When Faith Meets Fear — Understanding Scrupulosity in OCD
Article 1 in a five-part series.
When Alex, now a university student, was in fifth grade, he began to experience something he couldn’t explain—a restless surge of energy that felt like it had to go somewhere.
“I would scratch myself until I would bleed,” he remembered. “I [was trying to] get out the magical energy.” “I was hopping around the room like a kangaroo.”
Only later would he learn that what he was experiencing was obsessive-compulsive disorder (OCD). At the time, his symptoms were not specifically religious. But as he grew older and became more religiously observant, OCD found a foothold in faith.
His family wondered whether his behavior was religious devotion, or compulsion? “At the end of the day, it’s always a little bit of both,” he said. “But the OCD doesn’t negate the fact that this is a part of my identity.”
What Is Scrupulosity?
In scrupulosity, OCD symptoms become intertwined with religious or moral concerns, shaping how individuals interpret thoughts, rituals, and spiritual responsibility. It can involve repeated prayer, confession, ritual washing, or overwhelming guilt about thoughts and intentions. Rev. Dr. Katie O’Dunne, an interfaith chaplain and OCD specialist, describes it memorably:
“OCD is really gross ice cream that happens to show up in a lot of different artificial flavors,” she said. “It’s all the same gross ice cream, but it just tastes a little different based on what someone is passionate about.”
For people of faith, scrupulosity often takes the “flavor” of prayer, ritual, or spiritual worthiness. Although it can resemble intense devotion, its driving force is not peace or conviction, but anxiety and the need to reduce doubt. One of the most difficult aspects of scrupulosity is that it often blurs the line between genuine belief and OCD-driven compulsion.
Why Religion?
Rabbi and psychotherapist Noah Tile explains that OCD often targets deeply held values. When religion or spirituality is central to someone’s life, he notes that OCD symptoms may interfere with faith practices and become intertwined with religious observance and spiritual concerns.
This may show up in direct ways, such as:
fears of doing something morally or spiritually wrong
worries about performing rituals or practices “correctly”
distress over perceived spiritual or moral failure
It may also appear more indirectly, through:
questions about suffering (“Am I being punished?”)
existential worries
self-worth tied to morality, values, or level of devotion
While the content of these fears varies across traditions, the underlying OCD cycle remains the same.
For some people, these fears take specifically religious forms. O’Dunne notes that in Buddhism, scrupulosity may center on suffering and attachment: “What if I remain attached to things? What if I never stop suffering?” In Hinduism, she says, it may emerge through ritual and devotion: “What if I am not approaching the appropriate deity. …What if I am not fully focused when I am performing this ritual?”
Recent research indicates that scrupulosity symptoms may affect up to one-third of individuals with obsessive-compulsive disorder (OCD) in secular populations, although the prevalence in the general population appears to be far lower — likely no more than about 0.33%.
The Central Struggle
The challenge lies in distinguishing genuine practice from compulsion. As O’Dunne has observed, what appears to be a religious concern is often driven by OCD, and the two can be difficult to separate.
This can be further complicated when well-meaning clergy unintentionally reinforce the cycle — individuals engaging in rigid practices may be praised for their devotion, even when those behaviors are actually being driven by OCD and making symptoms worse.
Across traditions, scrupulosity often follows a similar psychological pattern: concerns about faith, purity, or morality become shaped by dread, shame, and intrusive doubt rather than by spiritual grounding.
Looking Ahead
In this five-part series, the articles that follow look more closely at how scrupulosity appears in specific religious contexts and how faith communities can support healing alongside clinical care.
Interviews Conducted by Abby Shapiro
Scrupulosity Blog Series - The following sources informed the content of the Scrupulosity Blog and provide additional context on OCD, scrupulosity, and evidence-based treatment approaches. See HERE. Key Terms Appendix - HERE.
Coming soon: A clear, practical guide to understanding OCD — and what helps.