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One of the unique difficulties in identifying and untangling the dysfunction of scrupulosity is that the irrational content triggering anxiety is tied in some way (albeit sometimes loosely or even irrationally) to legitimate religious doctrines and practices. Researchers have explained, “Clinicians and patients alike often have difficulty differentiating normative practice from pathological symptoms of scrupulosity because religious rituals and compulsive rituals may appear similar.”[1]

Scrupulosity Is Not a Higher, More Noble Way to Live Your Religion

Those of you suffering from scrupulosity are good people (even though you don’t believe it), but scrupulosity does not make you better at living your religion. In fact, it corrupts your religious practice. “Scrupulosity masquerades as a desirable, higher standard of righteousness and personal worthiness—but it’s not! Instead, it actually denies Christ and his gospel. Scrupulosity replaces our loving, merciful Father and the Spirit with punishing, crippling anxiety and guilt, creating a rigid, demanding checklist approach to gospel living. This is because scrupulosity isn’t about faith; it’s about obsessive anxiety.”[2]

Philosophers have further opined, “Scrupulosity is not a moral virtue, partly because people with scrupulosity are actually concerned with moral behavior neither for its own sake nor for the sake of other people but only as a means to reduce their own underlying doubts and anxiety. That goal distinguishes people with scrupulosity from moral saints and people with moral virtues.”[3] These philosophers have identified five reasons for this claim.[4]

1. People with scrupulosity “fixate on or assign disproportionate weight to certain issues to the exclusion of other important issues.” This occurs when motivated by anxiety rather than legitimate religious or moral drive.
2. People with scrupulosity are rigid without the flexibility to adapt relative to circumstances. They perform compulsions even when circumstances render the acts completely senseless (except to assuage their anxiety). Yet moral saints are flexible and can adjust their particular religious or moral behaviors as needed while still adhering to their values and goals.
3. People with scrupulosity are inhibited by obsessions over possible harms (unlikely to occur), while moral saints are generally more concerned with probable harms (likely to occur).
4. Although concerned with moral issues, such as harm to others, the issue at hand for those with scrupulosity is often their own perceived responsibility for causing the harm, rather than concern over the harm itself. Their worry is more about “keeping their own hands clean.”
5. Those with scrupulosity promote moral values, but not for the right reasons. For example, they may focus on protecting someone, but the acts of protection are not done for the person’s welfare as much as it is to soothe their own anxiety. One person reflected on his morality-based compulsions: “The ‘right thing to do’ is often nothing more than a selfish attempt to rid myself of my doubt and guilt.”[5]

In religious practice you want to choose to perform religious or moral actions, such as praying, out of genuine desire to love God. Yet “prayer motivated by obsessional thoughts is not technically ‘religious’—such prayer is ‘fear-based’ rather than ‘faith-based.’”[6] One client commented, “I was praying for days and weeks and got nothing because I was praying in my fear.”

Contrasting Scrupulosity and Healthy Religious Faith

In attempting to distinguish psychopathology from healthy expressions of religious devotion, one author focused on the following concepts: the extent to which religious adherence exceeds requirements of the religious doctrine or law, getting observance to ordinances or rituals “right,” interference with religious practice (e.g., church attendance), and resemblance to OCD (e.g., repetition and reassurance seeking).[7] I will discuss these four concepts in turn.

First, healthy religiosity invites a follower to be devout and careful in all aspects of religious practice and everyday living. However, an interesting aspect of scrupulosity lies in its selectiveness. People suffering from scrupulosity usually have a particular concern in one or more areas of practice, and anxiety is hyperfocused on those particular doctrines, principles, or practices.[8] Ironically, these may interfere with other aspects of their religious observance that may be more important.[9] For example, a person may have an obsessive concern about being perfectly honest and yet give no thought to using poor language or dishonoring the Sabbath.

Second, conventional religious rituals are performed to maintain tradition, participate in community, experience peace and comfort in the face of trials of stress, and so forth. We want to approach our religiosity in a healthy, flexible manner: “Healthy religious observance . . . is generally typified by . . . moderate and flexible approaches to most areas of religious belief and practice, viewing perfect adherence as more of an ideal than as an imperative that is necessary to avoid subjective guilt or the threat of severe punishment.”[10] Scrupulosity transforms conventional religious worship rituals into compulsive rituals. In this the spirit of the doctrine gets “lost on the sufferer” who is unable to enjoy the intended soothing and healing benefits.[11] Instead, personal worship gets hijacked by anxiety. Prayer, scripture study, and church or temple attendance no longer create feelings of connection with the Spirit. Instead, they’re done out of fear of punishment and condemnation. For example, one client recorded,

Since I was eleven, I have had to say my prayers in the same order every time. If I don’t do it right, it doesn’t count; I need to say another prayer to add on the things I missed. If I forget to thank God for something, it means I am ungrateful and not faithful enough. If I forget to pray for someone, they might not be safe and protected—and if they are hurt or become sick, it is at least partially my fault because I didn’t do something so small as to add a sentence asking God to protect them.

Because of all this, I have always dreaded saying my prayers and then felt horribly guilty that I dreaded it. I have felt terribly anxious if I strayed at all from the prescribed order because I worry that something awful would happen or that if I do it wrong, I am a bad person and God will be displeased. I have felt so stuck, and it seemed impossible to change this prayer at all.

Third, healthy religious practice is usually associated with positive emotions, but religious compulsive rituals are usually associated with fear and anxiety.[12] In scrupulosity the cognitive flexibility needed to tolerate uncertainty and faith is restricted. This severely interferes with a person’s religious practice. The fear and anxiety felt by someone suffering with scrupulosity often makes church attendance and other religious practices feel oppressive and damning.

Fourth, although there are order, ritual, and ordinances in healthy religious practice, these are done in thoughtful, worshipful ways. They invite calm and feelings of spiritual connection. However, the chaotic press that anxiety causes for one with scrupulosity will render a distinctive flavor to his or her religious practice. Although the one suffering with scrupulosity may not be able to attune to this issue, for the astute observer, scrupulosity OCD does not look or feel like normal, regular religious practice. It will just feel “off.” One client uses the phrase, “If it feels like OCD, it’s OCD.” This idea came to her from the counsel of a physician that specializes in OCD: “OCD may mimic the feeling of reality, but reality never mimics the feeling of OCD. This fact is a very important principle: If it feels like it might be OCD, it is OCD! If it were reality, it wouldn’t feel like it even might be OCD.”[13]

Clients helped me construct table 8.1,[14] which contrasts scrupulous faith with a healthy faith based on their experiences. This is helpful for describing some general differences, as well as to answer for yourself the grounding question we discussed in chapter 2: “Which side of the chart am I on?”

Table 8.1. Contrasting scrupulosity and pure religion

Pondering these ideas, a client thoughtfully contrasted these ideas in his own chart, as presented in table 8.2.

Table 8.2. Client chart contrasting scrupulosity and pure religion[15]

Recognizing qualities of pure religion can help those with religious OCD dispute its harsh messages. One person described an incident from his time serving as a missionary: “I shook hands with someone who smoked, so I knew I might have cigarette residue on my hands. Knowing the residue was on my hands, I later touched my mouth but hadn’t yet washed my hands. So, I was willfully breaking the Word of Wisdom because I was now ingesting something I was told to avoid.” This occurrence caused intense anxiety that prompted intense feelings of unworthiness and guilt, which in turn led to compulsive confession and repentant prayers.

