I didn’t know what scrupulosity was until I was 23 and sitting in a psychiatrist’s office. After months of extended panic attacks, someone I trusted recommended this psychiatrist to me, adding that he was a kind and Christian man. So I made an appointment and sat in his office, unsure of what to expect.
I told him about my incessant shame over sin and the striving to be perfect for Christ. I told him that as a second-grader, I seriously contemplated my salvation and whether or not it had “stuck.” I told him about the hours I spent memorizing the Bible in high school, elusively searching for the peace and joy Scripture talks about. I told him about the twice-a-day calls to my dad for reassurance that I was normal, that my irrational spiritual fears weren’t going to happen. And I told him about the panic attacks I was having, about how they all centered on one big, scary spiritual fear.
He listened to me and then casually told me I had something called scrupulosity, or religious obsessive-compulsive disorder (OCD). He said it so simply, as if there were a neon sign above my head blinking my diagnosis.
Scrupulosity—a subtype of OCD focused on moral or religious obsessions and compulsions—comes from the Latin word for a small stone, evoking the pain of having a pebble stuck in one’s shoe. It is a small thought lodged in the brain. Intrusive in nature, it nags and nags and nags until the sufferer cannot think of anything else but that one thought, often a spiritual fear. And that fear can come in many different forms.
The International OCD Foundation lists many fears that can be categorized as scrupulosity: fear of committing blasphemy or offending/angering God, fear of having committed a sin or behaving overly morally, fear of going to hell or being punished by God, fear of being possessed, fear of death, fear of the loss of impulse control, and obsessively needing to acquire certainty about religious beliefs. Church historians think Christian greats like Martin Luther, John Bunyan, and Saint Thérèse of Lisieux dealt with scrupulosity.
Many of these are fears any “normal” person might hold. Isn’t this just another way of describing legalism? Most people, I assume, do not want to go to hell or be punished by God. The difference between scrupulosity and legalism, however, is that the scrupulous brain cannot let go of that one thought, that one fear. Someone struggling with legalism may experience great relief after a meeting with his or her pastor, but for someone with scrupulosity, that irrational fear will only return. Around and around, that one question spins in the scrupulous brain: What if, what if, what if?
So we read our Bibles for hours a day. We pray the same verse over and over and over again. We confess the same sins—both real and perceived (“just in case”). We find someone to vent to about all of our spiritual fears. These coping mechanisms—these compulsions—work for a little while at providing reassurance. But soon enough, the fears return and the loop continues. Over and over and over again, forever afraid.
Because our OCD latches onto the thing we hold most dear—our relationship with God—the gospel contorts into a doctrine of fear. On the outside, we look like elite Christians, always reading our Bibles and showing up at church whenever the doors are open, but our motivations are driven by fear rather than joy. We have somehow lost the concepts of peace and joy in the equation of our faiths. We need help—both spiritual and psychological—to recover them.
I’ve known people who have been spiritually healed from their OCD. However, my story of healing hasn’t been one miraculous moment. Rather, as Eugene Peterson famously titled his book, it’s been “a long obedience in the same direction.” I have fought this battle daily through deep relationships with family, friends, clergy, trustworthy therapists, kind psychiatrists, and—above it and within it and orchestrating it all—God’s provision and grace.
Early on in my healing journey with scrupulosity, I learned that I can’t control that my brain gets hooked on my spiritual fear, but I can control whether or not I fight it. Fighting it is a losing battle; the more I fight, the bigger the fear will get. Instead, I learned to acknowledge the thoughts; to say, “Okay, I recognize this fear is here, but I don’t need to do anything about it.” Like taking a leaf and setting it in a stream, I have learned (and continue to learn) how to accept fear and then let it go.
Psalm 131 (NRSVue) puts this practice into spiritual terms:
O Lord, my heart is not lifted up,
my eyes are not raised too high;
I do not occupy myself with things
too great and too marvelous for me.
But I have calmed and quieted my soul,
like a weaned child with its mother;
my soul is like the weaned child that is with me.
O Israel, hope in the Lord
from this time forth and for evermore.
This psalm reminds me that I can give God all my big, scary spiritual fears; God is able to hold them for me. I do not need to lift my heart up; I do not need to raise my eyes too high. There is so much that is “too great and too marvelous for me.” Instead, I can calm and quiet my soul in the arms of God—the arms of God are big enough to hold all of it.
And I have to continually—each day, each hour, sometimes each moment—remind myself of this. It’s not a one-time switch but a continual process. I am not “healed.” I still take medication every night, and just yesterday I sat in my psychiatrist’s office for a checkup. I also stand in line to receive the Eucharist each week, which transcends my medication and reminds me of Christ’s bodily presence and sacrifice.
It’s been ten years since my diagnosis and discovery—ten years of receiving the Eucharist, taking medication, and going to therapy. Since then, I’ve realized that there are many others out there like me, religious or not (one study conservatively estimated at least 1.5 million Americans). I’ve also realized that so few pastors and spiritual mentors recognize or are aware of scrupulosity.
For those who struggle with this diagnosis, you are deeply loved by a God who longs to draw near to you. Despite the difficulty and the confusion, God is faithful. And above and beyond your big, scary spiritual fears, there is God’s grace—a reality that exists even when it isn’t felt in the moment. Surround yourself with people who speak this grace over you.
For those with spiritual authority, know that those who live with scrupulosity are sitting in your pews. We love God, but we need words of peace spoken over our frayed and fidgeting souls, words of peace when the tumult of our waves rises above our heads.
Drew Brown is a writer currently pursuing his doctor of ministry degree at Western Theological Seminary. He writes on his Substack, Slow Faith.
