Scrupulosity is a manifestation of obsessive-compulsive disorder in which obsessional fears or compulsive rituals are religious or moral. Clinicians often struggle working with scrupulous individuals. Clinicians must disentangle religious from compulsive ritual and help patients violate the latter but not the former, which often involves becoming acquainted with unfamiliar and complex religious norms and working collaboratively with clergy. Therefore, effective exposure and response prevention (ERP) requires skilled psychotherapy technique and creativity along with cultural sensitivity and respect of patient values. In this chapter, we illustrate the application of ERP for scrupulosity with the case of David. We highlight issues related to psychoeducation, the therapeutic stance, motivational and cognitive work, and both in vivo and imaginal exposures. Throughout, we elaborate on clinical decision-making processes that guide treatment.
- Religious obsessions
- Religious rituals
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Subjective units of distress, used as shorthand to gauge degree of anxiety from 0 (none) to 10 (extreme).
It is important to note that many individuals who suffer from scrupulosity do not describe having ultimate fears of eternal damnation or divine punishment, per se. For many, simply living in a feeling of a state of sin is simply unacceptable. At times, there are fears that there will be “punishments in this world if not in the world to come,” but even this is not uniform.
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Siev, J., Huppert, J. (2016). Treatment of Scrupulosity-Related Obsessive-Compulsive Disorder. In: Storch, E., Lewin, A. (eds) Clinical Handbook of Obsessive-Compulsive and Related Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-17139-5_4
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Print ISBN: 978-3-319-17138-8
Online ISBN: 978-3-319-17139-5