The term “religious OCD” comes from the Church of England, where it was characterized by the 16th-century minister John Moore. In a sermon, he described the struggle of scrupulosity as “religious melancholy.” He also described the torment of dedicated worshipers who have intrusive and unwanted thoughts. Although Moore’s description is somewhat extreme, it is an accurate portrayal of what is involved.
What is Religious OCD?
Religious OCD is a type of OCD (obsessive-compulsive disorder) that can develop in people of any age. It is characterized by obsessions and compulsions related to religion. People with religious OCD may excessively worry that they are unworthy of salvation or that they will go to hell because of unwanted intrusive thoughts. They may spend excessive amounts of time praying or confessing their sins. They may also avoid certain places or objects that they believe are cursed.
Studies have shown that religious individuals scored higher on measures of obsessions, over-importance of thoughts, responsibility and OCD symptoms.  
One common cause of religious OCD is a fear of offending god. While most religious individuals will move on from a blasphemous thought, scrupulous sufferers may spend hours doing mental rituals.
OCD sufferers with religious scrupulosity may have strong religious beliefs. Those who struggle with scrupulosity often engage in religious rituals in an attempt to reduce their feelings of anxiety. These rituals may include repeating religious phrases or repeatedly calling a religious leader to obtain reassurance. It’s important to distinguish between prayer that meets the religious requirements and excessive compulsive behaviours.
In a sense, religious OCD is very similar to moral scrupulosity. When it comes to determining if religious OCD is causing your symptoms, the first step is to identify the cause and seek help.
Common symptoms of religious ocd
- Rereading religious texts to the extreme
- Excessive washing or religious rituals (much more than is required)
- Seeking reassurance from friends or family about their religious obsession
- Avoiding triggering situations
Common religious obsessions
- Fear that god is extremely angry with them
- Fear of judgement from other believers or religious leaders
- Fear of having thoughts that offend god
- Fear of accidentally breaking religious traditions
- Fear of unknowingly having forbidden ingredients in their food
- Fear that their prayers are not sincere enough
- Having a feeling that they will go to hell
- Fear that the wrong thoughts will make them morally compromised
CBT for religious OCD
While religious OCD can be very distressing, it is treatable with Cognitive Behavioral Therapy (CBT). CBT for religious OCD can help people to identify and challenge their distorted ideas about the need to engage in compulsions. It can also help them to develop healthy coping mechanisms for dealing with anxiety and fear. With treatment, people with religious OCD can learn to manage their symptoms and live full and productive lives.
One underlying cause of religious OCD is a sense of moral and personal responsibility for having unwanted blasphemous thoughts. One study compared low-religious undergraduates to high-religious students in terms of OCD symptoms, obsessive beliefs and guilt. 
The results showed that only the highly religious students experienced obsessional symptoms and this was because of their heightened sense of personal guilt due to feeling responsible for the uncontrollable intrusive thoughts.
Therefore CBT that focuses on changing maladaptive ideas of responsibility for thoughts may help individuals feel less guilty and anxious when an intrusive thought appears. Making these healthy changes to a religious person’s belief system and implementing exposure and response prevention therapy (ERP) will help reduce their anxiety when intrusive thoughts appear.
Religious CBT has been shown to be effective for religious patients, perhaps because the treatment is consistent with the person’s religious faith. One study showed that religious CBT resulted in a decrease in OCD symptoms which persisted for 6 months after intervention. 
ERP for religious OCD
ERP, or exposure and response prevention can be used to help the individual gradually expose themselves to their fear triggers without engaging in their usual compulsive behavior in order to reduce anxiety over time when exposed to the same trigger.
Guided prayer repetition – a variation of ERP specific to religious OCD
Religious OCD patients that pray often may find themselves hesitating or repeating the same prayers, fearing that they aren’t concentrating or that they had intrusive thoughts during the prayer. This can result in lost time and as a result, they may spend less time with their family etc.
A religious person may find it difficult to avoid the urge to engage in the compulsion. In this case, guided prayer repetition can be useful to help them resist the urge to ritualise during exposure sessions.
This involves instructing the person to repeat the prayer from the beginning if they repeat the prayer. This introduces an aversive consequence and as a result, the patient is motivated to continue the prayer without engaging in the compulsion.
Case studies have shown that this variation of ERP therapy has helped religious individuals overcome this type of OCD and they are able to read religious text smoothly. 
Related article about OCD guilt and confession: How to recover from moral scrupulosity OCD
While religious OCD can be very distressing, it is treatable with CBT and ERP. CBT for religious OCD can help people to identify and challenge their distorted thoughts and beliefs. It can also help them to develop healthy coping mechanisms for dealing with anxiety and fear. ERP can also help improve OCD symptoms. With treatment and motivation to improve, people with religious OCD can learn to manage their symptoms, improve their mental health and live full and productive lives whilst being practising believers.
What is the Difference Between Scrupulosity and Typical Religious Behavior?
Typical religious behaviour includes praying or washing rituals that are mandated by a particular faith. This is in contrast to compulsive behavior rituals which can prevent you from practising your faith in a healthy way.
What Causes Religious OCD?
It’s important to note that religion is not the cause of OCD. Instead, people with OCD may become preoccupied with a particular theme throughout the day.
1: Religiousness and obsessive-compulsive cognitions and symptoms in an Italian population (2002) https://pubmed.ncbi.nlm.nih.gov/12074375/
2: Obsessive-compulsive disorder and Jewish religiosity (2003) https://pubmed.ncbi.nlm.nih.gov/12637849/
3: Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians (2012) https://pubmed.ncbi.nlm.nih.gov/22484698/
4: Effect of Religious Cognitive Behavioral Therapy on Religious Obsessive-compulsive Disorder (2017) https://pubmed.ncbi.nlm.nih.gov/29387669/
5: Compulsive prayer and its management (2009) https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20558