213. Pt 2: Why Scrupulosity is so Complicated and Hard to Treat
In this episode, Carrie continues exploring why scrupulosity can feel so layered and difficult to untangle. She examines the hidden fears, spiritual experiences, and beliefs about God that may be quietly fueling the struggle.
Episode Highlights:
- How scrupulosity often attaches itself to other OCD themes
- What it means to identify the “primary obsessional doubt” beneath the surface
- Why theology and personal history both matter in recovery
- How early relationships can shape your view of God
- Why healing may require examining both belief systems and identity
- What it looks like to move from an identity rooted in fear to one rooted in being loved
Episode Summary:
Why Is It So Hard to Trust a Therapist When You Have Scrupulosity?
Welcome back, OCD Warriors.
In Part One, we talked about the lack of awareness in church spaces, beliefs about mental health and medication, and how Christians sometimes struggle with thoughts and feelings. Today, I want to go deeper.
One of the most complicated layers of scrupulosity is this: distrust.
Many Christians struggling with OCD come to me after trying to get help from someone who simply did not understand what they were going through. Sometimes the first person they talk to does not have the clinical training to treat OCD well. Other times, they sit across from a therapist who does not share their faith and cannot grasp why certain fears feel so spiritually intense.
That experience lingers.
It makes you cautious. It makes you hesitant to try again. And sometimes it makes you question whether real help even exists.
Why Does Getting Help for Scrupulosity Feel So Complicated?
Scrupulosity lives in a space where faith and clinical treatment intersect.
Because the fears sound spiritual, it makes sense to seek spiritual help first. But OCD follows a specific reasoning pattern, and without understanding that process, reassurance can unintentionally make things worse.
On the other hand, working with someone who does not understand why certain fears feel eternal can feel just as unsettling.
That tension alone can delay healing.
Why Does Scrupulosity Rarely Show Up Alone
Another layer that makes this theme so complex is that it often attaches itself to other OCD struggles.
Relationship doubts can turn into fears about being outside of God’s will. Intrusive thoughts can morph into questions about salvation. Contamination fears can become spiritualized.
Now the anxiety feels heavier. Not just uncomfortable, but ultimate.
And if we only focus on the surface issue, we may never get to the deeper fear underneath.
What Is Beneath the Surface of the Fear?
When we slow down enough, there is often something more vulnerable at the core.
Not just “Am I right?”
But “Am I still loved?”
Not just “Did I sin?”
But “Am I disconnected from God?”
Until that layer is acknowledged, treatment can feel like circling the same arguments again and again.
How Do My Experiences Shape My View of God?
For some people, scrupulosity is intertwined with early experiences of authority, correction, or fear.
If you grew up feeling constantly criticized, it can subtly shape how you imagine God responding to you. If you learned that love was conditional, that belief can follow you into your spiritual life.
Sometimes the nervous system is reacting to old patterns, not to God Himself.
Healing may require looking gently at where those patterns began.
What Happens When My Identity Begins to Shift?
If you have long believed you are disappointing to God, stepping into the identity of beloved child can feel unfamiliar at first.
New beliefs require a new identity. And even good change can feel destabilizing.
Scrupulosity is layered for a reason. It is not simply a lack of faith or effort.
In this episode of Christian Faith and OCD, we continue unpacking why this theme can be especially complicated to treat and what that means for your healing journey.
If this resonates, I invite you to listen and lean in. 💛
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Transcript
Welcome back, OCD Warriors, to part two of Why Is Scrupulosity So Complicated and Hard to Treat? Hello, and welcome to Christian Faith and OCD with Carrie Bock. I’m a Christ follower, wife, and mother, and a licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. When I couldn’t find resources for my clients with OCD, God called me to bring this podcast to you with practical tools for developing greater peace. We’re here to bust through the shame and stigma surrounding struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith. I’m here to help you let go of the past and future to walk in the present, abundant life God has for you. So let’s dive right into today’s episode.
I got really long-winded, so we did part one last week, where I went over three points in greater detail. I would encourage you to go back and listen to that episode if you haven’t already. As a quick review, the first three points were: a lack of awareness in the church or biblical counseling circles, which leads to a delay in treatment; two, all kinds of beliefs about mental health and medication in the church; and number three, the Christian church has an unhealthy relationship at times with thoughts and feelings. So let’s dive right into the next point.
