Moral Scrupulosity OCD

WHAT IS MORAL SCRUPULOSITY OCD?

Those with Moral Scrupulosity (Moral Scrup) OCD are excessively concerned with being morally perfect. Unlike Religious Scrupulosity which is focused on living up to a person’s religious beliefs, the focus of Moral Scrup is on living up to a personal belief system or moral code. While most people are concerned with meeting moral standards, those with this form of OCD are consumed with a rigid desire to be moral, even when the “perfect,” moral choice is extreme. By the time people start treatment for Moral Scrupulosity, they may be acting counter to their values in the pursuit of being “perfect” in their morals.

MORAL SCRUPULOSITY SYMPTOMS

How do you know if you have OCD? Only a licensed practitioner can perform an official assessment and provide a diagnosis. That said, the symptoms of OCD include the presence of obsessions and compulsions that take up a significant amount of time, cause distress and impair social, occupational and other important areas of functioning.

OBSESSIONS

Obsessions are intrusive, upsetting, repetitive, thoughts, images and urges. In Moral Scrupulosity, obsessions can include thoughts like:

• I told that person I liked their soup, but I’m not sure that I did. Should I tell them?
• If people knew that I talked about that person behind their back, they might think I’m a bad person and stop talking to me.
• I took five dollars that I found on the street. What if I get arrested?

You can learn more about obsessions and OCD in general here.

COMPULSIONS

Compulsions are behaviors that individuals do in order to get rid of the anxiety, doubt and distress that often result from obsessions. These actions can be overt or covert. A person might do any number of things compulsively, like wash, check, avoid, seek reassurance, analyze thoughts and more. In Moral Scrupulosity OCD, compulsions can look like:

• Correcting yourself if you say something that’s not one hundred percent true
• Beating up on yourself in order to atone for wrongdoings
• Confessing to make sure that loved ones still accept them if the know all their faults

You can learn more about compulsions here.

TREATMENT FOR MORAL SCRUPULOSITY

EXPOSURE AND RESPONSE PREVENTION (ERP)

We approach the treatment of every subtype of OCD in the same way, with Exposure and Response Prevention (ERP). This involves facing the things that trigger thoughts and feelings without giving into compulsions. For instance, someone with Moral Scrupulosity might recall something they did in their past on purpose and choose not to confess in order to make sure they are not “bad.” The goal is to trigger oneself on purpose and drop compulsions like rumination, reassurance seeking, etc.

The ultimate goals of ERP for Moral Scrupulosity are to:

• allow for the presence of doubt thoughts about one’s moral character
• make space for distress
• accept that one cannot be morally perfect or know for sure that an action is moral

We want to be careful not to focus too much on the content of OCD as the thoughts themselves are not important. Still, there are some common roadblocks that people with this subtype face. ⁠If you’d like support for this subtype, the therapists at the Center for the Obsessive Mind have a great deal of experience supporting those with Moral Scrupulosity. You can learn more about the treatments and services we provide here, or email the Center here to find out more about working with her.

ACCEPTANCE AND COMMITMENT THERAPY (ACT) & MINDFULNESS

While ERP is considered the gold-standard treatment for OCD, Acceptance and Commitment Therapy (ACT) is also an evidence-based treatment for OCD that can be used with ERP. ACT draws upon mindfulness ideals in order to support people in witnessing and accepting their thoughts and feelings without judgment. By supporting this objective view of thoughts and feelings, ACT helps people to accept their inner experiences while they take actions based on what matters most to them. You can learn more about ACT here.

General Mindfulness as well as Meditation are also helpful supports for those in recovery from Moral Scrupulosity. Given that this subtype is a form of Pure Obsessional OCD, learning how to deal with mental compulsions is key to treatment. Meditation can support people in disengaging from mental compulsions. Mindfulness can support individuals to peacefully coexist with thoughts and feelings.