Moral OCD, also known as scrupulosity OCD, is a type of obsessive-compulsive disorder (OCD) that involves obsessions and compulsions related to morality, ethics, religious or philosophical beliefs. People with moral OCD experience intense feelings of guilt, self-doubt, shame and anxiety about whether they are morally good people. They may obsess over thoughts, doubts or mental images about committing sins, doing something unethical, or violating their personal values.
What are the symptoms of moral OCD?
Some common symptoms of moral OCD include:
- Obsessive fears about immoral thoughts or doubts about one’s character
- Intrusive mental images or “blasphemous thoughts” that contradict one’s religious beliefs
- Excessive concern over “right and wrong” or adhering to rules
- Compulsive behaviours to reduce feelings of guilt or anxiety
- Reassurance seeking from others about thoughts/behaviours
- Avoiding situations that may trigger obsessions or anxiety
- Repeating prayers, mantras or rituals to prevent harm
- Ruminating excessively over minor conflicts or past mistakes
People with moral OCD may realize their obsessions are irrational or excessive, but they cannot control them. The obsessions and anxiety feel very real in the moment.
What causes moral OCD?
The exact causes of moral OCD are unclear, but contributing factors may include:
- Genetics – OCD tends to run in families, so genetics likely play a role.
- Brain chemistry – People with OCD may have different levels of certain neurotransmitters like serotonin.
- Negative life events – Stressful or traumatic events may trigger the onset of OCD in some people.
- Personality traits – Being a perfectionist, having high moral standards, or black-and-white thinking could increase susceptibility.
- Brain structure – Some studies have found differences in parts of the brain associated with OCD.
OCD is essentially a disorder of the brain and biology. It is not caused by any character flaws or mistakes a person has made in life. Moral scrupulosity themes are common because they involve universal human concerns like right/wrong and guilt.
How is moral OCD treated?
Moral OCD is treated using cognitive-behavioral therapy (CBT) techniques and medication. Some effective treatment approaches include:
- Exposure and response prevention (ERP) – Gradually exposing yourself to feared thoughts/situations and resisting the compulsion to do rituals.
- Cognitive therapy – Identifying and challenging irrational thinking patterns that lead to obsessions.
- Acceptance and commitment therapy (ACT) – Learning to accept obsessive thoughts without reacting to them.
- Medications – Selective serotonin reuptake inhibitor (SSRI) medications can help reduce OCD symptoms.
Treatment is focused on reducing avoidance behaviors, decreasing reliance on compulsions, and recognizing that the obsessions are not meaningful threats. With proper treatment, individuals with moral OCD can overcome their symptoms and regain quality of life.
How is moral OCD different from normal morality or ethics concerns?
There are some key differences between moral OCD and ordinary moral concerns:
- Everyone has occasional doubts, guilt, or ethical dilemmas. But moral OCD obsessions are excessive, unrealistic, or distressing.
- Most people can let minor issues go. Those with moral OCD feel compelled to keep dwelling on minor mistakes or conflicts.
- People without OCD can recognize irrational fears. Moral OCD makes trivial things seem like major, ominous threats.
- Those with moral OCD rely heavily on compulsions for relief from obsessions. Most others do not need rituals to manage guilt.
- Moral values are usually principles one believes in. Moral OCD obsessions often go against one’s true principles.
In short, moral OCD causes you to obsess about things that you know deep down are not actually immoral. But the obsessions feel ego-dystonic and very distressing in the moment.
Examples of moral OCD obsessions and compulsions
Some examples of obsessions and compulsions seen in moral OCD include:
Obsessions
- Fear of accidentally committing blasphemy or sin
- Intrusive thoughts about harming others, sexually inappropriate acts, or sacrilege
- Worrying excessively about lying or cheating
- Doubt about already completed acts (e.g. “Did I actually commit that sin?”)
