Scrupulosity is a psychological condition characterized by obsessive thoughts and compulsive behaviors related to religious or moral themes. Individuals with scrupulosity experience excessive guilt, fear, and doubt about their adherence to religious or moral standards.
They may engage in repetitive religious rituals, seek reassurance about their moral conduct, or have intrusive blasphemous thoughts. Scrupulosity is often considered a presentation of obsessive-compulsive disorder (OCD) with a religious or moral focus.
Moroń, M., Krok, D., Niedbała, D., Biolik-Moroń, M., & Matuszewski, K. (2024). Dimensionality of scrupulosity and its associations with obsessive-compulsive symptomatology in a nonclinical sample: A network approach. Psychology of Religion and Spirituality. Advance online publication. https://doi.org/10.1037/rel0000520
Key Points
- The main findings of this study on scrupulosity and obsessive-compulsive disorder (OCD) symptoms include:
- Scrupulosity appears to be a unidimensional and independent syndrome of obsessive symptoms, separate from OCD symptomatology.
- The central symptoms of scrupulosity were worries that one’s thoughts and behaviors are unacceptable to God, fear of having immoral thoughts, and fear of disobeying rules.
- Obsessing symptoms were the bridge between scrupulosity and OCD symptoms.
- Severity of scrupulosity symptoms was higher among individuals reporting more frequent participation in religious ceremonies.
- The research, while informative, has limitations such as a cross-sectional design, use of a measure (PIOS) that may be more suitable for certain faiths and cultural contexts, and a predominantly Roman Catholic sample.
- The study highlights the importance of understanding the dimensionality and central symptoms of scrupulosity to inform therapeutic interventions for individuals with religious scruples.
Rationale
Scrupulosity, characterized by obsessions and compulsions centered around religion and morality, is often regarded as a presentation of obsessive-compulsive disorder (OCD; Abramowitz & Hellberg, 2019).
However, the dimensionality of scrupulosity and its associations with OCD symptoms remains unclear.
Scrupulosity dimensionality refers to the number and nature of distinct factors or dimensions that underlie the symptoms of scrupulosity. In other words, it concerns the question of whether scrupulosity is a unitary construct or if it comprises multiple, separate dimensions.
Previous studies have found both unifactorial (Gallegos et al., 2018) and two-factorial structures (Abramowitz et al., 2002) of the Penn Inventory of Scrupulosity (PIOS), a commonly used measure of scrupulosity.
Additionally, scrupulosity has been associated with various OCD symptoms such as contamination (Nelson et al., 2006), obsessing, and hoarding (Olatunji et al., 2007).
The present study aimed to investigate the dimensionality of scrupulosity and its associations with OCD symptoms using network analysis, a novel approach that examines dynamic interactions between symptoms (Borsboom, 2017).
Understanding the central symptoms of scrupulosity and its links to OCD can inform targeted interventions for individuals with religious scruples.
Method
The study employed network analysis to examine the dimensionality of scrupulosity symptoms and their associations with OCD symptoms in a non-clinical sample of religious individuals from Poland.
Procedure
Participants completed online measures assessing scrupulosity (PIOS) and OCD symptoms (Obsessive-Compulsive Inventory-Revised; OCI-R). They also reported on their religious affiliation, importance of religion for identity, and frequency of participation in religious ceremonies.
Sample
The final sample consisted of 322 individuals (227 women, 95 men) aged 18-79 (M=38.3, SD=14.05), predominantly Roman Catholic (96.9%) and with higher education (67.7%).
Measures
- Penn Inventory of Scrupulosity (PIOS): 19-item measure of scrupulosity with two dimensions (fear of sin, fear of God).
- Obsessive-Compulsive Inventory-Revised (OCI-R): 18-item measure of OCD symptoms (washing, obsessing, hoarding, ordering, checking, neutralizing).
- Religious affiliation, importance of religion for identity, and frequency of participation in religious ceremonies were also assessed.
Statistical measures
Network analysis is a statistical method that examines the relationships and interactions between variables or symptoms, representing them as nodes connected by edges in a network. It allows for identifying central and bridge symptoms within a network of psychopathology.
Network analysis using graphic LASSO regularization was employed to estimate networks of scrupulosity symptoms and their associations with OCD symptoms.
Community detection algorithms (Walktrap, Louvain) were used to identify dimensions within the networks. Centrality indices (strength, closeness, betweenness, expected influence) were computed to determine the most influential symptoms.
Results
- Scrupulosity symptoms formed a unidimensional network in 94.4% of iterations.
- In the network of scrupulosity and OCD symptoms, scrupulosity formed independent communities, with obsessing as the bridge symptom.
- The most central symptoms of scrupulosity were thoughts and behaviors unacceptable to God, immoral thoughts, and disobedience of rules.
