Overcoming Scrupulosity: A Guide to Treating Religious OCD
One of my favorite topics to help people with in counseling is religious anxiety, which is often known as scrupulosity. I get the opportunity not just to help somebody break a bad habit or begin to resolve a fear, but I get to be a part of a process where they discover joy in their faith. This joy comes without having to cut corners, leave the faith, or adopt a loose doctrine.
In my experience as a therapist, people struggling with religious scrupulosity are asking some variation of these three broad questions:
Am I going to hell because I didn’t get something right?
Have I messed up God’s will for my life through my sin, by not hearing His voice, picking the wrong career, or choosing the wrong partner?
If I don’t pray, confess, or attend services, does that mean something bad is going to happen?
Everyone struggling with some form of these questions has a story that makes one of them feel like a raw nerve whenever it gets triggered. These are not simply questions about a person's faith; they are symptoms of Religious OCD.
The Vicious Cycle of Religious OCD: Why You Can’t Dig Your Way Out
When someone comes to me struggling with these obsessions, I know that they are hoping I can do something that nobody can do. It's like they have been digging a hole, believing that if they just dig deep enough with their shovel, they will find the perfect theological answer or a specific verse that finally gives them peace.
They sit on my couch or talk with a pastor, hoping we will hand them the shovel that will defeat all shovels. They hope we will help them dig for the bit of information or reassurance they’ve been searching for all along. I anticipate this every time. Treatment that works for this kind of stuckness looks more like putting the shovel down rather than grabbing a bigger shovel that digs even better.
As you recover from Religious OCD, you learn to rest in the character and sufficiency of God rather than your own. You learn to accept some mystery about how God works without needing to resolve it. If all goes well, you learn how to enjoy God as a father and a friend rather than constantly fearing the consequences of getting something wrong.
Why Your Struggle is Not All Loss
Many mental health professionals who have read the writings of Martin Luther believe he likely struggled with religious scrupulosity, a subtype of OCD. It's fascinating to consider how his potential struggle with OCD was a big part of the Reformation. It is important that we see that our struggles are not all loss. They are often both our weakness and our greatest strength, and God has the power to redeem all of it.
The late Christian psychiatrist Gerald May demonstrates the potential power of a Christian’s struggle with anxiety:
“Many times I have seen people forced by anxiety to confront issues of meaning, consciousness, self, and God in ways that have led to deep spiritual openings, levels they would never have faced had they not been deeply distressed with their lives.”
- Care of Mind/Care of Spirit
OCD doesn’t respond well to logical arguments about the content of what you are struggling with. For that reason, I want you to consider a story from scripture rather than a theological argument.
Matthew 26:30–35 (ESV): And when they had sung a hymn, they went out to the Mount of Olives. Then Jesus said to them, “You will all fall away because of me this night. For it is written, ‘I will strike the shepherd, and the sheep of the flock will be scattered.’ But after I am raised up, I will go before you to Galilee.” Peter answered him, “Though they all fall away because of you, I will never fall away.” Jesus said to him, “Truly, I tell you, this very night, before the rooster crows, you will deny me three times.” Peter said to him, “Even if I must die with you, I will not deny you!” And all the disciples said the same.
Peter desperately wanted to get it right. Yet Jesus looks at him and the other disciples and says, you are going to mess up, and there is absolutely nothing you can do to stop it. Try your best to not let your mind go down a rabbit hole of theological arguments about predestination or free will right now.
Faithfulness is the goal, but our perfect faithfulness is not totally up to us. And there is grace for that. The only way Peter and the disciples could have avoided the agony they felt after denying Jesus would be to never have known Him at all. They could have remained fishermen who never went on the great adventure of knowing God in the flesh. Those who struggle with religious anxiety often take this route out of pain by distancing themselves from God so they don’t have to feel the pain of messing up. It doesn’t have to be this way.
How Does Religious Scrupulosity Heal?
So if the goal is to put the shovel down and not look for perfect faithfulness or perfect answers, then what does that look like? I'll try to explain it clearly and simply.
The most common evidence-based treatment for all types of OCD is called Exposure and Response Prevention (ERP). The response that we are trying to prevent is compulsive checking and reassurance. If you wonder if you have committed the unforgivable sin, you may compulsively research websites, sermons, and commentaries to be certain that you aren’t going to hell. If you think you messed up your life by not heeding God’s warnings and you picked the wrong partner, you may always be compulsively checking to make sure you still like him and other people like him. If you feel like something bad is going to happen if you don’t pray, then you’ll compulsively pray in certain ways all the time with no flexibility in your routine. If you feel like you must answer big existential questions about God’s sovereignty, God’s justice, and God’s mercy, then you’ll research and ruminate on those questions constantly.
In all of these examples, you are trying to find perfect certainty by engaging in your compulsions. The more certainty you seek, however, the more anxious and uncertain you become. Why is that? That’s because OCD only throws you questions/dilemmas that can’t be perfectly answered and require you to take a leap of faith. Even if the question is, “Did I turn the stove off?” or “Can I be sure that I didn’t hit someone with my car back there?”, you still have to take a leap of faith that you did it (or didn’t) and not turn around and check forever and ever.
Similarly, you eventually have to take a leap of faith and stop trying to perfectly answer these religious questions that haunt you.
