Scruples Disorder

Known as "scrupulosity" in the mental health community, a Scruples disorder refers to a psychological condition in which a person who has obsessive-compulsive disorder becomes fixated on religious rituals. Although Orthodox Judaism, Roman Catholicism and other faiths have rituals that require a certain degree of precision and devotion, scrupulosity can be distinguished from devoutness in that the former applies to a fixation that eclipses all other dimensions of one's spiritual life.

Obsessive-Compulsive Disorder (OCD)

• Obsessive-compulsive disorders such as scrupulosity can be thought of as two separate afflictions: obsessive thought patterns and an powerful compulsion to act on said thoughts. If an individual were only experiencing obsession, his symptoms would primarily be limited to intrusive thoughts and anxiety. Similarly, patients with compulsive behaviors (e.g., gambling, sex, risk taking, shopping, nail-biting, nose-picking) can help curb their symptoms by avoiding particular situations or activities.

  The difficulty with OCD is that when both disorders are present in a patient, they amplify one another through a kind of synergistic comorbidity. For example, scrupulosity-type OCD could begin with a patient's feelings of guilt at having committed some minor sin. This guilt could gradually give way to a severe anxiety that he will be punished by God. To assuage these incessant, intrusive fears, the patient would then compulsively turn to some ritual of atonement, such as going to confession, reciting a prayer or preparing an offering. However, because the obsessive component of the disorder keeps a steady stream of anxieties flowing into the patient's mind, he will repeat the rituals endlessly. In essence, his spiritual life has become cannibalized by his mental illness.

Symptoms

• Although particular manifestations may differ widely from one faith to another, persistent fear and excessive guilt tend to be the two "red flags" for scrupulosity. If a parishioner seems unable to accept forgiveness for minor sins or insists on undergoing disproportionately severe penance for small infractions, it could signal the disorder. Similarly, if religious fears begin to interfere with a person's ability to conduct his day-to-day affairs, scrupulosity could be to blame.

Incidence

• OCD, in all its forms, affects between 2% and 3% of the American population. Although it is not clear how many in this group specifically experience scrupulosity, the disorder has been observed among practitioners of Christianity, Judaism, Islam and other religions.

Treatment

• In most cases, individuals with scrupulosity and OCD respond to a combination of cognitive-behavioral therapy and medication. Exposure and response prevention (ERP) works to help the patient build up a tolerance to scrupulosity-related anxiety. By training the patient how to recognize the triggers and manage his feelings, ERP shows him how to deal with his anxiety without resorting to compulsive rituals.

Drug Therapy

• Although the underlying neurobiologic mechanism for OCD remains elusive, psychiatrists have found a correlation between OCD and the brain's serotonin system. Currently, a number of serotonin reuptake inhibitors, including clompiramine, fluoxetine, fluvoxamine and paroxetine, are being used to treat patients with OCD-related conditions.