- Analyzing past behaviors to check for immorality
- Fears of having unacceptable thoughts or being a bad person
Compulsions
- Repeating prayers or rituals until it “feels right”
- Mentally reviewing past events to check nothing bad was done
- Avoiding triggers like religious places or themes
- Over-confessing minor sins or errors
- Reassurance seeking from others about being a good person
- Researching philosophical rules excessively
- Checking repeatedly that nothing sinful/immoral was done
Carrying out the compulsions provides temporary relief from obsessions, but reinforces the OCD cycle long-term. True relief comes from sitting with uncertainty and resisting the urge to do compulsions, with support from a therapist.
Can moral OCD cause thoughts of harming others?
Yes, moral OCD can sometimes cause obsessional fears about harming others. For example:
- Fear of violently harming loved ones, strangers, or animals against one’s will
- Intrusive thoughts about sexually assaulting someone
- Obsessions about accidentally or intentionally killing others
- Worries about having the latent desire or potential to harm others
These kinds of harm obsessions are extremely disturbing to the sufferer. But it is important to understand that people with moral OCD have no actual intention or desire to harm anyone. The obsessional thoughts are ego-dystonic (go against the person’s true desires).
Compulsions like avoiding knives, loved ones, or checking news stories provide temporary relief. But true relief comes from facing uncertainties head on and recognizing the thoughts as meaningless obsessions.
Do people with moral OCD have a higher risk of committing immoral acts?
No, people with moral OCD are not at higher risk of committing immoral, unethical or harmful acts compared to the general public. In fact, there are several reasons why those with moral OCD are unlikely to act on their obsessions:
- They have an excessive conscience, not one that is too relaxed.
- Their obsessions go against their true moral values.
- They avoid situations that could lead to harm.
- The obsessive thoughts are ego-dystonic and unwanted.
- Their primary fear is harming others or doing immoral acts.
Those with harm obsessions have a pathological fear of harming others, not a desire to do so. Their moral standards are likely higher, not lower, than the average person’s. People with moral OCD deserve compassion, not judgment or suspicion.
Should you confess moral OCD thoughts to others?
No, confessing the content of moral OCD obsessions is generally not recommended. Instead, consider these healthier approaches:
- Tell loved ones you struggle with OCD focused on moral/religious themes.
- Explain the thought content is distressing but not reflective of your true self.
- Reassure them you have no intention to act on the thoughts.
- Ask them to help by not providing reassurance when you confess obsessions.
Confessing obsessions provides temporary relief but leads to a vicious cycle. The “confessor” feels compelled to confess again to receive forgiveness. It is better to take away the power of the thoughts by sitting with the uncertainty.
How can you support a loved one with moral OCD?
If a loved one opens up about their struggle with moral OCD, here are some ways you can support them:
- Learn about moral OCD to better understand what they are experiencing.
- Reassure them you know the intrusive thoughts are not their true intentions or desires.
- Avoid making moral judgments or providing reassurance when they confess obsessions.
- Encourage them to seek treatment from a therapist experienced in OCD.
- Remind them they are not their thoughts – they have intrinsic worth beyond whatever their OCD tells them.
- Ask how you can best support recovery without enabling rituals.
With compassion, education, boundaries and support, you can help your loved one get appropriate treatment and break free from the grip of moral OCD.
What is the outlook for people with moral OCD?
With proper treatment, the outlook for people with moral OCD is very hopeful. Cognitive-behavioral therapy leads to significant symptom improvement in most moral OCD cases. Although OCD is chronic, recovery is very possible.
It takes time and courage to face uncertainty and stop compulsions. But millions have overcome their moral OCD through CBT, medication, self-compassion, and support systems. With treatment, you can reclaim your sense of ethics, values and goodness.
Conclusion
Moral OCD is a challenging but treatable subtype of OCD involving obsessions related to right, wrong, ethics, responsibility, religious beliefs, or philosophy. Anyone can develop moral OCD, which has more to do with brain biology than one’s character. The key to recovery is recognizing that the obsessive thoughts are exaggerated and not meaningful threats in need of reaction. With proper support, those with moral OCD can overcome their obsessions and experience freedom from constant moral analysis.