He read this in the handbook for missionaries: “Strive to enjoy the companionship of the Holy Ghost, and follow His direction in living these principles and standards.” This counsel, that he could follow the Spirit in how he lived the standards of missionary life, was freeing for him. Since that time, rather than trying to make some arbitrary checklist of ways to live his life as a disciple of Christ, he’s come to focus on the reasons why God gives certain commandments, rather than just focusing on what he asks us to do. For example, in the smoking example above, he was able to recognize that the purpose of the law of health known as the Word of Wisdom is to have a healthy body so he can receive the promptings of the Spirit and be healthy enough to do the things in life God would have him do. He also realized that undue concern over a few toxic elements getting into his body in a haphazard manner was not the point of the Word of Wisdom.

Another example is from a married woman in her forties who had had years of medication and cognitive treatment, and yet full recovery finally came for her through spiritual rather than physical means.

Ironically, in trying so hard to live the gospel through the lens of scrupulosity, I was actually doing the complete opposite, without even realizing it or meaning to. I was completely denying Christ—who He is, what He did, and His role in my life. I couldn’t stop believing that it was by my merits and my perfection, not His, that my salvation was determined. I didn’t believe His Atonement applied to me and I was trying to save myself. Finally, I realized I could not do it alone and I acknowledged to my Heavenly Father in desperate prayer that I needed a Savior—and pleaded that the Atonement be applied in my behalf. I will always be grateful for the miracle that followed as I felt my guilt and pain swept away—after years of struggle I finally knew for myself that He is my personal Savior and that the power of His Atonement is real. The worry and fear that once consumed me has been replaced with lasting peace and I have come to know that I am worthy and loved, though not perfect. I know now what His grace can do, and I will forever be grateful for my personal Savior, Jesus Christ.

After this woman had this beautiful spiritual experience, she continued to learn and understand what she had to do by attending therapy, but this was a stunning turning point for her.

The Nature of God

Most religious belief systems teach that there is a God and that God is a good God.[16] From a Jewish perspective, verses in the Torah (comprising the first five books of the Bible’s Old Testament) teach of God’s great benevolence: “And the Lord passed before [Moses] and proclaimed: Lord, Lord, benevolent God, Who is compassionate and gracious, slow to anger and abundant in loving kindness and truth, preserving loving kindness for thousands, forgiving iniquity and rebellion and sin.”[17] From a Christian perspective, verses in later books in the Bible teach of the benevolent nature of God. For example, the prophet Isaiah wrote, “For the mountains shall depart, and the hills be removed; but my kindness shall not depart from thee, neither shall the covenant of my peace be removed, saith the Lord that hath mercy on thee.”[18] And the prophet Jeremiah wrote, “For I know the thoughts that I think toward you, saith the Lord, thoughts of peace, and not of evil, to give you an expected end.”[19] The Quʾran teaches, “Place your trust in Allah [God]; surely Allah loves those who trust in Him.”[20]

Believers who have scrupulosity study, understand, and teach this doctrine. They know its truth, and there have been times when they have felt its truth. Yet in moments of scrupulous anxiety, truth tends to dissolve into theory. While such believers know the truth of the doctrine for others, they often are not able to testify of its truth for themselves. In a complete contradiction of the tenets of most religious faiths, these believers, rather than trusting God to be good, loving, and kind, often become intensely afraid of God and see him as a rigid, malicious authoritarian looking for the slightest provocation to condemn them. There is no soothing salve. Before she understood what she was experiencing, one client, a woman in her late sixties who had studied the doctrines of her faith her whole adult life and knew of God’s good nature from that perspective, was desperately perplexed. She prayed to God, “Why am I afraid of you?” She found her unexpected answer during a lecture about scrupulosity. Another therapy client came to the awareness that in her anxiety the god she had been worshipping was “the wrong God,” because in her mind he was a “scary dictator-with-a-checklist type of God.” Yet another client commented, “Scrupulosity makes you feel that that God is malicious.” And still another client, a male in his late teens, expressed his fear this way: “If the worst happened it would mean I’m not a good person and that God doesn’t care about me. It means that God would send me to hell and that he hates me. At the judgment day he’d tell me: ‘you were a good person except that one thing you did.’ So, then I’m going to hell.” In one research study, an ultraorthodox rabbi indicated, “These people worship a punitive God that can never be satisfied.”[21]

Research has shown that people with OCD who have a negative concept of God tended to present with more severe OCD symptoms.[22] If you believe that God is looking for the smallest provocation “to get you,” you’re likely going to be more distressed about any potential sins or mistakes because you’ll be concerned about eternal condemnation and damnation. Whereas if you have a positive view of God—believing foundationally that he loves you, wants the best for you, and will offer you grace to assist you—you are less likely to have more extreme reactions (although research has suggested that the negative concept of God may not be causal in the development of scrupulosity).[23]

Views of Grace and Salvation

Religious beliefs of grace and salvation also intersect with one’s view of God’s nature. The concepts of cheap grace, costly grace, legalism, and scrupulosity can be visualized on a continuum, as seen in figure 8.3.

Figure 8.3. Views of salvation continuum

Believing in cheap grace puts all responsibility for salvation on God so that you do not have to do anything to secure your salvation. Dietrich Bonhoeffer, a Protestant pastor, theologian, and martyr, taught, “Cheap grace means the justification of sin without the justification of the sinner. . . . Cheap grace is the preaching of forgiveness without requiring repentance, baptism without church discipline, Communion without confession, absolution without personal confession. Cheap grace is grace without discipleship, grace without the cross, grace without Jesus Christ.”[24]

Next on the continuum is costly grace, the concept that something is required of the believer while also requiring something of God. Bonhoeffer continued, “[Genuine] grace is costly because it calls us to follow, and it is grace because it calls us to follow Jesus Christ. It is costly because it costs a man his life, and it is grace because it gives a man the only true life. It is costly because it condemns sin, and grace because it justifies the sinner. Above all, it is costly because it cost God the life of his Son.”[25]

Beyond that on the continuum is legalism, in which people believe they have to work doing nearly everything for their own salvation, while God is only there to judge them. Some researchers studied the concepts of grace (which they defined as the idea that God is active and helping us in our lives) and legalism (which they defined as a strict, literal, or excessive conformity to a religious code). Studying Brigham Young University students, these researchers found that better mental health was associated with less legalism (higher scores on measures of grace were correlated with lower scores of measures on anxiety and depression). The researchers commented, “A legalistic view of God may lead to poorer mental health partially because it interrupts the ability to experience grace. Legalistic beliefs and practices appear to diminish a sense that God is aware of their concerns, attends to their needs, and provides for them through divine grace.”[26]

Other researchers studying Latter-day Saints living in the United States found legalism (which they defined as a “strict belief and overemphasis on conduct through specific works for God’s approval and acceptance, and the lack of understanding and knowledge of accepting the grace of God towards the achievement of salvation”) to be positively correlated with perfectionism, scrupulosity, anxiety, depression, and shame.[27]

Beyond legalism on the continuum in figure 8.1 is scrupulosity, a legalistic mindset combined with extreme dysfunction in the form of OCD’s obsessions and compulsions. Indeed, in the case of scrupulosity, legalism is focused on marking off checklists to satisfy specific obsessional issues rather than seeking to live according to broader religious principles. Researchers found that scrupulosity mediated links between legalism and guilt and legalism and shame. They suggested, “The guilt and shame that LDS individuals may experience are mediated through the fear of not being good enough when their relationship with God is based on the need to please God through one’s own power, rather than on the reliance and receiving of God’s grace.”[28]

Interestingly, as seen in figure 8.4, you might want to consider that as these views shift along the continuum, so do one’s views of the nature of God or his character.

