The simplest answer, and perhaps the traditional answer, may be to describe it as an age-old problem that has long been understood as an affliction most often manifested in the “tender conscience.” Great saints have spoken about it and have counseled their followers about it. Still others, such as Saint Alphonsus Liguori and Saint Ignatius of Loyola, have suffered from it. For many people scrupulosity is understood as a religious problem, and for still others it is understood specifically as a Catholic problem.
For many years mental-health professionals dismissed scrupulosity as a symptom of neurotic behavior and treated it accordingly. Though not included as a specific entry in the Diagnostic and Statistical Manual of Mental Disorders, and although it has been long recognized by priests, rabbis, and spiritual directors, it has been only recently understood as a possible subtype of obsessive-compulsive disorder (OCD). Recent studies seem to suggest that approximately three million people suffer from OCD; it has been further asserted that approximately six percent of this group or approximately 180,000 people suffer directly with scrupulosity.
Our best available evidence seems to suggest that we might understand scrupulosity in two distinct manifestations: developmental scrupulosity and emotional scrupulosity. For the most part people who suffer with developmental scrupulosity are often able to trace the experience of scrupulosity to a specific time in adolescence during which they became excessively focused on sin and the consequences of sin. For still others who experience scrupulosity later as an adult it can often be traced to a powerful conversion experience, for example at the conclusion of the RCIA process (Rite of Christian Initiation for Adults). More often than not a person who suffers with developmental scrupulosity can experience relief if not a complete “cure” with the help of a kind and patient confessor. We might best understand developmental scrupulosity as the manifestation of a “tender conscience.” Emotional scrupulosity, on the other hand is a more enduring form of the disorder which generates intense emotional disturbances. The manifestation is considered as primarily obsessive when there is a persistent idea, image or impulse that a person views as intrusive and senseless. The person struggles and desires to rid themselves of this manifestation, often with no enduring success. The manifestation is considered as a compulsion when there is a repetitive action associated with the disorder that the person feels compelled to carry out. It is not at all uncommon that the person understands the compulsion to be senseless, i.e. the compulsive washing of hands, checking locks, repeating prayers, performing a specific ritual action associated with religious practice. When scrupulosity is emotionally rooted professional help is essential. It is not possible to pray yourself out of the experience of emotional scrupulosity and there is no patient or gentle confessor that can help you rationalize your behavior or experience. Prayer and of course a gentle confessor is important and useful, but behavior modification and some form of drug therapy is highly effective and required. We might best understand emotional scrupulosity as the manifestation of a distinct form of Obsessive-Compulsive Disorder (OCD).
“Good people, from all walks of life, find themselves possessed by a thought or a desire that does not seem to want to go away.”
Since our concern is a pastoral concern and not a clinical concern perhaps the best way to understand scrupulosity is to recognize the manifestation of the affliction. For most sufferers, the experience of scrupulosity is described as “thoughts that cannot be shaken.” It has been variously described as being possessed by “a thousand frightening fantasies” or as “constructing a spider web in the mind.” Others describe the affliction as being constantly and unrelentingly “pricked by a pin.”
Joseph Ciarrocchi, PhD, (died 2010) in an article entitled “Ministry to Scrupulous Persons” that appeared in the Jesuit journal Human Development, identified the core experience of scrupulosity as “an intrusive idea, often associated with a sinful impulse, which the person abhors but cannot shake.”
What the doctor is describing is the exact situation of the person who suffers from scrupulosity. Good people, from all walks of life, find themselves possessed by a thought or a desire that does not seem to want to go away. Even though they may realize that they are obsessing over a particular thought or idea, they can summon no amount of logic or rational argument that would help. They continue to obsess, and they continue to be robbed of the peace they long for. The thought continues to disturb them, through no fault of their own. In fact, that which the person desires is exactly the opposite of what they experience.
In addition to the “thought that will not go away,” there is yet another manifestation of scrupulosity that might be even more paralyzing. Since the thoughts that obsess the person are often understood within the context of faith and spirituality, their experience of faith is marked with anxiety and fear instead of a source of peace and strength. They want to believe, they are doing all that they can to believe and to be hopeful, but they just cannot seem to shake a feeling of impending doom, disappointment, or eventual condemnation.