This article draws upon the insights shared by clinical psychologist, Dr Amy Talbot, at an ADM Mental Health Institute Spotlight Session on Obsessive Compulsive Disorder (OCD).
When someone is wrestling with certain spiritual concerns, such as—‘Have I committed the unforgiveable sin?’, or ‘God is very disappointed with me because I’m not taking his word seriously enough’—our knee-jerk (and entirely appropriate) reaction is to pursue a spiritual solution. If you are the one experiencing the tussle, you might seek the assistance of a trusted pastor or mature Christian. If you are the one offering pastoral support, you will probably ask a few questions to gain a clear understanding of the issues involved and turn to the Scriptures for counsel. Hopefully, the wonderful gospel of God’s grace will relieve the feelings of distress and bring comfort and consolation.
There are times, however, when this course of action, done repeatedly, can make things worse. That’s because the need for ongoing reassurance may indicate an underlying mental health condition known as scrupulosity.
Scrupulosity is a sub-type of Obsessive Compulsive Disorder (OCD). At our recent Spotlight Session on OCD, Dr. Amy Talbot shared that OCD is marked by obsessions (‘recurrent, persistent thoughts, urges, or images that are unwanted, and trigger intense distress’) and compulsions (‘repetitive behaviours or mental acts that the individual engages in that are aimed at preventing or reducing anxiety or distress caused by obsessions, or preventing some dreaded event or situation’).
We all experience intrusive thoughts at times: did I forget to lock the house, or did I leave the stove on? Maybe you’ve been at a lookout, and you’ve had a strange thought about jumping off. Or perhaps a sudden thought about hurting someone. For most, such thoughts are easily set aside and don’t interfere with everyday life.
Not so for those experiencing OCD. Some trigger sets off an obsessive thought, feelings of distress follow, and the person engages in some compulsive behaviour or mental act that reduces the angst. But the more one seeks to settle these thoughts, the harder they become to resist. The intrusive thoughts can become more intense, with a need to respond with more compulsive behaviours that provides some temporary relief, only for the thoughts to return … and so the cycle continues and gains strength.
Many researchers and clinicians with expertise in OCD believe that it’s the appraisal or interpretation placed on the obsessive thought that drives the compulsive behaviour. For example, let’s consider the compulsion to wash hands excessively. The trigger might be touching a door handle. The obsessive thought is, ‘I’m contaminated’. If the appraisal made is, ‘I’ve had the thought; that means it’s true’, distress quickly follows which leads to the extreme hand washing.
One feature of OCD is that the obsessions and compulsions tend to focus on things we value. For Christian believers, our relationship with God is of utmost concern. Obsessive thoughts, therefore, can arise in relation to perceived failings in our faith and behaviour. Examples include:
Obsessive thoughts like these can lead to a variety of compulsions, including:
As I reflect on my own pastoral ministry, I can recall situations in years past when I have had multiple conversations with the same individual about their doubts or other spiritual concerns. My attempts to bring words of comfort were well-intended, but the reassurance I offered only served to reinforce the obsessive thinking—that’s why they kept returning with the same sense of unease.
Scrupulosity (and other OCD) symptoms can also be reinforced by misunderstanding some scriptural emphases. Verses that affirm that our outward life (words, thoughts, actions) reflects our heart (e.g. Proverbs 4:23; Matthew 12:33-37), or verses that suggest that our thoughts are essentially the same as actions (e.g. Matthew 5:21-22; 27-28), can result in someone granting intrusive thoughts a significance that is not, in fact, warranted.
So, what might be a helpful way forward? Whether you’re experiencing the symptoms of scrupulosity, or are seeking to provide support, Amy suggested that a compassionate church environment will bear a number of things in mind.
This includes recognising the possible signs, and understanding that intrusive thoughts are symptoms, not manifestations of sin or lack of faith.
An Associate Professor of English, Alan Noble, who has lived experience of scrupulosity, believes that ‘every minister is going to face at one point in their ministries or another: someone coming to them seeking moral or religious clarity in an unhealthy, compulsive manner.’1 OCD is the fourth most common psychological disorder in Australia (around 3% of the population); these traits will be present in most congregations. So, let’s be informed.
Our thought world is complex and there are psychological factors that impinge upon our patterns of thinking. As noted above, intrusive thoughts are normal. Each day we have many thoughts not aligned with our faith and values, yet these do not shift our convictions. Doubt, therefore, is frequently an accompaniment to the Christian life, and a scriptural response will attend more to Christ rather than focussing on how we think as the more important factor (see more in point five below). A church culture marked by such an understanding will make it easier for those wrestling with internal obsessive thoughts to feel able to disclose them and receive assistance.2
Addressing doubts or perceived failings will naturally involve talking through biblical and theological themes. When, however, the same conversation is happening again a week or two later, accompanied by significant anxiety or worst-case scenarios, let’s be alert that scrupulosity might be at play. We need to gently acknowledge that reassurance is not likely to be helpful and sit in the discomfort together.
Find a psychologist with expertise in the use of evidence-based treatments for OCD, such as Exposure & Response Prevention (ERP) and be able and willing to refer on for professional support. ERP involves facing up to the triggers and intrusive thoughts without engaging in the usual compulsive behaviours. Over time, the individual learns to tolerate distressing feelings until they subside on their own, thereby breaking the cycle. It may also be necessary to see a doctor—SSRI medication taken in high dosage for long duration can be effective.
Rather than the inward focus on obsessions & compulsions, focus on what God is like and what he has done. The very heart and wonder of the gospel is that it is what Christ has done outside of us that saves us, not our efforts to improve our Christian life. Faith can be weak; doubts can be strong; our love and service may be lukewarm. But no matter what inadequacies plague us, God’s grace and mercy abounds. Our sin and weakness stir his compassion. His forgiveness remains steadfast and secure. Although reassurance is not helpful, we all benefit from being reminded of rich biblical truths—that God loves us and will never forsake us as his beloved children.
Finally, let’s all play our part in making our churches safe spaces, where people can share their struggles without judgment or being shamed, and find prayerful support and encouragement.
How do you usually respond to someone who is wrestling with spiritual concerns? We’re likely to listen, pray, offer care, counsel, and comfort from God’s word. But (very) occasionally, this is entirely the wrong approach. That’s because the need for ongoing reassurance may indicate an underlying mental health condition known as scrupulosity – a sub-type of Obsessive Compulsive Disorder (OCD).
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