Skip to main content
SpringerLink
Log in

Scrupulosity: A Unique Subtype of Obsessive-Compulsive Disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

The earliest descriptions of obsessive-compulsive disorder (OCD) were religious, as was the understanding of their origins. With the emancipation, religion in OCD was relegated to its status today: a less common symptom of OCD in most Western societies known as scrupulosity. The frequency of scrupulosity in OCD varies in the literature from 0% to 93% of cases, and this variability seems predicated on the importance of religious belief and observance in the community examined. Despite the similarities between religious ritual and compulsions, the evidence to date that religion increases the risk of the development of OCD is scarce. Scrupulosity is presented as a classic version of OCD, with obsessions and compulsions, distress, and diminished functioning similar to those of other forms of OCD. The differentiation between normal religiosity and scrupulosity is presented, and the unique aspects of cognitive-behavioral therapy in treating scrupulosity, especially in religious populations, are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Greenberg D, Shefler G: Ultra-Orthodox rabbinic responses to religious obsessive-compulsive disorder. Isr J Psychiatry Relat Sci 2008, 45:183–192.

    PubMed  Google Scholar 

  2. Pitman RK: Obsessive-compulsive disorder in Western history. In Current Insights in Obsessive Compulsive Disorder. Edited by Hollander E, Zohar J, Marazziti D, Oliver B. Chichester, United Kingdom: John Wiley and Sons; 1994:3–11.

    Google Scholar 

  3. Ignatius S: Spiritual Exercises of Saint Ignatius of Loyola. Translated by Delmage L. Boston, MA: Daughters of Saint Paul; 1978.

  4. Enoch MD, Trethowan W: Uncommon Psychiatric Syndromes. Bristol, United Kingdom: John Wright; 1979.

    Google Scholar 

  5. Flecknoe R: Enigmatical characters. In Three Hundred Years of Psychiatry 1535–1860. Edited by Hunter D, Macalpine I. London: Oxford University Press; 1963:116.

    Google Scholar 

  6. Cefalu P: The doubting disease: religious scrupulosity and obsessive-compulsive disorder in historical context. J Med Humanit 2010, 31:111–125.

    Article  PubMed  Google Scholar 

  7. Berrios GE: Obsessive-compulsive disorder: its conceptual history in France during the 19th century. Compr Psychiatry 1989, 30:283–295.

    Article  CAS  PubMed  Google Scholar 

  8. Lewis A: Problems of obsessional illness. Proc R Soc Med 1936, 29:325–336.

    CAS  PubMed  Google Scholar 

  9. Greenberg D: Are religious compulsions religious or compulsive: a phenomenological study. Am J Psychother 1984, 38:524–532.

    CAS  PubMed  Google Scholar 

  10. Greenberg D, Witztum E: The influence of cultural factors on obsessive compulsive disorder: religious symptoms in a religious society. Isr J Psychiatry Relat Sci 1994, 31:211–220.

    CAS  PubMed  Google Scholar 

  11. Greenberg D, Shefler G: Obsessive compulsive disorder in ultra-orthodox Jewish patients: a comparison of religious and non-religious symptoms. Psychol Psychother 2002, 75:123–130.

    Article  PubMed  Google Scholar 

  12. Shafran R, Rachman S: Thought-action fusion: a review. J Behav Ther Exp Psychiatry 2004, 35:87–107.

    Article  CAS  PubMed  Google Scholar 

  13. Abramowitz JS, Nelson CA, Rygwall R, et al.: The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord 2007, 21:91–104.

    Article  PubMed  Google Scholar 

  14. •• Miller CH, Hedges DW: Scrupulosity disorder: an overview and introductory analysis. J Anxiety Disord 2008, 22:1042–1058. This is a review of the concept of scrupulosity that proposes that it is distinct from OCD. This is one of the most comprehensive reviews of the topic, although we disagree with most of the analyses and conclusion.

    Article  PubMed  Google Scholar 

  15. Cohen AB, Rozin P: Religion and the morality of mentality. J Pers Soc Psychol 2001, 81:697–710.

    Article  CAS  PubMed  Google Scholar 

  16. Yorulmaz O, Gençöz T, Woody S: OCD cognitions and symptoms in different religious contexts. J Anxiety Disord 2009, 23:401–406.

    Article  PubMed  Google Scholar 

  17. •• Siev J, Chambless DL, Huppert JD: Moral thought-action fusion and OCD symptoms: the moderating role of religious affiliation. J Anxiety Disord 2010, 24:309–312. This study reaches the interesting conclusion that TAF, a cognitive concept posited to encourage the development of OCD, is associated with OCD only in religions in which the concept is not normative.

    Article  PubMed  Google Scholar 

  18. Siev J, Cohen AB: Is thought-action fusion related to religiosity? Differences between Christians and Jews. Behav Res Ther 2007, 45:829–837.