Figure 8.4. Views of salvation continuum overlaid with one’s view of God’s nature from that perspective

Cheap grace, legalism, and scrupulosity eclipse[29] one’s view of heaven and the nature of God in one’s life and eternal journey. These perspectives distort, corrupt, and obscure beautiful religious truths and hinder mental health. However, the concept of costly grace and the belief in God’s justice and mercy can be insulators against mental health concerns such as anxiety and scrupulosity.

The Concept of Faith

Part of a healthy religious practice is to accept the concept of faith.[30] By definition, faith means to have a “strong belief in God or in the doctrines of a religion, based on spiritual apprehension rather than proof.”[31] It wholly embraces uncertainty. There is no sensory knowledge or empirical proof—and religious believers overtly accept that premise. In the Bible a father was told by Jesus Christ that his son could be healed if the father believed. “And straightway the father of the child cried out, and said with tears, Lord, I believe; help thou mine unbelief.”[32] For members of The Church of Jesus Christ of Latter-day Saints, faith in the Lord Jesus Christ is known as the first principle of the gospel.[33] The Lectures on Faith states that “the plan of salvation . . . was a system of faith—it begins with faith, and continues by faith; and every blessing which is obtained in relation to it is the effect of faith, whether it pertains to this life or that which is to come. To this all the revelations of God bear witness.”[34]

Anxiety does not tolerate this basic premise of faith. The compulsive “nature of anxiety . . . leads you to feel when you have questions or concerns about your religious belief that faith by itself is not acceptable—you must have knowledge or certainty to make a final decision about your faith right now.”[35] While anxiety demands an answer, the confusion it causes prevents you from being able to identify a solution. In addition to confusion, scrupulosity also has a severe intolerance for uncertainty. It provokes fear of the unknown and negatively biased, persistent thoughts about the unknown.[36] This focus actually increases anxiety. One client described this uncertainty to his mother in an email:

How have you found certainty that everything works out in the end? I’m over here terrified of what happens after I die and I can’t find any way of calming myself down. Maybe I’ll have earned some kind of hell, maybe everyone goes to hell for no reason, maybe there’s nothing, maybe I go to heaven and then wake up one day in hell for no reason, maybe this is hell. I just want peace and I can’t find it. I’m trying to be more spiritual, and I’ve been going through the gospel library app, but everything there either makes me more terrified, or does nothing to make me feel better. I’m really scared and depressed and I don’t know what to do.

In Martin Luther’s struggle with faith, he also talked about uncertainty:

When I was a monk, I made a great effort to live according to the requirements of the monastic rule. I made a practice of confessing and reciting all my sins, but always with prior contrition; I went to confession frequently, and I performed the assigned penances faithfully. Nevertheless, my conscience could never achieve certainty but was always in doubt and said: “You have not done this correctly. You were not contrite enough. You omitted this in your confession.” Therefore, the longer I tried to heal my uncertain, weak, and troubled conscience with human traditions, the more uncertain, weak, and troubled I continually made it. In this way, by observing human traditions, I transgressed them even more; and by following the righteousness of the monastic order, I was never able to reach it.[37]

Perfectionism

Perfectionism[38] can be both adaptive and maladaptive.[39] Adaptive perfectionists are hard workers who set high goals for themselves, but they are flexible and adjust when needed. Failure to meet their standards results in adaptive behavior, such as engaging their problem directly, trying again, readjusting standards, working harder, or simply accepting the situation.[40] Or if they do struggle when they fail to meet those standards,[41] they may be disappointed but can work through the situation, create greater flexibility in their thinking, and resiliently move forward. Indeed, researchers have found that working to meet high standards is associated with higher self-esteem and life satisfaction.[42]

Maladaptive or toxic perfectionism, however, is an undesirable, pathological type of perfectionism. Researchers studying university students who were members of The Church of Jesus Christ of Latter-day Saints found that maladaptive perfectionism was positively correlated with scrupulosity (meaning higher perfectionism was correlated with higher scrupulosity) but adaptive perfectionism was not.[43] Often people become trapped by their frantic efforts to meet their high standards with an error-free performance. They often have “the tendency to believe there is a perfect solution to every problem, that doing something perfectly (i.e., mistake free) is not only possible, but also necessary, and that even minor mistakes will have serious consequences.”[44] These people are generally very loyal to God and committed to keeping his commandments and trying to perfectly follow him, but when they fail to meet their own unattainably high standards they are overcome by anxiety, panic, and obsessive rumination about their perceived failures. Instead of actively engaging their problems, negative perfectionists tend to avoid them.[45] Negative perfectionism is associated with categorical thinking (the tendency to view the world in black-or-white terms) and intolerance and distrust of others.[46] One researcher explained, “The perfectionist paradigm typically combines unrealistic expectations with an unhealthy preoccupation with faults, weaknesses, mistakes, and sins. . . . Fear of failure is a constant concern. Though it is correlated with conscientiousness, perfectionism goes far beyond diligent effort and ‘demand[s] absolute perfection from the self.’ Perfectionists tend to engage in an unrelenting quest for flawlessness and berate themselves or others for falling short of this impossible standard.”[47] This researcher summarized, “Thus the problem with perfectionism is not high expectations; it is neurotic expectations that are unrealistic and oppressive.”[48]

Maladaptive or toxic perfectionism is in large part defined by a feeling of discrepancy, the feeling that one is never good enough. Discrepancy has been associated with guilt and shame.[49] One author explained, “We are not good enough for ourselves because we don’t fit with our own image of perfection. We cannot forgive ourselves for not being what we wish to be, or rather what we believe we should be. We cannot forgive ourselves for not being perfect.”[50] Yet Elder Jeffrey R. Holland taught, “I would hope we could pursue personal improvement in a way that doesn’t include getting ulcers or anorexia, feeling depressed or demolishing our self-esteem. That is not what the Lord wants. . . . My brothers and sisters, except for Jesus, there have been no flawless performances on this earthly journey we are pursuing, so while in mortality let’s strive for steady improvement without obsessing over what behavioral scientists call ‘toxic perfectionism.’”[51]

Toxic perfectionism can also be driven by misconception of religious doctrine. In the Bible, Jesus Christ taught, “Be ye therefore perfect, even as your Father which is in heaven is perfect.”[52] Christians struggling with toxic perfectionism may have their (imperfect) efforts to live an error-free performance devastated by this scripture. President Russell M. Nelson sought to clarify this doctrine for suffering Christians while giving encouragement:

In Matthew 5:48, the term perfect . . . means “to reach a distant end, to be fully developed, to consummate, or to finish.” Please note that the word does not imply “freedom from error”; it implies “achieving a distant objective.”