Number four, why scrupulosity is so complicated and hard to treat, is a severe distrust of non-Christian providers, as I spoke about in terms of the biblical counseling examples. Unfortunately, Christians who are struggling with OCD, often the first person they seek help from lacks the necessary skills and experience to truly be able to help them. I find that really sad, but that’s the truth.
Now, some people don’t trust non-Christian providers based on past negative experiences, and I’ve heard all of the stories from you guys about trying to seek help and really just feeling like the person just didn’t get it. I mean, I think as clients—I’m someone who’s the therapist, but I’ve been to several different therapists—sometimes you sit down with a therapist and you can just exhale. You’re like, ah. They get it. They understand what I’m dealing with. They’re able to make empathetic reflections and say, yeah, that makes sense to me, and here’s why. It seems like you’re feeling this way, and there’s this sense of relief that comes over you, like, okay, this person is gelling. But then there are other times where you meet with therapists and you’re like, this person just has no idea what I am going through right now. They may have difficulty empathizing with your experience.
This can be true if someone doesn’t believe in God or value religious experience. They may have a really hard time empathizing that potential blasphemy or potential sin is really distressing to you, or this idea that you might be outside of God’s will or that you might not go to heaven. It can be just hard for them to get that. Maybe at the same time, there have been negative experiences where people have done non-religiously sensitive exposures, haven’t really worked with a pastor or spiritual leader, as IOCDF really recommends and proposes, just making sure that the clinician is working with the church, especially if they’re unfamiliar. Sometimes those things have happened.
Also, I’ve heard stories about therapists maybe making fun of hell, for example, trying to kind of make things more lighthearted or get the client to not take it so seriously. However, of course, this is going to be very distressing to somebody with scrupulosity who believes hell is a real place.
I just want to say a note here about, okay, in an ideal world, you would be able to find a Christian who has good clinical knowledge about OCD and is able to treat you. What if you have to go into maybe an intensive outpatient treatment program, a residential treatment program? What if you really, really need to use your insurance? You’re financially limited in the providers that you can see. Maybe there aren’t a whole lot of people who take insurance that are treating OCD. I would say, I think a lot of times people fear being led astray, but typically those people that fear that are pretty strong and grounded in what they actually believe. And I would say, don’t underestimate God’s ability to use nonbelievers.
What I mean by that is you look at this whole situation with Moses and Pharaoh, for example. Ultimately, God used Pharaoh and the Egyptian people, who were not following Him, in order to bless the people of Israel. They essentially got all of this gold and other things that they gave them for their journey, let them release them from slavery in the end, of course, after all the plagues and all that. This is shown through Scripture, even God using other nations to discipline Israel. So don’t underestimate the ability for God to use nonbelievers. If you need treatment and you need help, if you find a really good clinician, they’re going to be somebody that wants to work with you from your particular faith experience and your particular belief systems.
Now, people may think that it’s easier for me because I’m a Christian who works with Christians. Newsflash: it’s not. I still have to do this work myself because there are so many different denominations and streams of Christianity. I have to ask a lot of questions often to find out where people are coming from, and people don’t always hold the same beliefs or practices that I do. And so I’m really looking at where are they coming from, how are their symptoms affecting them, and how maybe their beliefs are intertwined. The OCD is intertwined with the particular belief system, and understanding the belief system and the practices, of course, helps.
I can tell you just from personal experience that working with somebody who’s Catholic versus somebody who’s in the Orthodox church versus somebody who’s a Mennonite versus somebody who’s in a charismatic church—their beliefs and practices may be very different, and that’s okay. Regardless of where you’re coming from, you can still recover in your OCD journey. You don’t have to completely change denominations or anything of that nature.
Number five, scrupulosity often does not exist by itself but becomes an offshoot of other OCD themes. It’s pretty rare that I find somebody who is only dealing with scrupulosity. Typically, they have had a history of other OCD themes, or they’re starting with one OCD theme, and then scrupulosity interferes and almost adds this whole other layer on top of the theme.
So even if someone has, for example, themes about relationships—should I be with this person or not?—then that can go into, well, if I marry this person, then I’m somehow messing up God’s will for my life if it wasn’t meant for us to be together. It could be a situation where I have some type of contamination OCD, but then that gets blended in with, it’s a sin to be contaminated, or I’m unclean in some type of way because of my sin. And so then I’m doing some type of hand-washing rituals because of certain thoughts I’m having.
