Accompaniment is key for those who suffer from scrupulosity

by Randy Kiel | May 15, 2024

This article may be a difficult topic to read about, yet I write this because it is a subject that is quite unknown, often misunderstood, and at times wrongly dealt with. We know that physical pain is interpreted and formed in the brain but sourced in the body. How insulting it is when people with physical pain are told, “It’s all in your head!” I remember when a doctor told me that same statement about my back pain years ago. I think I have forgiven him. But this particular affliction is sourced in the conscience of the mind. It stabs the conscience with the judging knives of fear, doubt and guilt. 

In our relationships, we long to be understood by others because being understood comforts us. Nobody likes to be misunderstood; it hurts. Nobody likes to be thought of wrongly; it offends. Nobody likes to be  falsely accused; it frightens. But the affliction that stabs the conscience with the full force of a guilty conviction is called scrupulosity. The scrupulous thoughts are not merely painful, they are dangerous. If they are believed by the suffering person, they can cause immense mental and emotional damage. This damage is not only within the internal nature of the one suffering, but it most often flows into their personal relationships.

What is scrupulosity?

In Latin, the word scrupulis means “a small, sharp stone.” Scrupulosity is a psychological disorder that is primarily characterized by a distorted sense of guilt and obsession. Like a small but sharp stone, it feels as though it lives within the conscience of the person. It is usually accompanied by compulsive moral dilemmas and unattainable religious practices. It is rooted in obsessive compulsive disorder. As a disorder, it is not a spiritual matter or a sin problem, but to the contrary, scrupulosity looks for sin where sin is not. This suffering will commonly speak messages to the person that they are at risk or are already in a state of mortal sin and must be more penitent. The problem then shows itself by an obsession of guilt that is unable to release the compulsion to repent because “There must be something wrong!” 

The scrupulous person will have extreme difficulty making decisions and choices or being flexible with others because of the internal rigidity of fear that lives within the conscience of the person. Above all else, they deeply desire to please God. While the desire to please God is good, this ability is unattainable by the one who suffers with this condition because in the midst of their mind’s obsessive-compulsive loop, therein lies the terror of eternal damnation which may be lurking around every corner. 
Catholics are not the only group of people with the risk of scrupulosity. It can affect all religions as well as other highly rigorous systems, but within religion, scrupulosity lives with a raging internal battle between holiness and sin, righteousness and failure, heaven and hell. It resides between rigidity and self-judgment.

Commonly, people don’t realize that they have this condition because, as from its root of OCD, the rituals which are sought are seen commonly in Catholic practice and are often held with a high spiritual value. This makes the distinction between disorder and devoutness quite difficult. A penitent soul seeking sainthood by living a devout life may have no sign of scrupulosity or this same person may be consumed with scrupulosity. It takes time and relationship with a person to distinguish the difference. Our Catholic impulses and conventional knee jerk reactions to spiritualize these matters, such as encouraging the person to go to confession or pray the rosary,  will not aid the person, but will most likely further the psychological trappings of this affliction.

What to do?

Because religion is not the cause of scrupulosity, it likewise will not be the way toward resolve. Since it is within the psychology and possibly even the biology of the person, it must be dealt with as a psychological mental health matter. While it may affect the person’s spiritual life, it is not rooted as a spiritual matter or condition of sin.

If clergy are to be of assistance, their knowledge of the accuracy of Church teachings may be helpful, but beware, the scrupulous person may be more well-versed in Church teachings than many clergymen. 

What is known so far for help, is that the combination of certain medications and the strong relationship with a professional mental health counselor and a spiritual director that is studied in this disorder, most often lead people to a much lighter sense of personal existence with reduced suffering. 

This suffering penitent needs accompaniment, not controls and fixes, let alone isolation and abandonment. “Lord, may we be granted your patience as we walk with one another, not to control, but merely to accompany.”