Scrupulosity
Encyclopedia
Scrupulosity is a psychological disorder characterized by pathological guilt about moral or religious issues. It is personally distressing, objectively dysfunctional, and often accompanied by significant impairment in social functioning. It is typically conceptualized as a moral or religious form of obsessive–compulsive disorder (OCD), although this categorization is empirically disputable.
The term is derived from the Latin scrupulum, a sharp stone, implying a stabbing pain on the conscience
. Scrupulosity was formerly called scruples in religious contexts, but the word scruples now commonly refers to a troubling of the conscience rather than to the disorder.
As a personality trait, scrupulosity is a recognized diagnostic criterion for obsessive–compulsive personality disorder. It is sometimes called "scrupulousness," but that word properly applies to the positive trait of having scruples.
in a religious context, e.g., by Roman Catholics, to mean obsessive concern with one's own sins and compulsive performance of religious devotion. This use of the term dates to the 12th century. Several historical and religious figures suffered from doubts of sin, and expressed their pains. Ignatius of Loyola
, founder of the Jesuit
s, wrote "After I have trodden upon a cross formed by two straws, ... there comes to me from without a thought that I have sinned; ... this is probably a scruple and temptation suggested by the enemy." Alphonsus Liguori
, the Redemptorists' founder, wrote of it as "groundless fear of sinning that arises from 'erroneous ideas'". Although the condition was lifelong for Loyola and Liguori, Thérèse of Lisieux stated that she recovered from her condition after 18 months, writing "One would have to pass through this martyrdom to understand it well, and for me to express what I experienced for a year and a half would be impossible." Martin Luther
also suffered from obsessive doubts; in his mind, his omitting the word enim ("for") during the Eucharist
was as horrible as laziness, divorce, or murdering one's parent.
Although historical religious figures such as Loyola, Luther and John Bunyan
are commonly cited as examples of scrupulosity in modern self-help books, some of these retrospective diagnoses may be deeply ahistorical: these figures' obsession with salvation may have been excessive by modern standards, but that does not mean that it was pathological.
Scrupulosity's first known public description as a disorder was in 1691, by John Moore
, who called it "religious melancholy" and said it made people "fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it". Loyola, Liguori, the French confessor R.P. Duguet, and other religious authorities and figures attempted to develop solutions and coping mechanisms; the monthly newsletter Scrupulous Anonymous
, published by the followers of Liguori, has been used as an adjunct to therapy. In the 19th century, Christian spiritual advisors in the U.S. and Britain became worried that scrupulosity was not only a sin in itself, but also led to sin, by attacking the virtues of faith, hope, and charity. Studies in the mid-20th century reported that scrupulosity was a major problem among American Catholics, with up to 25% of high school students affected; commentators at the time asserted that this was an increase over previous levels.
Starting in the 20th century, individuals with scrupulosity in the U.S. and Britain increasingly began looking to psychiatrists, rather than to religious advisors, for help with their disorder.
Exposure and response prevention (ERP), a form of behavior therapy, is widely used for OCD in general and may be promising for scrupulosity in particular. ERP is based on the idea that deliberate repeated exposure to obsessional stimuli lessens anxiety, and that avoiding rituals lowers the urge to behave compulsively. For example, with ERP a person obsessed by blasphemous thoughts while reading the Bible would practice reading the Bible. However, ERP is considerably harder to implement than with other disorders, because scrupulosity often involves spiritual issues that are not specific situations and objects. For example, ERP is not appropriate for a man obsessed by feelings that God has rejected and is punishing him. Cognitive therapy
may be appropriate when ERP is not feasible. Other therapy strategies include noting contradictions between the compulsive behaviors and moral or religious teachings, and informing individuals that for centuries religious figures have suggested strategies similar to ERP (see History). Religious counseling may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety.
Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic
medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.