With that background in mind, let us consider another highly significant statement made by the Lord. Just prior to his crucifixion, he said that on “the third day I shall be perfected.” Think of that! The sinless, errorless Lord—already perfect by our mortal standards—proclaimed his own state of perfection yet to be in the future. His eternal perfection would follow his resurrection and receipt of “all power . . . in heaven and in earth.”

We need not be dismayed if our earnest efforts toward perfection now seem so arduous and endless. Perfection is pending. It can come in full only after the Resurrection and only through the Lord.[53]

Adaptive Guilt Versus Toxic Guilt

Guilt can be healthy or unhealthy. In scrupulosity, misconceptions about perfectionism, as well as other religious doctrines, may contribute to higher levels of toxic guilt.

In the healthy practice of many religious faiths there are times, appropriately so, when parishioners experience guilt. “Guilt has been defined . . . as a disagreeable emotional condition associated with transgression of personal rules, morals, or mores. By this definition, guilt may resolve with reparation, restitution, and forgiveness.”[54] The Bible Dictionary of The Church of Jesus Christ of Latter-day Saints defines guilt as “the condition of having done wrong, or the feelings of regret and sorrow that should accompany sin.”[55] Adaptive guilt, or healthy guilt, is considered normal[56] and serves to inform us when we have truly mistreated another or violated a personal or religious standard for which rectification is appropriate.[57] For example, in the Book of Mormon the prophet Alma states, “Only let your sins trouble you, with that trouble which shall bring you down unto repentance.”[58]

However, in scrupulosity OCD, guilt becomes obsessive and toxic because it’s pathological. It is an over-assumption of responsibility and blame regarding things for which you are not responsible. It’s not based on a need to truly repent because of sin. In fact, it “has no functional purpose or any useful outcome.”[59] It drives you to seek certainty over normally occurring incidents, “for which rectification is neither necessary nor appropriate.” This means you may be feeling compelled by your guilt to “fix things that aren’t broken.”[60] It is an OCD symptom, not an indicator of insufficient morality.

Researchers identified fourteen different studies examining toxic or pathological guilt in OCD. They found that guilt plays a substantial role in OCD (not only in scrupulosity but in other OCD forms as well).[61] Here they discuss the relationship between compulsions and guilt: “Scrupulous rituals serve the opposite function of their intended purpose. Scrupulous rituals are driven not only by an obsessive need for certainty, to achieve a state of perfection, and to feel ‘right,’ but also to allay guilt caused by an obsession that violated the literal ‘letter’ of the religious law (i.e., a blasphemous thought). As a result, the ‘spirit’ of the religious law—that one is forgiven for (unintended) transgressions—becomes lost on the sufferer who is not able to experience the intended restorative benefit the ritual was created to provide.”[62] A maxim I often share with clients particularly struggling with maladaptive guilt is to save guilt for sin.

Confession in Scrupulosity—a Compulsive Ritual

Toxic guilt often prompts a person to offer confession. Confession motivated by a desire to reduce obsessive-compulsive anxiety, rather than to benefit from true godly sorrow, becomes a destructive compulsion. There are three ways that I have seen my scrupulous clients engage in compulsive confession: informal and formal confession, oversharing of scrupulous obsessional details, and obsessive apologizing.

Compulsive informal and formal confession

In religious tradition, confession can be formally offered to a religious authority or informally done in personal prayer as previously discussed in chapter 7. One Catholic author wrote that confession of sin “is a straightforward requirement; yet the scrupulous can make it very complicated. The Church requires only a good confession, not a perfect one. A perfect confession is not humanly possible; only God is capable of perfectly describing and enumerating sins.”[63] This author also clarified that “the reason God forgives us is not for being able to recall with meticulous accuracy all the details of our sins. . . . God forgives us because we are sorry for having committed sins.”[64]

Compulsive personal prayer confessions are often kept private, and the person may have poor insight about the dysfunctionality of the behavior. Due to the nature of compulsive prayer and confession, people suffering from scrupulosity may pray for hours a day but generally don’t feel peace or greater intimacy with Deity. Typically they feel desperate, and the desperation only grows with the lengthier prayers or confessions. One person commented that his prayers were “repetitive” and that he was “always just begging” for forgiveness all the time.

Compulsive formal confession to an ecclesiastical authority is often more easily recognizable as problematic. Martin Luther compulsively confessed, often daily. He confessed for as long as six hours on one occasion.[65] Luther confessed most often to Johannes von Staupitz, the vicar of the Augustinian order: “I often made confession to Staupitz. . . . He said, ‘I don’t understand you.’ This was real consolation! Afterward when I went to another confessor I had the same experience. In short, no confessor wanted to have anything to do with me. Then I thought, ‘Nobody has this temptation but you,’ and I became as dead as a corpse.”[66]

One way to discern the presence of scrupulosity is to ask other people in the same faith community if they have the same concerns or live in the same way as does the scrupulous individual. Luther’s first-person account provides strong evidence for his scrupulosity diagnosis; his ecclesiastical leaders not only didn’t think there was a legitimate spiritual problem, but they were basically ejecting him from confession. Luther wrote, “Sometimes my confessor said to me when I repeatedly discussed silly sins with him, ‘You are a fool.’”[67] In fact, Father Staupitz became frustrated with Luther and once cried, “If you expect Christ to forgive you, come in with something to forgive—parricide [the killing of a parent or other near relative], blasphemy, adultery—instead of all these little peccadilloes [a small, relatively unimportant offense or sin].”[68]

This feedback did not ease Luther’s anxieties. This is because, as we’ve discussed, reassurance does not work, even when the reassurance comes by those who are in religious authority. If you get the reassurance you seek, you don’t believe it anyway or you don’t believe it for very long. Some researchers asserted that those with scrupulosity are “almost completely unresponsive to authoritative assurances.”[69] Another writer, in describing how scrupulosity impacts the sufferer, indicated that “the scrupulous person . . . tends to be mistrustful of himself and of others—including the many confessors he has ‘tried’—and to cling to one conviction, that of his own sinfulness.”[70] Truly it is the case that those struggling with scrupulosity “do not find reassurance through the normal means available to them.”[71]

A contemporary example comes from a young man who struggled with scrupulosity as he began serving as a missionary for The Church of Jesus Christ of Latter-day Saints. He described what happened when he was in training in the Missionary Training Center (MTC).

