Moral scrupulosity is a common presentation of Obsessive Compulsive Disorder (OCD) wherein the client feels like they have to “always do the right thing.”  While this sounds like a positive trait, moral scrupulosity can cause a tremendous amount of internal suffering.  

Some moral scrupulosity runs in parallel with religion. We may question whether or not we are acting in a way that is in line with our sacred texts or our church’s rules around behavior.  People with OCD may also look to authority figures in their workplaces or homes, and obsessively worry whether they are living up their standards.  When moral scrupulosity presents in children, they agonize about whether or not they are a “good child.”

Other times, moral scrupulosity is entirely internally driven.  Whatever personal rules get established, they must be followed rigidly.  For example, a person may consider it wrong to eat before others at the dinner table.  So they compulsively observe that all other family members have started eating before picking up their fork.  In moral scrupulosity, the client with OCD has established ethical guidelines, and they may not always be useful or even objectively “right.”  

Furthermore, moral scrupulosity leads us to the compulsions of checking and reassurance seeking to soothe our fundamental worry that we are immoral.  Even passing thoughts are not immune to the OCD’s scorn.  In fact, those clients that have both harm OCD (obsessive but essentially benign thoughts about harming themselves or others) and moral scrupulosity OCD can find themselves in frequent negative self-talk spirals.  “How could I think that? Am I such a bad person?”  The person is then driven to compulsively over-correct for a hurtful thought, in order to soothe their fears.  A mother who has intrusive thoughts about hurting her baby as well as moral scrupulosity, may spend hours observing the baby monitor to balance out her mental “wrongdoing.”

Moral scrupulosity, like other presentations of OCD, can be effectively treated with Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP).  Utilizing CBT, we would essentially lead a client to observe, evaluate, and examine the evidence around these obsessive thoughts about morality, and question the necessity and efficacy of the compulsions.  CBT would also support a client in letting go of some of the negative self-beliefs that may be the core fears behind the moral scrupulosity.  

With ERP treatment for moral scrupulosity, we would create real-life and imaginational exposures wherein the client does “immoral” things and learns to tolerate the distress.  In the dinner table example, our client would be assigned the homework to take a bite of the food before anyone else in his family and then to resist any secondary compulsions that may come up as a result of this OCD challenge.  

Moral scrupulosity may seem like a relatively unproblematic dimension of OCD, but it is very important to get treatment.  The suffering caused is internal.  Many moral issues are contradictory and we may be caught in decision paralysis.  For many, the striving for moral perfection can be both exhausting and defeating.  

To move past this type of OCD, we must also reach a place of deep knowing that we do not need the scrupulosity to be moral.  Therapy can address these core fears and bring a new sense of confidence in our inherent goodness.