Treatment of scrupulosity in children has not been investigated to the extent it has been studied in adults, and one of the factors that makes the treatment difficult is the fine line the therapist must walk between engaging and offending the client.
of scrupulosity is speculative; available data do not permit reliable estimates, and available analysis mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. Available data suggest that the prevalence
of obsessive–compulsive disorder does not differ by culture, except where prevalence rates differ for all psychiatric disorders. No association between OCD and depth of religious beliefs has been demonstrated, although data are scarce. There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0-7% in countries like the U.K. and Singapore, to 40-60% in traditional Muslim and orthodox Jewish populations.
The term is derived from the Latin scrupulum, a sharp stone, implying a stabbing pain on the conscience
Conscience
Conscience is an aptitude, faculty, intuition or judgment of the intellect that distinguishes right from wrong. Moral judgement may derive from values or norms...
. Scrupulosity was formerly called scruples in religious contexts, but the word scruples now commonly refers to a troubling of the conscience rather than to the disorder.
As a personality trait, scrupulosity is a recognized diagnostic criterion for obsessive–compulsive personality disorder. It is sometimes called "scrupulousness," but that word properly applies to the positive trait of having scruples.
History
Scrupulosity is the modern-day medical diagnosis that corresponds to a traditional use of the term scruplesScruples
The word scruples or scruple can mean: – a doubt or hesitation that troubles the conscience or that comes from the difficulty of determining whether something is right...
in a religious context, e.g., by Roman Catholics, to mean obsessive concern with one's own sins and compulsive performance of religious devotion. This use of the term dates to the 12th century. Several historical and religious figures suffered from doubts of sin, and expressed their pains. Ignatius of Loyola
Ignatius of Loyola
Ignatius of Loyola was a Spanish knight from a Basque noble family, hermit, priest since 1537, and theologian, who founded the Society of Jesus and was its first Superior General. Ignatius emerged as a religious leader during the Counter-Reformation...
, founder of the Jesuit
Society of Jesus
The Society of Jesus is a Catholic male religious order that follows the teachings of the Catholic Church. The members are called Jesuits, and are also known colloquially as "God's Army" and as "The Company," these being references to founder Ignatius of Loyola's military background and a...
s, wrote "After I have trodden upon a cross formed by two straws, ... there comes to me from without a thought that I have sinned; ... this is probably a scruple and temptation suggested by the enemy." Alphonsus Liguori
Alphonsus Liguori
Saint Alphonsus Maria de Liguori was an Italian Catholic bishop, spiritual writer, scholastic philosopher and theologian, and founder of the Redemptorists, an influential religious congregation...
, the Redemptorists' founder, wrote of it as "groundless fear of sinning that arises from 'erroneous ideas'". Although the condition was lifelong for Loyola and Liguori, Thérèse of Lisieux stated that she recovered from her condition after 18 months, writing "One would have to pass through this martyrdom to understand it well, and for me to express what I experienced for a year and a half would be impossible." Martin Luther
Martin Luther
Martin Luther was a German priest, professor of theology and iconic figure of the Protestant Reformation. He strongly disputed the claim that freedom from God's punishment for sin could be purchased with money. He confronted indulgence salesman Johann Tetzel with his Ninety-Five Theses in 1517...
also suffered from obsessive doubts; in his mind, his omitting the word enim ("for") during the Eucharist
Eucharist
The Eucharist , also called Holy Communion, the Sacrament of the Altar, the Blessed Sacrament, the Lord's Supper, and other names, is a Christian sacrament or ordinance...
was as horrible as laziness, divorce, or murdering one's parent.
Although historical religious figures such as Loyola, Luther and John Bunyan
John Bunyan
John Bunyan was an English Christian writer and preacher, famous for writing The Pilgrim's Progress. Though he was a Reformed Baptist, in the Church of England he is remembered with a Lesser Festival on 30 August, and on the liturgical calendar of the Episcopal Church on 29 August.-Life:In 1628,...
are commonly cited as examples of scrupulosity in modern self-help books, some of these retrospective diagnoses may be deeply ahistorical: these figures' obsession with salvation may have been excessive by modern standards, but that does not mean that it was pathological.