Over the course of six weeks, I met with the branch president at the MTC and confessed six times. I always remembered more—more times when I had [listed perceived sins]. . . . At one point in the MTC, I emailed my dad, asking if I needed to confess yet another past “sin” that I had thought of. When he told me that I hadn’t done anything wrong, it didn’t bring me relief. Instead, I took it as a sign that Satan was using my family’s mercy to lull me into complacency. I grew convinced that I would have to endure alone. . . . And I confessed again.[72]

Confession is such a problematic area for those with scrupulosity, the draw to confess so compelling. One more story illustrates the utter futility of compulsive confession:

I constantly have thoughts that I did something immoral, or sinned, every single day. I constantly obsess, argue, play over, justify, try to ignore, try to forget, and try to get rid of thoughts about past sins and mistakes in my head. I would constantly go in and confess to priesthood authority about past mistakes and sometimes about little things that I thought were sins. I continued to confess over and over again to the point where I was confessing almost every week. Before confessing each time, my mind told me it was the last thing, but it was a lie, it was never the last time. Afterwards a different thing or detail would pop up and it would start all over again. I just want to be happy. But my mind won’t leave me alone. I feel like I can’t be happy, return to God, or receive forgiveness until I confess to others. I don’t know if the right thing to do is to confess more or if it is actually an OCD/scrupulosity problem that I need to overcome. I struggle to see light and hope for the future.[73]

When confession has been driven by toxic anxiety, some people may be concerned that their church leader might not have fully understood their confession, didn’t ask enough questions to elicit certain details, or was perhaps going too easy on them. One client exhibited this tendency: “I was also stuck with not being able to know if the bishop and stake president, or whoever I confessed to, had completely understood my confession. That is why I continued to describe my confessions to them. I would often ‘overconfess’ just to make sure that I got everything off of my chest and that they understood the gravity of my wrong actions.” In the Catechism of the Council of Trent, Catholics were counseled, “Should the confession seem defective, either because the penitent forgot some grievous sins, or because, although intent on confessing all his sins, he did not examine the recesses of his conscience with sufficient accuracy, he is not bound to repeat his confession.”[74]

A church leader (bishop, priest, imam, or rabbi) has stewardship for your spiritual welfare. Yet toxic anxiety does not respect the role of your ecclesiastical leader in your spiritual life or respect your religious leader’s ability to discern your worthiness or receive revelation on your behalf. Generally, it won’t even consider it. It will always lay full responsibility for your spiritual standing before God squarely on your shoulders. Even if you (insert any scrupulous worry here, such as leaving out a detail in your confession), do you trust that the Holy Spirit, the Spirit of Truth, knows the status of your heart and can give revelation to your ecclesiastical leader about your penitence or worthiness?

If you feel the urge to confess the same issues again, in most cases that is being driven by anxiety, and not by religious sensitivities. Elder Richard G. Scott taught, “I testify that when a bishop or stake president has confirmed that your repentance is sufficient, know that your obedience has allowed the Atonement of Jesus Christ to satisfy the demands of justice for the laws you have broken. Therefore you are now free. Please believe it. To continually suffer the distressing effects of sin after adequate repentance, while not intended, is to deny the efficacy of the Savior’s Atonement in your behalf.”[75]

When people recognize the toxic pattern of repeated confessions in their religious devotion, they would do well to get the mental health help they need by choosing to meet with a therapist. Religious clergy who identify this type of toxic, compulsive confession in a parishioner would also do well to encourage him or her to visit with a trained and competent mental health professional. This is because anxiety-driven confessions are a mental health issue and not rooted in spiritual shortcomings of the person. Clergy are essential for spiritual guidance, but mental health professionals are essential for mental health treatment. Elder Alexander B. Morrison taught, “We must understand . . . that ecclesiastical leaders are spiritual leaders and not mental health professionals. Most of them lack the professional skills and training to deal effectively with deep-seated mental illnesses and are well advised to seek competent professional assistance for those in their charge who are in need of it.”[76]

So when anxiety peaks and you are struggling with urges to return to a church leader to just clarify something, or to share just one more detail, or to get reassurance that you are okay in the eyes of the Lord, the best thing to do is to not do it. By resisting that urge to confess repeatedly, you can learn to avoid succumbing to the obsessive-compulsive cycle. In time the thoughts may no longer be a trigger for anxiety and inappropriate guilt (or if they are still a trigger, the anxiety level may be significantly reduced), allowing you to finally find the clarity and peace that can be felt by genuinely and properly interpreting promptings from the Holy Spirit. In the Bible, Jesus Christ says, “Peace I leave with you, my peace I give unto you: not as the world giveth, give I unto you. Let not your heart be troubled, neither let it be afraid.”[77]

Compulsive confession is also quite frequently done using a spouse, a partner, or parent as a confessor. This can be particularly problematic. These types of confessions do not reduce pain—they share it! One client, a married man in his early thirties, fell prey to this compulsion before beginning his work with me. Every conversation with his wife was laced with his confessions of one kind or another. His wife’s description of the situation shows the deep-seated and insidious nature of her husband’s habit of compulsive confession:

After we were married and he told me about his past with pornography, we immediately started seeing a counselor together. This is when he was taught to “check in” with me to “hold himself accountable.” This turned into “confessing” every single thought that came into his head, all day. I can see how this fueled the development of scrupulosity and it was very painful for me to listen to all day, but we honestly thought this was “part of therapy” to help the problem. Obviously, five years later we now know it did not help at all and actually made things worse.

He would call me telling me things like he thought he looked down someone’s shirt or that he looked at a girl too long or that he had to work with a girl during class and thought it was inappropriate. Then it turned into having to go back and tell me every sin he has ever done from before we met that he “forgot” about. Then it turned into having to go confess things to the bishop. Then he started telling me about how we did things (we didn’t do) when we were dating and how we needed to go confess them two years after we were married. Over time it turned into worse and more descriptive “sins.” . . . When his last therapist told him he should be able to “be honest and be able to talk with his wife about everything,” he took that VERY literally. It’s the worst it has ever been.[78]

The husband described his long struggle before he overmastered this fearsome aspect of his scrupulosity:

I had the fear of being a liar and unfaithful to my wife. I worried about every hug I gave, every thought I had, everything I said to anyone of the opposite sex. I was so scared to even talk to coworkers of the opposite sex. In my mind, the only way to be honest with my wife was to confess and to confess everything—every thought, every hug, and every conversation. The more I confessed, the more I spiraled into confessing more frequently. It wasn’t just daily, or hourly, but confessing became constant. It was so mentally and physically draining that I could barely focus at work or at home with my family.

All these confessions never helped me and actually damaged my relationship with my wife. Each time I confessed to her it was like I was breathing a poisonous gas into the air that she had to breathe in too. It nearly destroyed our marriage. It got to the point that my wife begged me to stop, and I couldn’t. I had lost all self-confidence and completely relied on her for validation and reassurance.

Fortunately, I was able to overcome confessing to my wife. Each day that I didn’t confess I felt more and more capable. I began to trust myself more and more. I reclaimed my life. I reclaimed my relationship with my wife. I went from chronically confessing every day for years, to completely stopping in less than a month. Most days I don’t even have the thought to confess anymore.

Compulsive oversharing

I consider oversharing of scrupulous obsessional details to also be a form of compulsive confession. This type of information can be tremendously damaging to relationships—particularly if the person you are sharing with does not have the scrupulosity know-how to take some of OCD’s horrific details in stride—especially when the content is sexual, violent, or blasphemous in nature. Another client, a married man in his mid-twenties, shared his insights:

Scrupulosity often appears to the outside world as sinful, disgusting, and immoral. When you openly share scrupulous struggles, it is like inviting someone to pick at a scab before healing has taken effect. The person viewing the scab may say “yes, that is ugly, let’s get rid of it” and then rip the scab off before allowing the scab to fully heal. Sadly, when this happens, healing is delayed and the scrupulous behaviors become more intense. Inviting others to view and remove your scrupulosity “scabs” will only hurt and delay your recovery. Scrupulosity should be handled discreetly and privately with the expertise of a mental health expert who knows best the unique therapy needed for recovery.