- Severity of some scrupulosity symptoms was higher among individuals reporting more frequent participation in religious ceremonies.
Insight
This study provides valuable insights into the nature of scrupulosity and its relationship with OCD symptoms.
The findings suggest that scrupulosity is a distinct syndrome, separate from OCD, characterized by a unidimensional structure.
The central symptoms revolve around fears of having thoughts and behaviors unacceptable to God, immoral thoughts, and disobeying religious rules.
Obsessing symptoms appear to be the link between scrupulosity and OCD.
The association between the frequency of religious ceremony attendance and the severity of scrupulosity symptoms highlights the potential role of religious context in the development of scruples.
These findings can guide therapeutic interventions for scrupulosity, focusing on addressing the central symptoms and the underlying religious beliefs and practices that may contribute to their severity.
Future research could explore the causal relationships between religious factors and scrupulosity, as well as examine scrupulosity in diverse religious and cultural contexts.
Strengths
- Use of network analysis to examine symptom interactions and dimensionality
- Assessment of both scrupulosity and OCD symptoms
- Inclusion of measures of individual religiosity
- Relatively large sample size for obtaining stable correlation estimates
Limitations
- Cross-sectional design preventing causal inferences
- Use of PIOS, which may be more suitable for certain faiths and cultural contexts
- Predominantly Roman Catholic sample, limiting generalizability to other religions
- Lack of assessment of broader psychopathological context (e.g., anxiety, neuroticism)
Clinical Implications
The results of this study have significant implications for the understanding and treatment of scrupulosity.
Identifying the central symptoms of scrupulosity (i.e., fears of thoughts and behaviors unacceptable to God, immoral thoughts, disobedience of rules) can guide targeted interventions addressing these core concerns.
Therapeutic approaches may need to incorporate discussions about the individual’s religious beliefs, their image of God, and the moral standards of their religious denomination.
The link between obsessing symptoms and both scrupulosity and OCD suggests that interventions targeting obsessiveness could be beneficial for individuals with religious scruples.
Additionally, the association between frequency of religious ceremony attendance and scrupulosity severity highlights the importance of considering the individual’s religious context and practices in understanding and treating scrupulosity.
Mental health professionals may need to collaborate with religious leaders or incorporate pastoral counseling to address the religious aspects of scrupulosity effectively.
References
Abramowitz, J. S., & Hellberg, S. N. (2019). Scrupulosity. In E. Storch, D. Mckey, & J. Abramowitz (Eds.), Advanced casebook of obsessive–compulsive and related disorders. Conceptualizations and treatment (pp. 71–87). Academic Press.
Abramowitz, J. S., Huppert, J. D., Cohen, A. B., Tolin, D. F., & Cahill, S. P. (2002). Religious obsessions and compulsions in a non-clinical sample: The Penn Inventory of Scrupulosity (PIOS). Behavior Research and Therapy, 40(7), 825–838. https://doi.org/10.1016/S0005-7967(01)00070-5
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13. https://doi.org/10.1002/wps.20375
Gallegos, J., Sánchez-Jauregui, G., Hidalgo, J., Davila-de Gárate, S. M., Támez-Díaz, O. G., & Fisak, B. (2018). The validation of a Spanish version of the Pennsylvania Inventory of Scrupulosity—Revised. Mental Health, Religion & Culture, 21(2), 194–203. https://doi.org/10.1080/13674676.2018.1432582
Nelson, E. A., Abramowitz, J. S., Whiteside, S. P., & Deacon, B. J. (2006). Scrupulosity in patients with obsessive–compulsive disorder: Relationship to clinical and cognitive phenomena. Journal of Anxiety Disorders, 20(8), 1071–1086. https://doi.org/10.1016/j.janxdis.2006.02.001
Olatunji, B. O., Abramowitz, J. S., Williams, N. L., Connolly, K. M., & Lohr, J. M. (2007). Scrupulosity and obsessive–compulsive symptoms: Confirmatory factor analysis and validity of the Penn Inventory of Scrupulosity. Journal of Anxiety Disorders, 21(6), 771–787. https://doi.org/10.1016/j.janxdis.2006.12.002
Keep Learning
- How might cultural and religious contexts influence the presentation and severity of scrupulosity symptoms?
- What are the potential benefits and challenges of incorporating religious or pastoral counseling in the treatment of scrupulosity?
- How can mental health professionals effectively address the central symptoms of scrupulosity (e.g., fears of unacceptable thoughts/behaviors, immoral thoughts, disobedience) in therapy?
- What role might cognitive distortions (e.g., thought-action fusion) play in the development and maintenance of scrupulosity?
- How can future research further elucidate the causal relationships between religious factors (e.g., beliefs, practices) and scrupulosity?