Scrupulosity's first known public description as a disorder was in 1691, by John Moore
John Moore (Bishop of Ely)
John Moore was an English cleric, scholar, and book collector. He was bishop of Norwich and bishop of Ely ....
, who called it "religious melancholy" and said it made people "fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it". Loyola, Liguori, the French confessor R.P. Duguet, and other religious authorities and figures attempted to develop solutions and coping mechanisms; the monthly newsletter Scrupulous Anonymous
Scrupulous Anonymous
Scrupulous Anonymous is a Roman catholic monthly newsletter published by the Liguori Mission, associated with the Redemptorist Order, founded by Saint Alphonsus Liguori.The newsletter focuses on individuals who need help in dealing with scrupulosity...
, published by the followers of Liguori, has been used as an adjunct to therapy. In the 19th century, Christian spiritual advisors in the U.S. and Britain became worried that scrupulosity was not only a sin in itself, but also led to sin, by attacking the virtues of faith, hope, and charity. Studies in the mid-20th century reported that scrupulosity was a major problem among American Catholics, with up to 25% of high school students affected; commentators at the time asserted that this was an increase over previous levels.
Starting in the 20th century, individuals with scrupulosity in the U.S. and Britain increasingly began looking to psychiatrists, rather than to religious advisors, for help with their disorder.
Characteristics
In scrupulosity, a person's obsessions focus on moral or religious fears, such as the fear of being an evil person or the fear of divine retribution for sin. Although it can affect nonreligious people, it is usually related to religious beliefs. In the strict sense, not all obsessive–compulsive behaviors related to religion are instances of scrupulosity: strictly speaking, for example, scrupulosity is not present in people who repeat religious requirements merely to be sure that they were done properly.Treatment
Treatment is similar to that for other forms of obsessive–compulsive disorder. Typical treatments for OCD seem to be relatively ineffective for scrupulosity, or may require special considerations. Little overall support exists for any of the several possibly-effective treatment approaches.Exposure and response prevention (ERP), a form of behavior therapy, is widely used for OCD in general and may be promising for scrupulosity in particular. ERP is based on the idea that deliberate repeated exposure to obsessional stimuli lessens anxiety, and that avoiding rituals lowers the urge to behave compulsively. For example, with ERP a person obsessed by blasphemous thoughts while reading the Bible would practice reading the Bible. However, ERP is considerably harder to implement than with other disorders, because scrupulosity often involves spiritual issues that are not specific situations and objects. For example, ERP is not appropriate for a man obsessed by feelings that God has rejected and is punishing him. Cognitive therapy
Cognitive therapy
Cognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...
may be appropriate when ERP is not feasible. Other therapy strategies include noting contradictions between the compulsive behaviors and moral or religious teachings, and informing individuals that for centuries religious figures have suggested strategies similar to ERP (see History). Religious counseling may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety.
Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic
Serotonergic
Serotonergic or serotoninergic means "related to the neurotransmitter serotonin". A synapse is serotonergic if it uses serotonin as its neurotransmitter...
medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.
Treatment of scrupulosity in children has not been investigated to the extent it has been studied in adults, and one of the factors that makes the treatment difficult is the fine line the therapist must walk between engaging and offending the client.
Epidemiology
The prevalencePrevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
of scrupulosity is speculative; available data do not permit reliable estimates, and available analysis mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. Available data suggest that the prevalence
Prevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
of obsessive–compulsive disorder does not differ by culture, except where prevalence rates differ for all psychiatric disorders. No association between OCD and depth of religious beliefs has been demonstrated, although data are scarce. There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0-7% in countries like the U.K. and Singapore, to 40-60% in traditional Muslim and orthodox Jewish populations.
Further reading
- Beattie, Trent (2011). Scruples and Sainthood.