Rhonda Ortiz at Integrated Catholic Life has an excellent piece on how to recognize and fight against scrupulosity. Here is her description of the three types of scrupulosity.

1. Scrupulosity Resulting from Idealism Developmental scrupulosity is a byproduct of a deep faith experience, such as conversion or growing awareness of God, particularly in adolescence. In the process, a person can become overly-sensitive and overly-reactive to sin. The person worries about “doing it wrong” and overcompensates by trying to do “it” perfectly, whether that be religious practice or making any number of moral decisions.

The good news about developmental scrupulosity is that with the help of good spiritual direction and a solid prayer life, a person can grow out of it.

2. Scrupulosity Within a Group Dynamic Milieu-influenced scruples are the second type, representing the fact that “scruples can be taught.” This happens when significant authority figures—family, religious leaders, influential friends—in one’s life “transmit a strong fear component in their [religious] message.” Scruples come when, as a response, the person comes to believe “that bad thoughts will be punished or that only perfection pleases God.”

Milieu-influenced scruples differ from the other types in that the scruples are shared within a group. Catholics can experience milieu-influenced scruples in parish life, in religious orders, in lay movements and confraternities, among family and friends, and even online—anywhere where we meet collectively as Catholics.

The particular scruples vary greatly; one religious group may be rigorous about a particular moral dimension but permissive about others. Ciarrocchi warns against thinking that these scruples reflect liberal-conservative concerns within a group; what truly drives this type of scrupulosity is worry and fear.

A person affected by milieu-influence scruples has two options for dealing with them: he can choose to leave that particular group or he could choose to stay in the group but adjust his beliefs to ones not driven by fear. Either way, with the help of a good spiritual director, he should strive to learn and relearn the Church’s teachings in light of God’s unfailing love.

Also, I will echo St. Alphonsus Liguori and recommend avoiding persons and books that exasperate one’s scruples. For example, for many years I had to avoid reading Thomas à Kempis’ The Imitation of Christ—that great spiritual classic!—because I felt my own scruples flaring up every time I tried to read it. Thankfully, I’m in good company: there are many, many saints in heaven who never read the Imitation!

3. Scrupulosity as Obsessive-Compulsive Disorder —The third type of scrupulosity Ciarrocchi names is emotional scrupulosity, where “scrupulosity represents specific symptoms for the emotional disorder obsessive-compulsive disorder (OCD),” an anxiety disorder where “the presence of either obsessions or compulsions . . . significantly interfere with normal functioning.”

OCD is a disorder of the brain and behavior that causes severe anxiety. According to the National Institute of Mental Health, one percent of Americans suffer from OCD. (In a similar vein, eighteen percent of Americans have or have had an anxiety disorder; some anxiety and OCD symptoms overlap.)

An obsession is a persistent idea, image, or impulse that the person views as intrusive and senseless. Usually the person tries to get rid of it. A compulsion is a repetitive act that a person feels compelled to carry out. The act does not usually make sense to the person even though he or she feels required to do it. Compulsions can also be internalor mental, e.g. saying a prayer to oneself in response to a blasphemous idea.

There is a ton of good stuff in this article and I would definitely second all of Ms Ortiz’s recommendations for reading and resources, especially the work by my colleague, Dr. William van Orum (whom Ortiz mentions several times). Dr. Van Orum directs the American Mental Health Foundation and I’m pleased to serve on their advisory board. It’s good to see his excellent work being recognized.

Additional Thoughts About Treating Scruples

The only thing I would add to Ms. Ortiz’s comments is that it can be difficult to get effective counseling help for scrupulosity in general and type 3 in particular (the type that is most consistent with obsessive compulsive disorder). The problem is that many clinicians use something call Exposure and Response Prevention (ERP) therapy to treat OCD. This approach involves exposing the client to the thing they are obsessed about (a germy object, for instance) and then teaching them to relax and overcome the obsessional thoughts and feelings while in the presence of that object. It can be a very effective form of treatment for general OCD, but you can’t use it to treat scrupulosity because you can’t exactly tell a client to go and do something sinful and then teach them relaxation techniques while they, say, cheat on their husband. That, combined with the fact that scruples often involve moral/religious content that many secular counselors can’t relate to, leaves a lot of therapists scratching their heads when they encounter scrupulous clients. That, in turn, can leave a lot of scrupulous clients feeling like there is no hope. Happily, that is not the case.

In addition to ERP, there is another effective form of treatment for OCD, developed by Dr. Jeffrey Schwartz called the 4R method that helps the client Relabel, Reattribute, Refocus and Revalue the scrupulous feelings and find relief without having to be exposed to the source of their anxiety. We use this approach very effectively, along with several other techniques that integrate spiritual insights as well as cognitive therapy, with our scrupulous clients in the Pastoral Solutions Institute’s Catholic Tele-Counseling Practice. If you are struggling with scruples and are looking for help, I encourage you to pick up Dr. Schwartz’s book, Brain Lock, and, if you decide to seek professional assistance, be sure to work with a faithful therapist who is familiar with the 4R approach to treatment.

The good news is that, with the right kind of help, even people with severe scruples can live much more peaceful lives. I’m grateful to Rhona Ortiz for highlighting this important issue in her article and I join her in encouraging all people who are struggling with scruples to take advantage of all the resources that can help them win the battle against disordered guilt and anxiety.