Scrupulosity

[10] Exposure and response prevention (ERP), a form of behavior therapy, is widely used for OCD in general and may be promising for scrupulosity in particular.

[1][2] ERP is based on the idea that deliberate repeated exposure to obsessional stimuli lessens anxiety, and that avoiding rituals lowers the urge to behave compulsively.

[10][11] However, ERP is considerably harder to implement than with other disorders, because scrupulosity often involves spiritual issues that are not specific situations and objects.

[1] Although serotonergic medications are often used to treat OCD,[10] studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.

[7] There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0–7% in countries like the U.K. and Singapore, to 40–60% in traditional Muslim and orthodox Jewish populations.

Ignatius of Loyola, founder of the Jesuits, 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.

"[20] Martin Luther also suffered from obsessive doubts; in his mind, his omitting the word enim ("for") during the Eucharist was as horrible as laziness, divorce, or murdering one's parent.

[21] Although historical religious figures such as Loyola, Luther and John Bunyan are commonly cited as examples of scrupulosity in modern self-help books, some of these retrospective diagnoses may be deeply ahistorical: these figures' obsession with salvation may have been excessive by modern standards, but that does not mean that it was pathological.

[22] Scrupulosity's first known public description as a disorder was in 1691, by 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".

Duguet, and other religious authorities and figures attempted to develop solutions and coping mechanisms;[1] the monthly newsletter Scrupulous Anonymous, published by the followers of Liguori, has been used as an adjunct to therapy.

Studies in the mid-20th century reported that scrupulosity was a major problem among American Catholics, with up to 25 per cent of high school students affected; commentators at the time asserted that this was an increase over previous levels.

[23] Starting in the 20th century, individuals with scrupulosity in the U.S. and Britain increasingly began looking to psychiatrists, rather than to religious advisors, for help with the condition.