Compulsive apologizing

Compulsive apologizing may also be considered a form of compulsive confession. A healthy apology is in response to healthy or adaptive guilt, when you have truly done something to wrong another and you are trying to make amends. If you have succumbed to compulsive apologizing, what may have originally been genuine remorse gets lost to obsessive-compulsive priorities: seeking for certainty and reassurance.

There is a difference between healthy apology and compulsive apologizing. [79] A healthy apology will be given once as a clear, honest, and direct expression of your remorse for a specific problem. On the other hand, compulsive apologizing is offering repeated apologies as you seek to feel right,obtain reassurance, and gain certainty. The genuine nature of the intended apology is lost to these compulsive processes, and the apologizing is rendered ineffective.

If you find yourself getting your “reassurance fix”[80] through any of these three compulsive styles of confession, unless you “utterly refuse” (as one of my clients would say) to engage in the compulsion, you will continue to be driven to confess again and again and again since the urge to confess is not driven by a genuine prompting from the Holy Ghost or your own upright moral compass, but by toxic anxiety. Ignatius of Loyola recorded, “Although I made confession, there still remained some things which I thought I had not confessed. After confessing, my scruples returned, each time becoming more minute, so that I became quite upset. Although I knew that these scruples were doing me much harm and that it would be good to be rid of them, I could not shake them off.”[81]

St. Thérèse, who began suffering with scrupulosity in childhood, describes just how temporarily she felt the relief of compulsive confession. During a difficult period, she relied particularly on her older sister for reassurance: “I had no peace till I had told Marie everything.” Yet she acknowledged, “This was most painful, since I imagined I was obliged to tell absolutely all my thoughts, even the most extravagant. As soon as I had unburdened myself I felt a momentary peace, but it passed like a [lightning] flash, and my martyrdom began again.”[82]

If you find yourself on the other end of the compulsive cycle—you are the parent, sibling, friend, therapist, or religious authority—please remember the futility of offering reassurance for those suffering with scrupulosity. An ultraorthodox Jewish rabbi wrote that if you offer reassurance, its effect is often temporary because the individual is “assailed by further thoughts or finds some rationale for rejecting the response, and so a new request for reassurance is made.”[83]

The Repentance Process in Scrupulosity “Doesn’t Work”

Confession is a legitimate religious doctrine, and many believers can testify to its cleansing power to help them heal spiritually and grow closer to the Divine. The above examples show how the process of confession can fail to work for you as it should when it becomes corrupted by toxic anxiety. A genuine repentance process will always work when one goes to God in penitent contrition for legitimate sin, but for those with scrupulosity, the anxiety corrupts one’s ability to feel the forgiveness God offers.

In the Book of Mormon, Alma the Younger was legitimately what we may, in today’s vernacular, call a “bad guy” in his earlier years. Later in his life, after his repentance and work in the church, he described his wicked history. He indicated that he and his friends, the sons of Mosiah, “went forth even in wrath, with mighty threatenings to destroy [the Lord’s] church.”[84] His was a work of “destruction.”[85] Alma recalled how he was later confronted by an angel:

I was racked with eternal torment, for my soul was harrowed up to the greatest degree and racked with all my sins.

Yea, I did remember all my sins and iniquities, for which I was tormented with the pains of hell; yea, I saw that I had rebelled against my God, and that I had not kept his holy commandments.

Yea, I had murdered many of his children, or rather led them away unto destruction; yea, and in fine so great had been my iniquities, that the very thought of coming into the presence of my God did rack my soul with inexpressible horror.

Oh, thought I, that I could be banished and become extinct both soul and body, that I might not be brought to stand in the presence of my God, to be judged of my deeds.

And now, for three days and for three nights was I racked, even with the pains of a damned soul.[86]

So what happened to Alma? His tortured soul was relieved upon receiving Christ and seeking forgiveness:

O Jesus, thou Son of God, have mercy on me, who am in the gall of bitterness, and am encircled about by the everlasting chains of death.

And now, behold, when I thought this, I could remember my pains no more; yea, I was harrowed up by the memory of my sins no more.

And oh, what joy, and what marvelous light I did behold; yea, my soul was filled with joy as exceeding as was my pain!

Yea, I say unto you . . . that there could be nothing so exquisite and so bitter as were my pains. Yea, and again I say unto you . . . that on the other hand, there can be nothing so exquisite and sweet as was my joy.

Yea, methought I saw . . . God sitting upon his throne, surrounded with numberless concourses of angels, in the attitude of singing and praising their God; yea, and my soul did long to be there.[87]

On a different occasion, Alma summed up his earlier struggle in these terms: “I did cry out unto the Lord Jesus Christ for mercy, . . . and I did find peace to my soul.”[88]

During his torture of soul, Alma longed to be extinct and feared to face God. When he received Jesus Christ and repented, light, peace, and hope filled him just as fully as the previous terror had filled him. So much so, that he then longed to be with God. What a dramatic 180-degree turnaround! And yet, that is how the religious doctrine of repentance works when toxic anxiety isn’t hijacking or corrupting its healing influence. Although those with scrupulosity feel all the terror of a damned soul, they can’t seem to experience the soul-elevating relief of a saved soul. One person shared this: “I didn’t have the judgment at the time to know what was really happening—all I knew is I felt horrible and couldn’t feel better. I didn’t know what to do and I was totally stuck. ‘Repenting’ wasn’t working.”

Guilt over our (legitimate) sin and feeling the need to repent is of the Spirit, not driven by anxiety. Sure, there may be some nervousness knowing that you will need to humble yourself and confess to the injured party or to an ecclesiastical leader (if appropriate), but generally the Spirit will bless you with a clarity and a calmness of mind so you will know what you need to do to repent. Scrupulosity, however, is driven by anxiety. There may be intense pressure. You may feel chaotic. You may have that frantic sense of confusion and being overwhelmed. It may get progressively worse and expand to other areas of concern. The person quoted above continued: “I’ve come to feel the difference between the Spirit gently whispering to me when I have actually sinned and when a correction is needed versus the relentless anxiety that led me to obsess about every tiny mistake and to try to be absolutely perfect in every detail. I’ve learned how to repent in a productive and cleansing way when I sin instead of the compulsive, repetitive, futile ‘repentance’ I was driven to in the past.”

When Attending Church Is So Painful

In chapter 6, I talked about safety behaviors. Avoidance of, or escape from, an anxiety-provoking situation constitutes a safety behavior. Avoidance will have a direct effect on anxiety (hint: it reinforces anxiety). In addition, avoidance is problematic because it may limit your ability to cope by reducing other resources that can be helpful to you. For example, in scrupulosity (and other disorders such as social anxiety), some people who are distressed by church choose the avoidance route and stop participating in their public church worship meetings or their personal worship activities (such as prayer or scripture study). One of my clients at the beginning of her therapy process tearfully said it would “just be easier to tap out and be a good person.” Others may think they should stop going to church because their anxiety deceitfully tells them that since they are struggling, they are hypocrites for attending worship services.

But by not going to church, they’ve abandoned a resource that offers various helps to them. One client shared this experience:

Recently I told a friend briefly about my experience with scrupulosity. Afterwards he asked me, “For someone who has every reason to leave the church, why did you stay?” I realize now that the church, or my testimony, or the gospel is not the problem. Anxiety is the problem. As I continue to learn how to separate my feelings of anxiety from the content that surrounds my anxiety (which is usually centered around the gospel), I am then able to recognize both the anxiety I feel and the gospel of Jesus Christ individually for what they really are. I realized that I don’t have every reason to leave the church, but I do have every reason to stay, because when unobscured by anxiety, the gospel is a message of pure hope and joy that I would never want to live without.