    Article  PubMed  Google Scholar 

  19. Zohar J, Hermesh H: Obsessive-compulsive disorder. Isr J Psychiatry Relat Sci 2008, 45:149–150.

    PubMed  Google Scholar 

  20. Mataix-Cols D, Frost RO, Pertusa A, et al.: Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety 2010 Mar 24 (Epub ahead of print).

  21. Greenberg D, Witztum E, Pisante J: Scrupulosity: religious attitudes and clinical presentations. Br J Med Psychol 1987, 60:29–37.

    PubMed  Google Scholar 

  22. Taylor J: The rule of conscience. In Three Hundred Years of Psychiatry 1535–1860. Edited by Hunter D, Macalpine I. London: Oxford University Press; 1963:163–165.

    Google Scholar 

  23. Moore J: Of religious melancholy. In Three Hundred Years of Psychiatry 1535–1860. Edited by Hunter D, Macalpine I. London: Oxford University Press; 1963:252–253.

    Google Scholar 

  24. Tolin DF, Abramowitz JS, Kozak MJ, et al.: Fixity of belief, perceptual aberration, and magical ideation in obsessive-compulsive disorder. J Anxiety Disord 2001, 15:501–510.

    Article  CAS  PubMed  Google Scholar 

  25. Diduca D, Joseph S: Schizotypal traits and dimensions of religiosity. Br J Clin Psychol 1997, 36:635–638.

    PubMed  Google Scholar 

  26. White J, Joseph S, Neil A: Religiosity, psychoticism, and schizotypal traits. Pers Individ Dif 1995, 19:847–851.

    Article  Google Scholar 

  27. Alonso P, Menchon JM, Pifarre J, et al.: Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. J Clin Psychiatry 2001, 62:535–540.

    CAS  PubMed  Google Scholar 

  28. Fallon BA, Liebowitz MR, Hollander E, et al.: The pharmacotherapy of moral or religious scrupulosity. J Clin Psychiatry 1990, 51:517–521.

    CAS  PubMed  Google Scholar 

  29. Abramowitz JS, Franklin ME, Schwartz SA, Furr JM: Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. J Consult Clin Psychol 2003, 71:1049–1057.

    Article  PubMed  Google Scholar 

  30. • Huppert JD, Siev J, Kushner ES: When religion and obsessive-compulsive disorder collide: treating scrupulosity in ultra-Orthodox Jews. J Clin Psychol 2007, 63:925–941. This is a guide to effective CBT for scrupulosity in a specific religious population.

    Article  PubMed  Google Scholar 

  31. Mataix-Cols D, Marks IM, Greist JH, et al.: Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychother Psychosom 2002, 71:255–262.

    Article  PubMed  Google Scholar 

  32. Mahgoub OM, Abdel-Hafeiz HB: Pattern of obsessive-compulsive disorder in eastern Saudi Arabia. Br J Psychiatry 1991, 158:840–842.

    Article  CAS  PubMed  Google Scholar 

  33. Abramowitz JS, Huppert JD, Cohen AB, et al.: Religious obsessions and compulsions in a non-clinical sample: the Penn Inventory of Scrupulosity (PIOS). Behav Res Ther 2002, 40:825–838.

    Article  PubMed  Google Scholar 

  34. Foa EB, Huppert JD, Leiberg S, et al.: The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002, 14:485–496.

    Article  PubMed  Google Scholar 

  35. Nelson EA, Abramowitz JS, Whiteside SP, et al.: Scrupulosity in patients with obsessive-compulsive disorder: relationship to clinical and cognitive phenomena. J Anxiety Disord 2006, 20:1071–1086.

    Article  PubMed  Google Scholar 

  36. Fineberg NA, Sharma P, Sivakumaran T, et al.: Does obsessive-compulsive personality disorder belong within the obsessive-compulsive spectrum? CNS Spectr 2007, 12:467–482.

    PubMed  Google Scholar 

  37. Rosmarin DH, Pirutinsky S, Siev J: Recognition of scrupulosity and non-religious OCD by Orthodox and non-Orthodox Jews. J Soc Clin Psychol 2010 (in press).

  38. •• Huppert JD, Siev JS: Treating scrupulosity in religious individuals using cognitive-behavioral therapy. Cogn Behav Pract 2010 (in press). This is a general guide to CBT with scrupulosity.

  39. Sackett DL, Straus SE, Richardson WS, et al.: Evidence-based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone; 2000.

    Google Scholar 

  40. Elliott C, Radomsky AS: Blasphemous obsessions in obsessive-compulsive disorder (OCD): collision or cooperation between psychology and spirituality? Couns Spiritual 2008, 27:51–69.

    Google Scholar 

  41. Hepworth M, Simonds LM, Marsh R: Catholic priests’ conceptualisation of scrupulosity: a grounded theory analysis. Ment Health Relig Cult 2010, 13:1–16.

