Moral Scrupulosity is a subtype within Obsessive Compulsive Disorder. It is an excessive concern with morality, and can be part of many other OCD subtypes (contamination, harm, sexual obsessions, real event, etc). Part 1 covered the basics in understanding this theme, and how we can treat it with evidence-based approaches. This article will dive into three essential skills for moving toward recovery.
Emotional Reasoning (feeling guilt = I’ve done something wrong)
In OCD treatment, we look at thinking traps. These are patterns of thought that are exaggerated or extreme. We all experience them, but they are very prevalent in anxiety disorders and OCD. With moral scrupulosity in particular; a common thinking trap is emotional reasoning. This trap is taking our feelings at face value, believing they are there for a reason.
Ex) If I woke up anxious, there must be something wrong.
Ex) I have a bad feeling about this event… I will cancel my plan to go.
Ex) I feel guilty after sending that email, I must've said something offensive
With OCD, many people experience intrusive feelings. These can come out of the blue, with no apparent trigger. If we aren’t catching emotional reasoning, we will be at OCD’s beckon call all day long.
Catching emotional reasoning is a skill that is built over time. Start by writing out examples of when this has happened for you. Then, start to label when it comes up throughout the day “I was about to send a text because I felt guilty - that was emotional reasoning”. It may seem too simple, but step 1 is to label and acknowledge when it's happening.
After we build awareness, we can start to notice and label our emotions without as much attachment. We recognize that we will have the whole spectrum of emotions, and that's just a part of being human. We build more flexibility when strong emotions arise, and that is the ultimate mastery.
Self Compassion as Exposure Work
Self Compassion is an essential part of treatment for all subtypes of OCD. With Moral Scrupulosity, it is especially important, and will likely feel like exposure work.
For many flavors of Moral Scrupulosity, self-criticism is an active compulsion. Beating yourself up for mistakes that you made in the past, or believing that you may just not be a good person at all. Because you’ll work to reduce compulsions, the exposure will be to resist beating yourself up - and instead, let yourself off the hook.
Does this mean we condone unethical behavior? No. Does this mean we understand mistakes happen, and have a humanistic approach? Yes! Below are some examples of using compassion-focused ERP.
Trigger: Asking a friend about their job, when you remember they were let go last month.
Obsession: Feelings of guilt, thoughts of “what kind of person asks that?” “Don't you even know your friend?”
Compulsion: Apologizing several times + sending a follow up text to say you are so sorry for asking such an insensitive question, beating yourself up
Compassionate ERP: Catching your mistake, “oh man, I just remembered what happened last month - how are you doing with the transition?” and then letting yourself off the hook + leaving it as a cold case
Trigger: Picking up something off the floor at the grocery store, but realizing you didn't have “clean” hands when you get into your car
Obsession: Feelings of anxiety + guilt. What if an elderly person puts that in their cart? What if you are responsible for getting someone sick?
Compulsion: Going back into the store with sanitized hands, and moving the item to the back of the shelf
Compassionate ERP: Giving yourself credit for doing something kind (putting the item back) and not mentally investigating endless scenarios
Trigger: Checking your grades and seeing you got an A on a paper
Obsession: Feelings of anxiety + guilt. Did I cheat on that paper and not realize? Did I properly cite my sources, or did I plagiarize? Did I con my teacher into giving me an A?
Compulsion: Pulling up the paper and reviewing all citations, giving yourself reassurance that you did not cheat and are not a bad person
Compassionate ERP: Giving yourself credit for the effort and time that went into your paper + resisting re-reading the paper, leaving it as a cold case
Reign in Confessing & Reassurance Seeking
Confessing and reassurance seeking are common compulsions in Moral Scrupulosity. Confessing is the act of sharing unwanted thoughts, feelings, urges, or events with a sense of urgency. Confessing is often directed to loved ones - but can be with anyone. Reassurance Seeking is asking questions with a hope of feeling less anxious, while having a certain answer in mind.
These can be sneaky compulsions. Confessing may look like; sharing the details of your day with your partner - scanning their reaction to see if you missed anything. Reassurance Seeking may look like “getting a second opinion” but the intention is specific - wanting to hear a specific answer to alleviate uncertainty and anxiety. For example:
“I didn’t say anything offensive last night - right?”
“You didn't think Jodie was mad at me when we saw her, right?”
Asking a partner or parent: “Do you really love me?” “Nothing bad is going to happen to you tonight?"
Signs of reassurance seeking are: repeatedly asking the same question over and over, asking people who are otherwise unqualified to answer (asking a friend a medical question, asking someone to guarantee they won't get into a car accident before leaving the house), feeling a strong sense of urgency related to the question, and so on.
With OCD treatment, our ultimate goal is to cut out all compulsions - but these are a great place to start.
Overview
Mastering your OCD means embracing flexibility, compassion, and valued-living. It's acknowledging that you’re not perfect - but nobody is! We are human, we make mistakes, and can still live by our values. Although this theme can feel overwhelming, it is treatable with evidence-based approaches. Recovery from OCD is possible.
Madeline Moersch, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD and Anxiety Disorders.