Moral Scrupulosity in OCD

Overview

• Moral Scrupulosity is a subtype of OCD focusing on fears about one's moral integrity, distinct from religious scrupulosity.
  • Concerns over whether one's actions align with personal morals or societal standards.
  • Individuals with moral scrupulosity often experience intense guilt and fear of being judged or deemed immoral.
• OCD exploits areas of high personal value, such as being a good person, causing compulsions to develop.

Manifestations

• Harm Obsessions: Unwanted thoughts of causing harm become linked with fears of being morally corrupt.
  • Fear of judgment from self and others.
  • Often involves self-criticism and fear of potential future harm.

Example Scenario

• Individual fears germs leading to illness in others.
  • Anxiety about being responsible for transferring germs.
  • Resulting in excessive cleaning to prevent perceived blame.

Compulsive Self-Shaming/Self-Criticism

• Repeated self-criticism serves to avoid uncertainty.
  • Results in lower self-worth and continued OCD cycles.
• As individuals progress in treatment (e.g., ERP), self-shaming can increase as part of adaptation to uncertainty.
• Self-shaming can serve as a reminder to prevent future perceived moral failings.

Treatment

• Exposure and Response Prevention (ERP) is the effective treatment strategy.
  • Involves facing scrupulous triggers without resorting to compulsions.
  • Patients develop a hierarchy to gradually confront and manage anxiety triggers.
  • Includes tolerating uncertainty and the possibility of being wrong or judged.
  • Imaginal exposures can address abstract feared outcomes.

Key Takeaways

• Guilt and self-judgment are central issues in moral scrupulosity.
• Addressing moral scrupulosity requires accepting uncertainty and reducing compulsive behaviors.
• ERP assists individuals in managing their fears and learning to live with uncertainty.

Conclusion

• Individuals can find fulfillment despite uncertainty about their morals and actions.
• OCD should not dictate one's moral compass or life navigation.