But how?
We have to get to the place where we can confidently replace, “I’m definitely going to hell,” or “I’m definitely not going to hell,” with, “It is within the realm of possibility that I’m going to hell, but it seems unlikely based on what I know of God’s character. I’ll never know for sure.”
We replace, “I did/didn’t pick the wrong person to marry,” with, “It’s possible that I picked the wrong person to marry, but I probably didn’t. I’ll never really know, and that’s okay.”
We replace, “Everything is going to be okay because my prayer, scripture, and church routine has been good this week,” with, “Everything might not be okay whether my routine has been perfect or not, and that’s not up to me.”
And we get there via exposures.
Effective exposures need to do three things:
Trigger you on purpose.
Make you do what you haven’t been able to do because of stress and fear.
Not allow you to engage in compulsions that normally temporarily relieve your distress.
Let’s say the question that’s bothering you is, “Am I going to hell because I committed the unforgivable sin (blasphemy against the Holy Spirit)?”
One week of an exposure plan may look like this:
Put stressful Bible verses that make you feel like you’re going to hell on sticky notes and put them on your bathroom mirror, in the front of your Bible, and on your car dashboard so you see them multiple times per day.
If you’ve been avoiding listening to sermons, going to church, reading scripture, reading Christian books, or anything else you used to value, start doing that again.
Don’t do your typical researching, reassurance-seeking from others, or intentional ruminating to try to make yourself feel better about the uncertainty that you might be going to hell.
I would add one controversial suggestion for religious scrupulosity: Regularly read and listen to a pastor or scholar who represents a denomination or view that is somewhat different than the one that you are struggling with from your denomination or background. (Example: a Catholic listening to a Presbyterian or a Baptist reading a Catholic, etc.)
Seems kind of crazy, right?
So, why does this work? I write more about the specific lessons learned in Exposure and Response Prevention here, but I want to hone in on what happens when we do exposures for scrupulosity or questions about God specifically.
When we do exposures for scrupulosity, the main thing that happens is that the noise of trying to seek perfect certainty quiets down and what we really know (or don’t know) about God begins to come to the surface.
Have you ever seen someone run with a weighted vest or warm up their arm by throwing a baseball that’s a few ounces heavier than a normal baseball? When they do that and then run without the vest or throw a normal weighted baseball, it feels 5 times easier. They have more strength to do the regular activity because they did the harder activity. Similarly, when we trigger ourselves on purpose by looking at all of the Bible verses that make us afraid we are going to hell, it makes it 5 times easier to hold a belief like, “It is within the realm of possibility that I’m going to hell, but it seems unlikely based on what I know of God’s character. I’ll never know for sure.”
Exposing ourselves in that way to our fear helps the noise of needing perfect certainty to fade, and we come to a more realistic, nuanced, not 100% certain belief that we can live with if we practice living with it.
The reason you’re miserable now is because you’re trying to feel perfectly certain about something that you can’t be perfectly certain about. That has to be replaced with a healthy uncertainty, and exposures help you get there in ways that you can’t get there with other strategies.
I always tell people with scrupulosity that the difference between me and them is not that I’m 100% certain that I’m not going to hell or 100% certain about any of the other religious topics that are stressing them out. What’s different about me, being that I don’t have OCD about that topic, is that I don’t really think about it that much. I pretty much believe something that sounds like, “That would stink if it were true, but it’s probably not true, so I’m just going to not think about it too much.” And the secret is that even those people who say they are 100% certain are all really believing something pretty similar to me deep down inside. Feeling 100% certain about something like that probably just isn’t quite possible. Maybe it is possible in very rare cases, but I don’t think that’s most people’s experience. It’s certainly not the experience of many respected Christians throughout history who left their writings and journals for us to read.
Finding Peace: A Prayer for Scrupulosity
I will leave you with this prayer from Eugene Peterson:
“I am grateful, God, that your plans do not depend upon my loyalty, that your salvation is not contingent on my steadfastness. Your resurrection takes place anyway. All praise to you, O God. Amen.”
If this is you, please know that you don’t have to stay stuck in misery. It’s hard work, but you can reach a place where your faith is more of a source of strength and joy than of fear and dread.
If you want to read more about how treatment for OCD works, please read my article about treatment: Exposure and Response Prevention (ERP) Therapy for OCD: A Simple Guide
About Tyler Slay
Tyler Slay, LPC, is a licensed professional counselor based in Madison, Mississippi. He specializes in treating Obsessive-Compulsive Disorder (OCD), anxiety disorders, and trauma. Tyler offers Christian counseling for clients who want therapy to align with their faith or who are seeking a faith-integrated approach to mental health.
He has completed advanced training through the International OCD Foundation and uses evidence-based treatments including Exposure and Response Prevention (ERP), Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT).
Tyler provides therapy for children, teens, and adults across Mississippi, both in person and via telehealth. He also works with clients struggling with perfectionism, boundary-setting and assertiveness, family conflict, pornography, anger, failure to launch, relationships, depression, autism (Asperger’s), social skills, tics, PANS/PANDAS, body dysmorphic disorder (BDD), and body-focused repetitive behaviors (BFRBs), including skin picking & hair pulling disorders.
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