So I’ve seen this come up quite a bit. Any type of sexual themes also ends up feeding scrupulosity. What kind of Christian am I if I have these thoughts? Maybe that means this about my faith. I don’t really love God because I’m having these types of intrusions or I’m having sexual intrusions. And then, like I said before, confusing that temptation for sin. So scrupulosity getting combined with other forms of OCD creates these extra layers to deal with, right?
So we’re not really at the root of the issue sometimes when we’re just dealing with the scrupulosity if it is connected to another theme. So it may be helpful to look at what someone was obsessing with before the scrupulosity came along and latched onto the top of it. Even something like I gave the example before about the denominations. It’s like, are we really at what ICBT would call the primary obsessional doubt? You can get caught up in the weeds a lot in scrupulosity, which makes it super hard on the treatment end.
So for the example that I gave earlier about which denomination to follow, is that really the primary obsessional doubt? Or is the primary obsessional doubt at a deeper layer, such as, what if I offend God, or what if I make the wrong decision and I’m outside of what God wants me to do? People can spend a lot of time in therapy hashing out these ideas or ruminating about, well, this denomination says this and that denomination says that. You can get super in the weeds about Calvinism versus communionism and these other things that may be really bothering someone, but then you’re never actually getting down to the root of what is actually scaring them.
What are you actually concerned about? And typically what I’ve seen is there’s some type of worry or doubt about being disconnected from God in some way, shape, or form. Whether that’s present disconnection from God—I’m going to be sinning and God’s going to be displeased with me—or whether it’s future disconnection from God in terms of I’m not going to be saved and I’m not going to be going to heaven. You’re not going to really be able to deal with the issue if you can’t get down to the primary obsessional doubt in terms of ICBT or some type of core fear that you’re experiencing.
Oftentimes, it’s really hard for people to go there because it’s very scary. It feels very vulnerable, and it’s hard to even maybe know in your own mind, what am I really doubting in this situation? If you do get down to that point—this fear of disconnection from God or fear of punishment or being unsafe, somehow missing something, and then if I miss it, I’m somehow going to be displeasing or rejected—when you get there to that vulnerable, scary place, then you can be able to recognize the obsessional reasoning process, the arguments that OCD is using, and get to what your alternative narrative needs to be.
Now, when you hit that primary obsessional doubt and, in essence, this core thing that you’re afraid of, then we get to point number seven, where treating scrupulosity requires that you take a hard look at your theology and where it came from. We get all kinds of ideas about God, whether that was from a pastor you grew up with who was hellfire and brimstone. You may not believe those things about God now, but it’s still stuck back in there in your subconscious, and your nervous system remembers that fear, that intense fear that you felt when you heard that pastor.
You may have had parents that quoted certain Scripture verses to you or were very harsh toward you in their discipline, and they may have somehow incorporated God into certain things. OCD-wise, God doesn’t want you to be a lazy person. God doesn’t want you to be dirty. Cleanliness is next to godliness, whatever it was. Those ideas from people got mixed in with your theology. You have to be able to examine, how did I come to believe the things that I do about God? I think that is crucial.
Oftentimes, there are things that we don’t recognize because it’s just the water that we’ve been swimming in. Until you get in treatment or talk to another therapist where they’re like, where did you come to have that belief? Or how did you get to that point? It’s like, well, it just is. It’s black and white, right?
There’s a lot of conversation nowadays about deconstructing your religious beliefs that you were taught and that you grew up with. You really don’t want to have deconstruction unless you’re going to have some type of reconstruction, right? What are we going to believe now about God? Are we going to use Scripture to inform our belief systems, or are we going on our own experiences?
Knowing that your experiences with God, if you have a relationship with Him, there may be experiences that you have that really challenge what you were taught. There may be Scriptures that you read in the Bible where you say, wait a minute, I wasn’t taught that. I was taught that I was nothing in the sight of God, that I wasn’t important, that I wasn’t valued, that I was just kind of here for God’s purposes. I was basically taught that I was scum. Now I’m seeing all these verses in the Bible about how God rejoices over me with singing, that we talked about on the love episode on the podcast, how God has loved us with an everlasting love, how God sees me as His child. And I look at my own children and see how I see them, and if God sees me that way, then wow, that’s completely different than what I grew up believing.
