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How Individuals with Obsessive-Compulsive Disorder (OCD) and Anxiety are More Likely to Develop Symptoms of Scrupulosity Lily Anderson Brigham Young University PSYCH 307: Writing Within Psychology Dr. Julianne Holt-Lunstad April 2, 2024

Abstract Scrupulosity is a mental health disorder that falls under the category of obsessive-compulsive disorder (OCD). Those with scrupulosity symptoms experience obsessions and compulsions similar to those with OCD; however, the symptoms are based on principles of religiosity. Individuals experiencing scrupulous fears have tendencies to see deities and higher powers in a negative light, as beings determined to punish or harm. People with scrupulosity can experience OCD-based symptoms such as negative implicit or explicit beliefs about God. Those dealing with scrupulosity have a challenging time distinguishing between what is normal and what is extreme when it comes to religion. They tend to feel undue guilt or anxiety when it comes to religion. To relieve these feelings, people dealing with scrupulosity relieve themselves by over- confession or visitation to religious leaders and performing rituals to an excessive degree. Not only do symptoms of scrupulosity affect one’s mental health and self -awareness, but they can also interfere with the health of relationships. Individuals with scrupulous fears tend to feel distress in their relationships as they battle against triggers and strive for relief. Given these tendencies, it becomes apparent that individuals already dealing with OCD are more likely to develop symptoms of scrupulosity than those who are in good mental health or have a healthy relationship with religion. Religiosity is not a factor when it comes to determining if someone could develop scrupulosity symptoms or not. However, other indicators stated above, in addition to poor mental health, could lead to one developing this mental health disorder. Keywords : anxiety, obsessive-compulsive disorder (OCD), religiosity, scrupulosity, spirituality Commented [JM1]: I'd change the wording around a bit Commented [JM2]: I didn't really understand what you meant by this Commented [JM3]: I'd chnage this to distressed

How Individuals with Obsessive-Compulsive Disorder (OCD) and Anxiety are More Likely to Develop Symptoms of Scrupulosity Scrupulosity is characterized as a form of OCD, as the individual deals with different obsessions and compulsions relating to religion or spirituality (Myers, Pirutinsky, et al., 2021). In some cultures, 10%-33% of individuals with OCD have religious obsessions or fears. In other cultures, as much as 40%-60% experience religious obsessions (Siev, Baer, et al., 2011). There are various symptoms or forms in which scrupulosity may be manifest. Some of the religious obsessions include intrusive profane images, fear of making mistakes or committing sin, and fear of punishment from God or another higher power (Buchholz, Abramowitz, et al., 2019). Compulsions include excessively repeating religious practices, such as prayer or confession, and a need for repeated reassurance from religious authorities (Buchholz, Abramowitz, et al., 2019). Typically, in religion, individuals view God as a loving and merciful being. However, individuals with scrupulosity view deities as having a fearful and harsh nature, characteristics that go against what is taught in most religions (Pirutinsky, Siev, et al., 2015). Scrupulosity symptoms can become so intense that they can often restrict functioning (McIngvale & Rufino, 2017). People dealing with scrupulosity have higher levels of OCD (McIngvale & Rufino, 2017). There are different theories surrounding what may trigger symptoms of scrupulosity. Some researchers suspect that those who see God or divine figures as punitive or cruel could be at risk of developing scrupulosity (Myers, Pirutinsky, et al., 2021). A few studies have shown positive correlations between negative beliefs about God and higher levels of scrupulosity. More research is being done to confirm those results and continue to experiment on the causes or factors that influence an indi vidual’s development of the disorder (Myers, Pirutinsky, et al., 2021). A study done to treat an individual case of scrupulosity-related Commented [LA4]: maybe you could add a prior sentence that is a hook

OCD concluded that many individuals with scrupulosity do not claim to have ultimate fears of eternal damnation or divine punishment. Instead, those with scrupulosity have fears of living in sin, and see it as unacceptable (Siev & Huppert, 2015). A causal link has not been found between religious practice and scrupulosity, and therefore those with a religious background are not necessarily more prone to developing scrupulosity symptoms (Greenberg & Huppert, 2010; Myers, Pirutinsky, et al., 2021). Religion is not a determinant of disorder but is another area in which OCD manifests itself (Tek & Ulug, 2001). Scrupulosity is a recently defined element and therefore there is little known about the sources of its development (Myers, Pirutinsky, et al., 2021). It is an understudied disorder and is often mistreated as general OCD instead of a religious subtype (Siev, Baer, et al., 2011). For individuals practicing religion with mental health disorders such as obsessive- compulsive disorder (OCD) or generalized anxiety disorder (GAD), it can be hard to distinguish between a normal religious practice and an out-of-proportion scrupulous fear (Pirutinsky, Siev, et al., 2015). Although individuals with good mental health are at risk of having scrupulosity, those with obsessive-compulsive disorder (OCD) and anxiety are more likely to develop scrupulosity symptoms manifested as negative explicit or implicit beliefs about God, extreme feelings of anxiety or guilt, and distress in relationships. Negative Explicit or Implicit Beliefs about God Many studies work to assess the connection between scrupulosity and explicit or implicit negative beliefs about God (Myers, Pirutinsky, et al., 2021). Those with religious OCD tendencies manifest their symptoms in ways such as intrusive thoughts about sin, blasphemous images, and fear of punishment from God (Abramowitz & Buchholz, 2020). Scrupulosity is a Commented [JM5]: I believe once you say the full name of OCD you can just say OCD instead of saying it's who name again

form of OCD involving religious or moral fears (Pirutinsky, Siev, et al., 2015). Scrupulous fears are a tendency to experience anxiety regarding sin, harming the positive relationship between religion and well-being (Lau & Ramsay, 2019). There have been studies conducted, concluding that those with scrupulosity tend to have a more negative concept of God and His character. Results of a study conducted by Pirutinsky & Siev (2015) showed that those with high explicit negative beliefs and negative implicit associations had higher levels of scrupulosity. However, research is needed to further assess the connections between explicit and implicit negative beliefs about God (Pirutinsky, Siev, et al., 2015). Having a negative perspective on who God is not a causal factor of symptoms of scrupulosity, but rather a correlating factor. As one associates negative experiences or perspectives with God’s character, it builds a mental framework of fear , that God may be unreasonable and punitive rather than merciful and loving. Another study was conducted to develop primes that could activate different beliefs about or perspectives on God and to see if those beliefs impacted symptoms of scrupulosity (Evey & Steinman, 2022). One part of the study assigned participants different readings: positive, negative, or neutral. As a result, the study showed that participants who read the negative condition had higher levels of anxiety following the task compared to participants assigned to the positive prime. The primes had the potential to active negative beliefs about God and have an impact on anxiety (Evey & Steinman, 2022). Due to the way that scrupulosity affects one’s perspective on the world around them, negative experiences in life that would seem normal to those without scrupulosity, can contribute to a negative perspective of God for those with scrupulous symptoms. Extreme Feelings of Guilt or Anxiety Commented [JM6]: I think when you start a new topic it has to be on a separate page

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