Scrupulosity

What is Scrupulosity?

Although Scrupulosity does not have its own diagnostic category in the official psychiatry handbook (The Diagnostic and Statistical Manual of Mental Disorders Opens in new window), the three most recent versions (DSM-IV, DSM-IV-TR, and DSM-5) do mention being “scrupulous” among the criteria for obsessive compulsive personality disorder (OCPD), e.g., if the patient “is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)” (DSM-5: 678).

Being scrupulous is not enough to qualify one as having Scrupulosity. For someone to be diagnosed with OCD or Scrupulosity, that individual must display “true obsession and compulsions” (DSM-5; 681;cf.p.242).

A Little History

Scrupulosity might be found as far back as ancient Rome. Plutarch speaks of “the superstitious man” who “turns pale under his crown of flowers, is terrified while he sacrifices, prays with a faltering voice, scatters incense with trembling hands, and all in all proves how mistaken was the saying of Pythagoras that we are at our best when approaching the gods. For that is the time when the superstitious are most miserable and most woebegone” (Plutarch, 1951:373, 375-376; cf. http://www.ocdhistory.net/biblio.html Opens in new window).

Judaism also refers to apparent cases of Scrupulosity in the Talmud (redacted by 500 CE) and to pretty clear cases of Scrupulosity by the 11th century (Greenberg et al., 1987; Greenberg & Huppert, 2010; cf. Mora, 1969). The 13th-century rabbi Nachmanides says about a particular matter of ritual purity,

It is not good for a person to be too strict, looking into doubts to invalidate [the ritual purification] for a light matter, for there is no end to the matter. … One should not insert his head into [these] serous, interminable doubts. (Laws of Niddah, 9:25)

Nachmanides here echoes a similar sentiment from over 700 years before that a person shouldn’t worry about whether some unobserved rodent might have dragged leaven into a house during Passover, when all leavened products are prohibited from the house: “there would be no end of the matter!” (Mishnah Pesachim 1:2)—whether there were people with such worries from 700 years before wasn’t recorded, but by the time of Nachmanides there apparently were.

Scrupulosity is clearer in the Catholic tradition by the time of Ignatious of Loyola, the 16th-century Catholic founder of the Jesuit order. For example, after carefully confessing all of his sins, his dictated memoirs record:

Even though the general confessions he had made … had been quite carefully done and all in writing, … still at times it seemed to him that he had not confessed certain things. This caused him much distress, because although he had confessed them all, he was not satisfied. Thus he began to look for some spiritual men who could cure him of these scruples, but nothing helped him. …

[H]is confessor ordered him not to confess anything of the past, unless it was something quite clear. But since he found all those things to be very clear, this order was of no use to him, and so he continued with the difficulty. … He persevered in his seven hours of prayer on his knees, getting up regularly at midnight, and in all the other exercises mentioned earlier. But in none of them did he find any cure for his scruples, and it was many months that they were tormenting him. (Loyola, 1991 [1553-1555]:77-78)

This is one of the earliest recorded cases of apparent Scrupulosity in Catholicism, and our understanding of the disorder owes much to the Catholic tradition.

The term Scrupulosity in fact comes from the Latin “scrupulosus,” from which we get the word “scruple”; but this word comes originally from a word referring to a pebble, which was then used figuratively to refer to a cause of uneasiness—in the way that a small pebble caught in one’s shoe would make one consistently uneasy without causing serious pain.

Protestantism also records cases of Scrupulosity perhaps as early as its founding, with many of Martin Luther’s concerns and discomforts about whether his confessions were complete anticipating Ignatius’s worries by only a few decades (Erikson, 1958).

A century later, the English cleric Jeremy Taylor wrote in 1660 of those persons who “dare not eat for fear of gluttony; when they are married they are afraid to do their duty, for fear it be secretly an indulgence to the flesh … and yet they dare not omit it for fear they should be unjust.” A generation later Bishop John Moore referred to what we now call “scrupulosity” as “religious melancholy.” He describes those with Scrupulosity as having a

fear, that what they do, is so defective and unfit to be presented unto God, that He will not accept it. … [They experience] naughty, and sometimes Blasphemous Thoughts … [which] start in their Minds, while they are exercised in the Worship of God … [despite] all their endeavors to stifle and suppress them. … The more they struggle with them, the more they increase.

Interestingly, Moore noted of them as well: They are mostly good: “They are mostly good People … for bad men … rarely know anything of these kind of Thoughts” Moore, 1692: 252–253).

This historical context raises a crucial question: If these people are “mostly good” (as Moore said) and sometimes even literal saints (like Ignatius), then why do modern psychiatrists treat Scrupulosity as a mental illness? Do we really want to say that a saint was mentally ill, or that Protestantism or the entire Jesuit order arose out of a mental disease?

Maybe we will want to say that—you’ll have to keep reading—though it is worth asking how those facts would matter if they are true. Does it tell us anything how those facts would matter if they are true?

Does it tell us anything about a religious or any social group or movement if one of the founders had a mental illness?

What if the mental illness prompted a founder to make certain rules or set up certain structures: Would that forever blemish the group?

Or can we set aside the mental states of the founders and consider the movements on their own merits?

These are difficult questions that, for now, we’ll gently sidestep in order to flesh out Scrupulosity more completely. Our understanding of Scrupulosity and of mental disorders in general has developed significantly since Scrupulosity was first recognized. So let’s look more closely at how we understand it now.

Scrupulosity is currently understood as a form of obsessive-compulsive disorder (OCD), so we begin by explaining OCD in general Opens in new window.