Whatever it is for you, I think you have to be able to take a hard look and recognize maybe something that I believe is not true and it’s not in alignment with my relationship with God.
I’ll give you a very small example in my life that is not of huge relevance, but I was taught as a child, growing up in the Baptist church, that speaking in tongues was not a thing, that it was a thing in the Bible. My dad was a very strong cessationist, where they believed that there was a point where speaking in tongues ceased and it was no more. Since being an adult and going to different churches, I’ve met some people that I consider to be very godly people and strong believers who speak in tongues. So I have a respect for those people, even though I haven’t been given that gift myself.
I would say that that’s one belief that has changed based on my own review of the Scriptures for myself as an adult and through personal experience of talking with other believers. I think we have to free ourselves to acknowledge that maybe our past self was wrong about something, and that’s okay. And maybe our beliefs can change. That’s not necessarily a bad thing.
I know that Steve and I have talked about this with some other non-essential beliefs, that some of his views on certain things have changed over time based on reading the Bible, prayer, personal experience, and talking with other people. So it’s okay and, I think, healthy every once in a while to examine what you believe about God and understand where that came from and why you believe that.
Number eight is you have to be willing to examine how your relationships with others are impacting the scrupulosity, how they’ve impacted your view of God. Specifically, those early relationships that we had with parents, teachers, coaches, grandparents really can influence how we view God. Oftentimes, we take those experiences from other people and place them onto God.
If you just felt like people were constantly disappointed in you, like you could never live up to their expectations, it makes sense that you would believe that God is that way. If you feel like people were just very harsh and always pointing out what you were doing wrong, or you were constantly being punished, maybe you really struggled to please people but you always seemed to get in trouble, and the punishment maybe didn’t quite fit the crime, was maybe harsher than it needed to be—I don’t know what your experience was—but that might be another example where you feel like, okay, God is really harsh and is coming down on me pretty hard.
I had a father who was pretty big and could be pretty scary when he was angry. Not in an I’m going to be beat up kind of way, but more of an authoritative, verbally scary type of way. I definitely put that onto God, like maybe God is like Dad and He’s going to yell at me if I get in trouble, or He’s going to be upset with me if I do the wrong thing. And it took me a while into my adulthood to be able to even call God Father. That just didn’t seem quite right to me.
This understanding now of God as a loving Father has completely changed and shifted things for me. It’s been a healing journey and very therapeutic for me. But it took me a while to get there because, as I shared on the very first episode of this podcast, when I was growing up, God seemed to be very harsh to me. In the Old Testament, God seemed very angry. Now I have a much more balanced view of that because I can definitely see God’s love throughout different pieces of the Old Testament. But back when I was a kid, things didn’t quite make as much sense for me.
I also didn’t see God as wanting to be intimately involved in every aspect of my life. I think my parents did a really good job of taking us to church and talking to us about God when it came to the big things and the moral things. But I really want my daughter to know something that maybe my child self didn’t know, that God cares about your math test on a Tuesday just as much as He cares about you making the right decision over here about something. God wants to be intimately involved in your life. He wants you to go to Him over all types of different things. Things that seem small to us are not insignificant to Him, and He has enough space to hold them. It’s not like we’re going to bother God. If we go to Him about our math test, He’s not going to be like, why are you talking to Me about that? He’s going to be like, I’m so glad that you talked to Me about that. God wants to give us peace.
I didn’t get that picture of God growing up, and now I’m able to tell my daughter, you can talk to God about anything, whatever you need to. And she just has these really sweet prayers at night where she thanks God for different toys in her room, and I just think that that’s beautiful.
Oftentimes, we overcomplicate our connection with God. Jesus said, come like a child. So if we look at how children approach God, then it’s much more simple and much easier than trying to follow a huge, long list of rules or picking apart every little thing to determine whether or not it’s a sin or it’s okay. I think that children have a greater understanding of things being about the heart and doing things out of love.