Indeed, research has shown positive benefits from religion. There is a positive association between religious commitment and overall well-being. There are negative associations between religious commitment and psychopathology (a negative association means they relate to each other by going in the opposite direction from each other), so people who are highly religiously committed will generally have lower mental health issues. Those using positive religious coping techniques (such as benevolent religious reappraisals, religious forgiveness or purification, and seeking religious support) report improved health and mental health outcomes.[89]

So those who show religious commitment can be more resilient and enjoy better mental health because of their use of religious coping. Unlike the maladaptive coping of safety behaviors that will make your anxiety worse, religious commitment is healthy and adaptive. If your religious faith and participation are causing you distress, seek the mental health treatment you need so you can more fully access the mental health boosting aspects of religious involvement. I am not suggesting white-knuckling your way through your religious participation, continuing to just suffer in pain—treatment can help you learn to engage religiously utilizing therapeutic principles that will, in time, make your participation less painful and, in time, even allow you to find solace and joy in your worship.

Notes

[1] Siev, J., Rasmussen, J., Sullivan, A. D. W., & Wilhelm, S. (2021). Clinical features of scrupulosity: Associated symptoms and comorbidity. Journal of Clinical Psychology, 77(1), 174. https://doi.org/10.1002/jclp.23019

[2] McClendon, D. T. (September 2019). Understanding scrupulosity (religious OCD). Ensign, online content only. https://www.churchofjesuschrist.org/study/ensign/2019/09/young-adults/understanding-scrupulosity-religious-ocd. Slightly edited for clarity.

[3] Summers, J. S., Sinnott-Armstrong, W. (2019). Clean hands? Philosophical lessons from scrupulosity. Oxford University Press, 78. (Capitalization in quotation standardized.)

[4] Summers & Sinnott-Armstrong, 2019. Clean Hands?, 86–91.

[5] Bell, J. (2007). Rewind, replay, repeat: A memoir of obsessive-compulsive disorder. Hazelden, 289.

[6] Abramowitz, J. S., & Hellberg, S. N. (2020). Scrupulosity. In E. A. Storch, D. McKay, & J. S. Abramowitz (Eds.), Advanced casebook of obsessive-compulsive and related disorders: Conceptualizations and treatment (pp. 71–87). Academic Press/Elsevier, 82. https://doi.org/10.1016/B978-0-12-816563-8.00005-X

[7] Greenberg, D. (1984). Are religious compulsions religious or compulsive? A phenomenological study. American Journal of Psychotherapy, 38(4), 524–532. https://doi.org/10.1176/appi.psychotherapy.1984.38.4.524

[8] Greenberg, D., & Huppert, J. D. (2010). Scrupulosity: A unique subtype of obsessive-compulsive disorder. Current Psychiatry Reports, 12, 286.

[9] Abramowitz, J. S., & Jacoby, R. J. (2014). Scrupulosity: A cognitive-behavioral analysis and implications for treatment. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 140–149.

[10] Abramowitz & Jacoby, 2014. Scrupulosity: A cognitive-behavioral analysis and implications for treatment, 140–149.

[11] Shapiro, L. J., & Steward, S. E. (2011). Pathological guilt: A persistent yet overlooked treatment factor in obsessive-compulsive disorder, Annals of Clinical Psychiatry, 23, 68.

[12] Greenberg, D., & Shefler, G. (2008). Ultra-orthodox rabbinic responses to religious obsessive- compulsive disorder. Israel Journal of Psychiatry and Related Sciences, 45(3), 183–192.

[13] Schwartz, J. M., & Beyette, B. (1996). Brain lock: Free yourself from obsessive-compulsive behavior. HarperPerennial, 43.

[14] McClendon, 2019. Understanding scrupulosity.

[15] Client work, used with permission.

[16] Some nontheistic (i.e., no belief in God) religions include Hinduism, Buddhism, and Jainism. Additionally, in some polytheistic belief systems (i.e., belief in many Gods), dystheism is a belief that a god is not good and may even be evil (such as in a trickster god). Misotheism. (n.d.). In Wikipedia. https://en.wikipedia.org/wiki/Misotheism

[17] Exodus 34:6–7, The Jewish bible with a modern English translation and Rashi’s commentary (The Judaica). https://www.chabad.org/library/bible_cdo/aid/9895/jewish/Chapter-34.htm

[18] Isaiah 54:10.

[19] Jeremiah 29:11.

[20] Quʾran 3:159–60.

[21] Horwitz, B., Littman, R., Greenberg, D., & Huppert, J. D. (2019). A qualitative analysis of contemporary ultra-orthodox rabbinical perspectives on scrupulosity. Mental Health, Religion & Culture, 22, 87. https://doi.org/10.1080/13674676.2019.1585778

[22] Siev, J., Baer, L., & Minichiello, W. E. (2011). Obsessive‐compulsive disorder with predominantly scrupulous symptoms: Clinical and religious characteristics. Journal of Clinical Psychology, 67, 1188–1196. https://doi.org/10.1002/jclp.20843

[23] Myers, S. G., Pirutinsky, S., & Rosmarin, D. H. (2021). Implicit and explicit beliefs about God and scrupulosity symptoms: A prospective study. Journal of Obsessive-Compulsive and Related Disorders, 28, 1–6.

[24] Bonhoeffer, D. (1995). The Cost of Discipleship. Touchstone, 44–45. As cited in Judd, D. K. (2016). Clinical and pastoral implications of the ministry of Martin Luther and the Protestant reformation. Open Theology, 2, 332.

[25] Bonhoeffer, 1995. The Cost of Discipleship, 44–45.

[26] Judd, D. K., Dyer, W. J., & Top, J. B. (2018). Grace, legalism, and mental health: Examining direct and mediating relationships. Psychology of Religion and Spirituality, 12. Advance online publication. https://doi.org/10.1037/re10000211.

[27] Allen, G. E. K., Wang, K. T., & Stokes, H. (2015): Examining legalism, scrupulosity, family perfectionism, and psychological adjustment among LDS individuals. Mental Health, Religion & Culture, 18(4), 246–258. https://doi.org/10.1080/13674676.2015.1021312

[28] Allen et al., 2015, Examining legalism, scrupulosity, family perfectionism, and psychological adjustment.

[29] Stevenson, G. E. (2017, November). Spiritual eclipse. The Church of Jesus Christ of Latter-day Saints, 45. https://www.churchofjesuschrist.org/study/general-conference/2017/10/spiritual-eclipse

[30] Based on McClendon, D. T. (2020, September 5). Anxiety and belief: 5 principles of faith to help you prevent your doubts from becoming a faith crisis. LDS Living. https://www.ldsliving.com/anxiety-and-belief-5-principles-of-faith-to-help-you-prevent-your-doubts-from-becoming-a-faith-crisis/s/93260

[31] Google Dictionary, s.v. “faith.” https://www.google.com

[32] Mark 9:23–24.

[33] Articles of Faith 1:4.

[34] Smith, J. (1985). Lectures on faith. Deseret Book, 1985, 80.

