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Religious faith and religious education are not generally the causes of Scrupulosity. Actually, Scrupulosity is a form of Obsessive-Compulsive Disorder. (OCD) OCD appears to be a biologically based disorder with severe psychological consequences. The disorder occurs in 2-3% of the population (5-7 million sufferers in the U.S.). About 10% of the first-degree relatives of affected persons also have OCD.

Obsessions are recurrent thoughts or impulses that make the person anxious (such as the fear that using a public toilet will make one sick) The obsessions persist despite efforts to control or suppress them. They feel intrusive and disturbing even though the person knows that they come from his own mind. Obsessions may include fear of harming someone, contamination or of doing something embarrassing.

Compulsions are repetitive behaviors or mental acts the person feels driven to perform, often with ritualistic rigidity, to prevent the anxiety connected with the obsessions. These may include urges to wash, count, check or repeat phrases to oneself.

OCD can occur in different forms. There are a variety of different types of obsessions and compulsions. The nature of intensity of these symptoms may vary over time. Aggressive, sexual and religious obsessions sometimes occur together in the same individual.

Treatment of Scrupulosity:
Like other forms of OCD, scrupulosity responds to medication and cognitive-behavioral therapy. Prior to studies in the 1980's, the usual view of OCD was that it was a relatively rare disorder with a poor prognosis. However, in addition to it being now recognized as much more common (2-3% prevalence rate), it is generally considered treatable. About 60%–80% of patients show some degree of response to treatment.

The serotonin system in the brain seems to be involved in the pathology of OCD, since the medications that have been shown to be help treat OCD increase the availability of this neurotransmitter. These medications include the serotonin re-uptake inhibitors: clomipramine, fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram.

Cognitive-Behavioral therapy—specifically ERP [Exposure and Response Prevention]—has been successfully used for the treatment of OCD. The idea behind ERP is that compulsions provide only a temporary reduction of the anxiety produced by obsessions. Furthermore, the only way to experience more permanent relief is to habituate (grow tolerant of…"get used to") the anxiety caused by the obsession--without performing the compulsion. Habituation is the key factor, and clinicians start by identifying triggers that bring on obsessional thoughts and compulsive behaviors. Then they develop a graduated hierarchy of anxiety based on the patient's report. The patient "challenges" him or herself by gradually moving up the hierarchy. In addition to exposure, the patient is instructed to refrain from carrying out the associated rituals or at least to delay the rituals by several minutes.

This treatment can be adapted to religious obsessions and compulsions. However, the therapist must proceed with sensitivity to the individual’s cultural and religious beliefs. If this is not done, the therapy may actually increase anxiety and resistance.

Scrupulosity related entry . . .

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