So how have your relationships with caregivers impacted your view of God? This is really where I believe a great EMDR application can come in. Because if we do have some of those wounding experiences that are stuck in our nervous system and you’re able to process through that and come to the other side where you’re feeling calmer and recognizing, oh, okay, I was hurt by certain people, or I understand I’m making a connection now between a parent and viewing God as harsh, or this super critical parent and viewing God as critical. That type of work typically isn’t going to enter into typical ERP or ICBT treatment.
One of the things that I think is really important and critical is to look at individuals as whole people, to look at the various aspects of what’s happening for them versus looking at them from a lens of diagnosis. When I was much earlier on in my career, someone would come to me and say, hey, I have trauma. I’m like, hey, great, I do this trauma therapy called EMDR. We could handle that. Or someone would come and say, hey, I have anxiety. Oh, great, here’s some tools that I can give you for anxiety. There’s also some things that we can do with EMDR that will really help you get down to the root and not have to carry so much anxiety around in your nervous system.
And it was this much cleaner process, right, of here’s a problem that someone has, and then here’s an appropriate intervention. And it’s also somewhat what we’re taught in school. The longer that you go along, the more complex individuals you find and the more you recognize different approaches can be helpful in different circumstances and situations. I don’t believe in a one-size-fits-all treatment process for anyone.
New beliefs require a new identity. If you are going to embrace new beliefs about faith, new beliefs about God—if you are no longer the unworthy stepchild in the family of God and you are going to be the beloved child—that requires putting on a new identity in Jesus. Sometimes shedding that old identity that’s comfortable or familiar to embrace your new identity in Christ can be really, really challenging if you’ve lived for a really long time believing God was disappointed in you or that you weren’t good enough or that you weren’t ever going to be able to meet His standards.
And now you’re trying to shift over every day into believing that you are absolutely and completely loved, that you have been saved, that the cross is the finished work of Jesus Christ, and there’s nothing else that you need to do to earn God’s love. Ephesians 4 talks about putting off the old self and putting on the new self and understanding who you are in Christ. Freedom is going to be uncomfortable at first if it’s a new experience for you.
What do you think about these points that I came up with? I would love to hear from you. If you’re a therapist that treats scrupulosity, if you’re a person that struggles with it, if you have a family member or a loved one, I’d love to hear your honest feedback on this episode because I just want to know, are other people seeing what I’m seeing in the world and talking about the complexities that get brought into the scrupulosity equation?
If you are struggling with scrupulosity, my hope is that you’ve gotten a few things out of this episode. One is that there is hope for you, that there is a pathway forward, that it may be complicated, but that doesn’t mean that you can’t get help with this. Number two, I hope that it’s validating to you that if you’ve struggled, if you’ve been to a couple different therapists, if you’ve tried the biblical therapy and then tried a clinical counselor who wasn’t Christian and tried to find this happy medium of what you were looking for between solid biblical truth and clinical skills that are going to be able to help you, know that you’re not alone. We get emails from people all the time who are seeking to find that.
If you happen to be a therapist that you feel like is aligned with that vision, where you’re a strong believer and also have strong clinical skills, please write to us. Please reach out via the podcast. You can go to kerrybock.com/podcast. There should be a contact form on there. If not, you can hit us up on the main contact form on the website. We’d love to hear from you. We probably could provide you some referrals because we do have people that reach out to us and ask, do you know anyone in my state? And unfortunately, nine times out of ten, the answer is no.
So if you are a Christian counselor who has some things you want to talk about or have conversations about on the podcast, we’d love to have you and love to be able to add you to our very small, at this point, referral list for Christians who are struggling with OCD.
And if you feel like you’ve only been getting a one-size-fits-all approach, it’s a really great opportunity for you to advocate for yourself and to figure out, okay, what’s the next step? What do I need? I provide consultations for people. I provide intensive experiences, multi-day therapeutic retreats. I have an online course called Empowered Mind for Christians who are struggling with all types of OCD, but many people in there are specifically struggling with scrupulosity. Come join that program and really squeeze all of the goodness that is in there out of it. It’s been able to help a lot of people at this point, and I pray that it continues to be able to help people who feel like they haven’t been able to get the help that they needed before, where it’s been out of reach for some reason for them.
You can reach me at carriebock.com. I love hearing from you guys. Until next time, may you be comforted by God’s great love for you.
Christian Faith and OCD is a production of By the Well Counseling. This podcast is for informational purposes only and should not be a substitute for seeking mental health treatment in your area.