[35] McClendon, 2020. Anxiety and belief, 12.

[36] Carleton, R. N. (2012, August). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics, 12(8), 937–947.

[37] Luther, M. (1999). Lectures on Galatians 1535: Chapters 5–6; 1519: Chapters 1–6. In J. J. Pelikan (Ed.). (1999). Luther’s works (Vol. 27). Concordia Publishing House, 13.

[38] See discussion in McClendon, D. T. (2021, June). A church educator’s guide to identifying and helping the scrupulous student. Religious Educator, 22(2), 138–140.

[39] Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence, challenges. Personality and Social Psychology Review, 10(4), 295–319.

[40] Fedewa, B. A., Burns, L. R., & Gomez, A. A. (2005). Positive and negative perfectionism and the shame/guilt distinction: Adaptive and maladaptive characteristics. Personality and Individual Differences, 38(7), 1609–1619.

[41] Craig, M. D. (2018, November). Divine discontent. Ensign.

https://www.churchofjesuschrist.org/study/general-conference/2018/10/divine-discontent

[42] Allen, G. E. K., & Wang, K. T. (2014). Examining aspects of religiosity, perfectionism, scrupulosity, and well-being among LDS individuals. Psychology of Religion and Spirituality,6(3), 257–64. Advance online publication. http://dx.doi.org/10.1037/a0035197

[43] Allen & Wang, 2014. Aspects of religiosity, perfectionism, scrupulosity, and well-being among LDS individuals, 257–64; Allen, G. E. K., Norton, A., Pulsipher, S., Johnson, D., & Bunker, B. (2021, August 5). I worry that I am almost perfect! Examining relationships among perfectionism, scrupulosity, intrinsic spirituality, and psychological well-being among Latter-day Saints. Spirituality in Clinical Practice. Advance online publication. http://dx.doi.org/10.1037/scp0000273

[44] Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 678.

[45] Fedewa, B. A., Burns, L. R., & Gomez, A. A. (2005). Positive and negative perfectionism and the shame/guilt distinction, 1609–1619.

[46] Fedewa et al., 2005. Positive and negative perfectionism, 1609–1619.

[47] Rau, A. D. (2011). “Be ye therefore perfect”: Beyond the perfectionist paradigm. Religious Educator,12(3), 38.

[48] Rau, 2011. Beyond the perfectionist paradigm, 38.

[49] Fedewa, B. A. et al. (2005). Positive and negative perfectionism and the shame/guilt distinction, 1609–619; Rice, K. G., & Slaney, R. B. (2002). Clusters of perfectionists: Two studies of emotional adjustment and academic achievement. Measurement and Evaluation in Counseling and Development, 35(1), 35–48.

[50] Ruiz, D. M., & Mills, J. (2010). The four agreements: A practical guide to personal freedom. Amber-Allen Publishing, 18.

[51] Holland, J. R. (2017, November). Be ye therefore perfect—eventually. Ensign. https://www.lds.org/general-conference/2017/10/be-ye-therefore-perfect-eventually. This is basically an anti-OCD talk. I would recommend reading the entire talk for those interested.

[52] Matthew 5:48.

[53] Nelson, R. M. (1995, November). Perfection pending. Ensign, 88.https://www.churchofjesuschrist.org/study/general-conference/1995/10/perfection-pending

[54] Shapiro and Steward, 2011. Pathological guilt, 64.

[55] The Church of Jesus Christ of Latter-day Saints. (n.d.). Guilt. In Bible dictionary. https://www.churchofjesuschrist.org/study/scriptures/gs/guilt

[56] Shapiro, L. J. (2015). Understanding OCD: Skills to control the conscience and outsmart obsessive compulsive disorder. Praeger, 16.

[57] Shapiro and Steward, 2011. Pathological guilt, 67–68.

[58] Alma 42:29.

[59] Shapiro, 2015. Understanding OCD, 13.

[60] Shapiro, 2015. Understanding OCD, 98.

[61] Shapiro and Steward, 2011. Pathological guilt, 69.

[62] Shapiro and Steward, 2011. Pathological guilt, 68.

[63] Beattie, T. (2011). Scruples and Sainthood: Accepting and overcoming scruples with the help of the saints. Loreto Publications, 107.

[64] Beattie, T. (2011). Scruples and Sainthood, 107.

[65] Judd, 2016. Clinical and pastoral implications of the ministry of Martin Luther, 327.

[66] Luther, M. (1999). Table talk. H. T. Lehmann & T. G. Tappert (Eds.). In Luther’s works (Vol. 54). Concordia Publishing House, 54. (Original work published 1566)

[67] As cited in Osborn, I. (2008). Can Christianity cure obsessive-compulsive disorder? A psychiatrist explores the role of faith in treatment. Brazos Press, 54.

[68] Bainton, R. H. (1950, 2012). Here I stand: A life of Martin Luther. Hendrikson Publishers, 41.

[69] Miller, C. H., & Hedges, D. W. (2008). Scrupulosity disorder: An overview and introductory analysis. Journal of Anxiety Disorders, 22(6), 1042–1058. https://doi.org/10.1016/j.janxdis.2007.11.004

[70] Mora, G. (1969). The scrupulosity syndrome. International Journal of Clinical Psychology, 5 (4),166.

[71] Ciarrocchi, J. W. (1995). The doubting disease: Help for scrupulosity and religious compulsions. Paulist Press, 5.

[72] Baker, D. (2019, September). My battle with religious OCD. Ensign, digital content only. https://www.churchofjesuschrist.org/study/ensign/2019/09/young-adults/my-battle-with-religious-ocd

[73] Client story, used with permission; emphasis added.

[74] Beattie, 2011. Scruples and Sainthood, 107.

[75] Scott, R. G. (2004, November). Peace of conscience and peace of mind. Ensign,18. https://www.churchofjesuschrist.org/study/general-conference/2004/10/peace-of-conscience-and-peace-of-mind

[76] Morrison, A. B. (2005). Myths of mental illness. Ensign. https://www.churchofjesuschrist.org/study/ensign/2005/10/myths-about-mental-illness

[77] John 14:27.

[78] Client story, used with permission.

[79] Shapiro, 2015. Understanding OCD, 156.

[80] Bell, J. (2007). Rewind, replay, repeat: A memoir of obsessive-compulsive disorder. Hazelden, 264.

[81] Ignatius of Loyola, Saint Ignatius’ Own Story: As told to Luis Gonzalez de Camara (W. J. Young, Trans.). Loyola University Press, 19. (As cited in Osborn, 2008. Can Christianity Cure Obsessive-Compulsive Disorder?, 38. Whereas Ignatius used the third person to describe himself, Osborn adapted the quote to read as a first-person narrative.)

[82] Thérèse de Lisieux, The story of a soul: The autobiography of St. Thérèse of Lisieux. Christian Classics Ethereal Library, 45. https://ccel.org/ccel/t/therese/autobio/cache/autobio.pdf

[83] Greenberg D., & Shefler, G. (2008). Ultra-orthodox rabbinic responses to religious obsessive-compulsive disorder, 185.

[84] Alma 26:18; 36:6.

[85] Alma 38:7.

[86] Alma 36:12–16.

[87] Alma 36:18–22.

[88] Alma 38:8.

[89] Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543.