., Ramezani Farani, A., Masoumian, S., Yaghmaie Zadeh, H., & Beigverdi, A. (2022). Comparing early maladaptive schemas and schema modes of individuals with high and low scores in scrupulosity and normal religious people. Iranian Journal of Psychiatry and Behavioral Sciences, 16(3), e111752.