    Article  Google Scholar 

  42. Dowson JH: The phenomenology of severe obsessive-compulsive neurosis. Br J Psychiatry 1977, 131:75–78.

    Article  CAS  PubMed  Google Scholar 

  43. Stern RS, Cobb J: Phenomenology of obsessive-compulsive neurosis. Br J Psychiatry 1978, 132:233–239.

    Google Scholar 

  44. Swedo SE, Rapoport JL, Leonard H, et al.: Obsessive-compulsive disorder in children and adolescents. Clinical phenomenology of 70 consecutive cases. Arch Gen Psychiatry 1989, 46:335–341.

    CAS  PubMed  Google Scholar 

  45. Riddle MA, Scahill L, King R, et al.: Obsessive compulsive disorder in children and adolescents: phenomenology and family history. J Am Acad Child Adolesc Psychiatry 1990, 29:766–772.

    Article  CAS  PubMed  Google Scholar 

  46. Foa EB, Kozak MJ, Goodman WK, et al.: DSM-IV field trial: obsessive-compulsive disorder. Am J Psychiatry 1995, 152:90–96.

    CAS  PubMed  Google Scholar 

  47. Eisen JL, Goodman WK, Keller MB, et al.: Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. J Clin Psychiatry 1999, 60:346–351.

    CAS  PubMed  Google Scholar 

  48. Pinto A, Mancebo MC, Eisen JL, et al.: The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry 2006, 67:703–711.

    Article  PubMed  Google Scholar 

  49. Garcia AM, Freeman JB, Himle MB, et al.: Phenomenology of early childhood onset obsessive compulsive disorder. J Psychopathol Behav Assess 2009, 31:104–111.

    Article  PubMed  Google Scholar 

  50. Chavira DA, Garrido H, Bagnarello M, et al.: A comparative study of obsessive-compulsive disorder in Costa Rica and the United States. Depress Anxiety 2008, 25:609–619.

    Article  PubMed  Google Scholar 

  51. Akhtar S, Wig NN, Varma VK, et al.: A phenomenological analysis of symptoms in obsessive-compulsive neurosis. Br J Psychiatry 1975, 127:342–348.

    Article  CAS  PubMed  Google Scholar 

  52. Khanna S, Channabasavanna SM: Phenomenology of obsessions in obsessive-compulsive neurosis. Psychopathology 1988, 21:12–18.

    Article  CAS  PubMed  Google Scholar 

  53. Jaisoorya TS, Reddy YC, Srinath S, et al.: Obsessive-compulsive disorder with and without tic disorder: a comparative study from India. CNS Spectr 2008, 13:705–711.

    CAS  PubMed  Google Scholar 

  54. Matsunaga H, Maebayashi K, Hayashida K, et al.: Symptom structure in Japanese patients with obsessive-compulsive disorder. Am J Psychiatry 2008, 165:251–253.

    Article  PubMed  Google Scholar 

  55. Eğrilmez A, Gülseren L, Gülseren S, et al.: Phenomenology of obsessions in a Turkish series of OCD patients. Psychopathology 1997, 30:106–110.

    Article  PubMed  Google Scholar 

  56. Tek C, Ulug B: Religiosity and religious obsessions in obsessive-compulsive disorder. Psychiatry Res 2001, 104:99–108.

    Article  CAS  PubMed  Google Scholar 

  57. Tükel R, Ertekin E, Batmaz S, et al.: Influence of age of onset on clinical features in obsessive-compulsive disorder. Depress Anxiety 2005, 21:112–117.

    Article  PubMed  Google Scholar 

  58. Karadaĝ F, Oguzhanoglu NK, Ozdel O, et al.: OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depress Anxiety 2006, 23:145–152.

    Article  PubMed  Google Scholar 

  59. Besiroglu L, Uguz F, Ozbebit O, et al.: Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder. Depress Anxiety 2007, 24:461–466.

    Article  PubMed  Google Scholar 

  60. Okasha A, Saad A, Khalil AH, et al.: Phenomenology of obsessive-compulsive disorder: a transcultural study. Compr Psychiatry 1994, 35:191–197.

    Article  CAS  PubMed  Google Scholar 

  61. Shooka A, al-Haddad MK, Raees A: OCD in Bahrain: a phenomenological profile. Int J Soc Psychiatry 1998, 44:147–154.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Herzog Hospital, POB 35300, Jerusalem, 91351, Israel

    David Greenberg

  2. Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel

    Jonathan D. Huppert

Authors
  1. David Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan D. Huppert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Greenberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greenberg, D., Huppert, J.D. Scrupulosity: A Unique Subtype of Obsessive-Compulsive Disorder. Curr Psychiatry Rep 12, 282–289 (2010). https://doi.org/10.1007/s11920-010-0127-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-010-0127-5

Keywords

Search

Navigation