Scrupulosity: The Intersection of Religious Trauma and OCD
by Reece, LPC-MHSP temp
Reece is a Queer, African-American therapist specializing in OCD and neurodivergent-affirming therapy at Healing Umbrella Psychotherapy
Safety, Religious Trauma, and Neurodivergence
The rules of religion can feel confusing, and the ways in which people inconsistently engage with it can be really difficult for neurodivergent humans. You might have learned conflicting messages about how it’s not okay to have sex before marriage but then seen others at Church be praised or recognized despite doing so.
Maybe you read the Bible word-for-word and took literally the sensory descriptions around hell, maybe you heard the question from pastors “are you sure you know where you are going today?”, and the uncertainty wasn’t something that felt safe to sit with because the stakes were too high, and so you learned to repeat prayers, to read until you felt “just right”, to try to mimic the things that others said you were supposed to feel, like closeness to an abstract being, and maybe you learned to believe that you were the problem, to always blame yourself.
In order to cope and survive, humans learn ways to adapt to our environments. While these protective strategies are often later labeled as “unhealthy coping mechanisms” and taught as unhelpful or bad, I wonder how these “irrational” efforts at preventing feared outcomes may actually reflect the deep sense of powerlessness in the face of consequences that were completely out of their control. Growing up being taught that you or people you care about in the world could burn forever and that it is your responsibility to save them really takes a toll on the body. It’s difficult enough to navigate relationships with family and peers, school and a neurotypical world as a neurodivergent person.
You might have received accommodations in school but been targeted because of the diagnoses you were labeled with early on. You might have come to understand your neurodivergence(s) through self-exploration later on in life and now be unpacking the ways in which you wish people had noticed, how much more manageable life might have been if someone had helped you understand yourself and helped you accommodate your needs. When there is so much unknown and out of one’s control, it makes a lot of sense to me that we would turn to what is in our control, even if it doesn’t make sense.
And if you see the things you fear not happening, how smart of your brain to connect it to something you are doing, to create this shield of safety around yourself. With marginalized identities, it can be deeply painful to feel like everything that is happening keeps happening to you.
About OCD & Scrupulosity
OCD or obsessive compulsive disorder is characterized by unwanted intrusive thoughts and physical or mental compulsive behaviors. Many people think of washing your hands excessively until they crack or being a “germ-freak” when they think of OCD. This narrow perception of OCD can make it really difficult for individuals to understand how debilitating and scary it can feel to have unwanted intrusive thoughts. Media perceptions don’t typically reflect the reality of how much OCD can change a person’s capacity to exist in the world.
One theme or subtype of OCD is called scrupulosity. Scrupulosity is an obsession with morality or religious purity. Examples might include obsessions* with making sure you never hurt anyone’s feelings (even though it is impossible to not do so as a human), feeling driven to tell the whole truth or worrying about lying by omission, or difficulty tolerating distress / sitting with discomfort around not knowing, despite your best efforts, how others may perceive you in a moral sense. This distress leads to compulsions, which are attempts to try to alleviate distress around fears that we cannot actually have certainty or control over.
Rethinking Framework of Compulsions from a Neurodiversity Affirming Lens
Compulsions are considered in the DSM to be irrational or “unrealistic” attempts to reduce anxiety around an individual’s fears of what might happen. It can be clinically helpful to seek a collaborative understanding of the function of the compulsions. An individual may or may not believe that the compulsion is actually preventing a specific feared outcome from happening. I find troubling an idea found in traditional treatment of OCD, that if the compulsion cannot be directly linked to preventing the feared outcomes from happening, then it is considered excessive and disordered. Usually, this is decided by those in positions of power (i.e. therapist, psychologist, researcher).
Questions you might ask yourself:
Is it possible that there is not enough time or space in a person’s life to examine the function of the compulsions and they are serving the role of distracting from other more urgent life stressors?
Is it possible that the compulsions are long standing coping patterns or stimming behaviors that are self-soothing or give an important sense of control / safety when an individual is otherwise stripped of their power in the world due to overlapping trauma, marginalization, etc.? If so, I wonder what it would be like to curiously seek to understand the ways in which compulsions were built up as protective responses to pain and when we aren’t tied to predetermined treatment goals or behavioral outcomes, how might that create more embodied safety and bolster the safe relationship in therapy?
Scrupulosity can be complicated by various positive reinforcements from friends, family, pastors, etc. that you are holy and good for engaging more with God. It can make an individual feel really special and unique if they are praised for being “good.” The problem comes when the internal shame for being human and the loneliness when someone is inevitably unable to be perfect – whether to the standards of others or those they have created for themselves in order to prevent the anxiety around failure or rejection, whether perceived or named by others.
Repetition can be self-soothing or a form of stimming for autistic individuals. Thus, things like prayer and attempts to seek certainty could be re-framed from a neurodiversity affirming lens as efforts to gather more information or really smart ways kids (or adults) learned to self-soothe. If we validate the ways in which our bodies are always looking to protect us and keep us safe, then more choice is created for clients to decide if the rituals formed around religion are serving them or if they want to create new ones, centering autonomy, informed consent, and the values of the client, which are really important in therapy.
Our learned responses to painful environments are often pathologized without first honoring the ways in which they were protective and making space to grieve the circumstances from which these mechanisms had to develop.
I wonder what it would look like to curiously draw attention to the ways in which we show up in the world and in relationships with ourselves and each other, with less of a lens for what is “wrong” or in need of fixing and more space for what is actually coming up, asking questions, and growing trust that even if the answers are scary or uncertain, it’s no longer up to you to fix something within yourself. In fact, maybe you revel in a newfound understanding that you are whole and belong, and that makes all of the difference.
*obsession is used here in the theme of language commonly used; many terms used to describe disorder in the framework of OCD can be morally neutral experiences that are looked at differently in the framework of the neurodiversity paradigm) such as hyperfocus, ritual, etc.
