What is Faith-Based OCD and how is it best treated? Registered Psychotherapist and CAC member, Noah Tile, shares his insights on understanding and treating religious scrupulosity.
For many, faith is a source of meaning, peace, and purpose. But for those with faith-based OCD, also known as scrupulosity, it can become a source of fear and endless doubt.
Scrupulosity is a form of obsessive-compulsive disorder (OCD) where religious or moral concerns become the focus of intrusive thoughts and compulsive behaviours. These obsessions and compulsions distort the meaning of faith, turning it into a relentless struggle for spiritual certainty.
Faith-Based Obsessions and Compulsions
People with scrupulosity experience obsessions, such as:
- Fear of sinning against God
- Fear of being an immoral person
- Fear of blasphemy
- Fear of being rejected by God, both now and in the afterlife
To cope, they may engage in compulsions like:
- Excessive praying
- Seeking reassurance from faith leaders
- Being overly cautious to avoid sinning
- Repeating religious rituals to get them “just right”
- Mental rumination on spiritual or moral matters
It is important to emphasize that religion is not the cause of OCD. Rather, OCD latches onto what matters most to a person. For devoted individuals, this often includes their faith.
The goal of treatment is not to reduce a person’s religious devotion but to help them practice their faith in a healthier, more fulfilling way. When approached thoughtfully, treatment can deepen their connection to their beliefs, turning their faith into a source of strength rather than distress.
Before discussing treatment options, it’s essential to recognize that OCD often revolves around deep existential issues. People with various OCD subtypes grapple with questions of morality, self-worth, life’s purpose, and taboo topics like violence or sexuality. Even without scrupulosity, all OCD struggles can impact an individual’s faith, leading them to feel unworthy of God’s love or question the reason for their suffering. Sensitivity to these challenges is crucial when supporting those affected by OCD.
Treatment for Scrupulosity
Treatment for scrupulosity follows evidence-based approaches for OCD, primarily cognitive therapy and Exposure and Response Prevention (ERP). Let’s explore how these methods work through the case of David, a client with scrupulosity.
A Case Study: David’s Journey
David is a 40-year-old Jewish man who finds immense meaning in his faith and community. However, his experience with OCD has turned this source of joy into a constant struggle.
In Judaism, keeping Kosher is central to dietary practices. Kosher meat is prepared according to strict laws, which include removing all blood through a salting and soaking process. For David, this practice became a trigger for obsessive thoughts.
Even though he buys certified Kosher meat, David worries that trace amounts of blood might remain. He fears that eating it could bring severe spiritual consequences, both in this world and beyond. These fears lead him to compulsively inspect his meat, a process that causes so much stress that he eventually avoids eating meat altogether.
David longs to enjoy his Shabbat meals again, without intrusive thoughts stealing the experience. Therapy focuses on helping him regain this connection.
Cognitive Therapy
The first step is addressing David’s beliefs about his rituals and fears. Through cognitive therapy, we help him understand that his compulsive checking is not a requirement of Halacha (Jewish law) but rather a behaviour driven by OCD.
To reinforce this, we collaborate with his Rabbi, who confirms that his actions are unnecessary within Jewish law. This clarification empowers David to trust his religious practices without overthinking them.
Next, we address David’s deeper fears of spiritual consequences. Using cognitive therapy and values-based Acceptance and Commitment Therapy (ACT) strategies, David reframes his beliefs, building confidence that God is not out to get him but desires a loving relationship.
We also choose Jewish scriptural sources that help strengthen his resolve to do OCD therapy. One quote that deeply resonates with him is from Rabbi Jonathan Sacks, z”l: “Faith is not certainty, but the courage to live with uncertainty.”
This process helps David align his treatment with his religious values. He begins to trust that his intrusive thoughts are a symptom of OCD, not a reflection of his character, spiritual standing, or a test from God.
Exposure and Response Prevention Therapy (ERP)
Once David has a stronger foundation, we move to ERP. The goal is to help David confront his fears without engaging in compulsions, avoidance, or reassurance-seeking. Obsessions are not in his control, but he can choose not to do his OCD rituals.
For David, ERP involves gradually eating meat without checking it for blood. Initially, this creates significant anxiety, but over time, he learns to sit with the discomfort without giving in to compulsive behaviours.
We carefully design exposures to respect David’s values. For example, he is never asked to violate Kosher laws, as this would contradict his faith. Instead, we focus on reducing the compulsions that disrupt his life.
With practice, David begins to reclaim his Shabbat meals, enjoying them as an act of faith and celebration rather than anxiety and fear.
Mental Health Tools for Faith-Based OCD
Throughout therapy, we integrate tools from ACT and DBT (Dialectical Behaviour Therapy) to help David manage anxiety and intrusive thoughts. These skills include:
- Distress tolerance and emotion regulation: Techniques to cope with difficult emotions without acting on compulsions.
- Mindfulness: Staying present in the moment rather than spiraling into rumination.
- Defusion: Recognizing intrusive thoughts as mental noise rather than truth.
These tools help David manage his OCD and deepen his spiritual practice by cultivating a calmer, more grounded connection to his faith. He learns to access his wise mind, or Neshama/Soul in Jewish terms, to guide him in making better decisions.
Progress and Reflection
Over time, David learns to trust God, himself and his religious practices without the constant need for certainty. He lets go of compulsions of these compulsions and his Shabbat meals become a time of joy and connection again, free from the grip of OCD.
Even if intrusive thoughts and compulsions are present occasionally, they do not disrupt him from living the life he wants—and that is what OCD treatment is all about.
Thank you to Noah Tile of our CAC for this insightful article on OCD treatment.
Read another blog post by Noah Tile: Beyond the Treatment Manuals: How I Treat OCD