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Scrupulosity is a medical term that refers to a relatively common form of obsessive–compulsive disorder characterized by pathological guilt about religious or moral issues. It is often highly distressing, and attributed to compulsive observance of religious rituals.
The term is derived from the Latin scrupulum, a sharp stone, implying a stabbing pain on the conscience. Scrupulosity was formerly called scruples in religious contexts, but the word scruples now commonly refers to a troubling of the conscience rather than to the disorder.
In scrupulosity, a person's obsessions focus on moral or religious fears, such as the fear of being an evil person or the fear of divine retribution for sin. Although it can affect nonreligious people, it is usually related to religious beliefs. In the strict sense, not all obsessive–compulsive behaviors related to religion are instances of scrupulosity: strictly speaking, for example, scrupulosity is not present in people who repeat religious requirements merely to be sure that they were done properly.
Typical treatments for obsessive–compulsive disorder (OCD) seem to be relatively ineffective for scrupulosity, or may require special considerations. Little overall support exists for any of the several possibly-effective treatment approaches. Evidence for effectiveness of drugs is meager. Exposure and response prevention (EPR), a form of behavior therapy, may be promising, and cognitive therapy may be appropriate when EPR is not feasible. Religious counseling may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety.
The clinical handbook of obsessive-compulsive disorders recognizes cognitive-behavior therapy (CBT) and serotonergic medications (e.g. sertraline) as possible treatments for OCD in general, but states that scrupulosity presents particular challenges to the use of exposure-based CBT. The handbook states that Ciarrochi's book on Scrupulosity (listed below) is a useful resource for helping strictly religious patients.
The prevalence of scrupulosity is speculative; available data do not permit reliable estimates, and available analysis mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. Available data suggest that the prevalence of obsessive–compulsive disorder (OCD) does not differ by culture, except where prevalence rates differ for all psychiatric disorders. No association between OCD and depth of religious beliefs has been demonstrated, although data are scarce. There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from countries like England and Singapore where the percentages are quite low (0–7%), to traditional Muslim and orthodox Jewish populations where the percentages are 40–60%.
Scrupulosity is the modern-day medical diagnosis that corresponds to a traditional use of the term scruples in a religious context, e.g., by Roman Catholics, to mean obsessive concern with one's own sins and compulsive performance of religious devotion. This use of the term dates back to the twelfth century. Ignatius of Loyola, founder of the Jesuits, had symptoms: in 1522–1523 he wrote "After I have trodden upon a cross formed by two straws,... there comes to me from without a thought that I have sinned;... this is probably a scruple and temptation suggested by the enemy". St. Alphonsus Liguori defined it in 1730 as "groundless fear of sinning that arises from 'erroneous ideas'".
Scrupulosity's first known public description as a disorder was in 1691, by Bishop John Moore, who called it "religious melancholy" and said it made people "fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it." In the nineteenth century, Christian spiritual advisors in the U.S. and Britain became worried that scrupulosity was not only a sin in itself, but also led to sin, by attacking the virtues of faith, hope, and charity. Studies in the mid-twentieth century reported that scrupulosity was a major problem among American Catholics, with up to 25% of high school students affected; commentators at the time asserted that this was an increase over previous levels.
Starting in the twentieth century, individuals with scrupulosity in the U.S. and Britain increasingly began looking to psychiatrists, rather than to religious advisors, for help with their disorder.
- ↑ 1.0 1.1 Template:C book
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- ↑ Clinical handbook of obsessive-compulsive disorder and related problems by Jonathan S. Abramowitz, et al 2008 ISBN 080188697X page 163
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- Ciarrocchi, Joseph W (March 1995). The Doubting Disease: Help for Scrupulosity and Religious Compulsions. Paulist Press. ISBN 0809135531.
- Collie, Robert (2000) The Obsessive-Compulsive Disorder: Pastoral Care for the Road to Change. Routledge ISBN 078900707X.
- Osborne, Ian (2008) Can Christianity Cure Obsessive-Compulsive Disorder?: A Psychiatrist Explores the Role of Faith in Treatment. Brazos Press ISBN 1587432064
- Santa, Thomas (1999) Understanding Scrupulosity. Liguori Publications ISBN 0764803735
- Van Ornum, William (1997) A Thousand Frightening Fantasies: Understanding & Healing Scrupulosity & Obsessive Compulsive Disorder. Crossroad Publishing ISBN 0824516052