You’re sitting in church or in prayer and an “evil” thought crosses your mind. 

“Why is that musician wearing such an unflattering outfit?” 

“Ugh, I wish the nasally singer behind me would shut up.” 

“I refuse to extend this prayer to the person I dislike.”

“This is boring. I need to get home!”

Then, once you realize the nature of your thoughts, you think to yourself: “I’m a horrible person and I’m going to hell. I must do something to get rid of these thoughts.” 

Sound familiar? Religious anxiety can take many forms, and it can be very confusing to deal with. As a therapist, I’ve helped patients cope with intense religious anxiety many times—but I’ve also grappled with it myself.

When I was around the age of 7, I started to become fearful of going to hell. Maybe it all started around the age of 5 when my grandmother drowned in a tragic boating accident because she wasn’t wearing a life jacket and couldn’t swim. My parents told me she was in heaven, but because I couldn’t see it, I couldn’t believe it. Then I found myself hooked in thought spirals, trying to figure things out about my beliefs and about God. I felt guilty about my lack of faith, and prayed compulsively every time I got a twinge of doubt.

I feared I was going to hell, simply because I doubted the existence of God. I feared the punishment I would receive for my doubt. This led to more reassurance-seeking from my parents, Sunday school teachers, and even my pastor at church. I prayed compulsively in bed every night, repeating prayers over and over until I got them just right, or until I fell asleep in utter exhaustion. It was not a rational way for anyone to live, let alone a 7-year-old, but that’s where I found myself—stuck in a fear loop, day after day. 

I was deemed the “worry wart” in the family. It wasn’t until years later that I uncovered what was really going on: religious OCD, a subtype of obsessive-compulsive disorder. Yes, that might sound odd to anyone who thinks that OCD is purely an obsession with tidy homes or hand-washing. But in reality, OCD comes in many forms, often targeting what a person most cares about and values in life.

What is Religious OCD?

Religious anxiety can present in many ways, and at any age. Before we go any further, it’s important to know that experiencing anxiety alone does not mean someone has OCD. The degree of disruption that’s caused to your life, along with the behaviors you use to deal with your distress, are key to determining an OCD diagnosis. 

For one thing, obsessive fears are often very strong, even all-consuming. Some examples of religious obsessions include:

• Fear of not having enough faith
• Fear of going to hell
• Fear of being “unclean” according to the rules of your religion
• Fear of having immoral thoughts or committing a sin

As a child, my own obsessions took the form of “what if” statements. What if I go to hell? What if God isn’t real? What if I am punished for my doubt? I also experienced intrusive images of the devil standing in my doorway, as obsessions can take the form of urges and images, not just thoughts. 

Compulsions are the other primary component of OCD. Compulsions are mental or physical acts that people do, often repetitively, in an attempt to alleviate the distress brought on by their obsessions and/or to prevent a feared “bad” thing from happening. My compulsions as a child were praying, ruminating, and seeking reassurance from my parents, just to name a few. Unfortunately, engaging in compulsions backfires. If there is any relief of anxiety, it is only temporary, and in turn it only reinforces the need to rely on compulsions every time one experiences an obsession.

Religious OCD by another name

Religious OCD may be referred to as Scrupulosity, Moral Scrupulosity, or Scrupulosity OCD. Whatever name you use to describe it, the key point is that it causes a person to become trapped in a vicious cycle of obsessions, anxiety, and compulsive behaviors. I’ve worked with a Jewish Rabbi, for example, who feared that he had misled a student merely by saying something incorrectly. This Rabbi then engaged in compulsions, repeating his correction over and over again, to ensure the student understood. A Catholic priest may worry that the amount of penance he assigned to a parish member during their confession was too much or too little, struggling to feel confident or certain about his practice. In response, he may engage in compulsive reassurance-seeking from his spiritual leader. In fact, an atheist might even fear going to hell, because what if they’re wrong about there not being a God?

These are examples where the obsessions and compulsions are directly related to the theme of religion. But there can also be other manifestations where religious anxiety is secondary to another theme of OCD. For instance, a person who struggles from Pedophila OCD (POCD) may also struggle with intrusive thoughts that they are evil and will go to hell or be punished because of their unwanted, distressing thoughts about molesting children. 

Why treating Religious OCD can be complicated

Sometimes people with religious OCD go to great lengths to justify their compulsions. They may believe that they are simply holding themselves to strict religious standards. After all, religion often teaches that there are consequences for certain thoughts and behaviors. 

As a therapist who works with people who value their religious belief systems, I know it is important to keep one’s religious values in mind during treatment. Sometimes it is necessary to untangle what is truly a religious practice versus an irrational fear that leads to compulsive behavior. It’s certainly not black and white. The important thing that I help people discern is the level of distress and impairment caused by their behaviors. In therapy we focus on breaking unhealthy patterns of behavior, while at the same time respecting the religious practices that they hold dear. What this looks like will vary from person to person.

Can therapy help with religious anxiety?

Therapy can be very beneficial if you are experiencing religious anxiety. Some people may prefer receiving counseling within their faith, such as with a trusted pastor or spiritual leader. (This is sometimes called spiritual counseling or lay counseling if it takes place with someone who does not hold a license to practice therapy.) However, if you meet diagnostic criteria for OCD and you’re struggling with religious fears, traditional talk therapy or counseling will not help. In fact, for people with OCD, traditional talk therapy can sometimes prolong the recovery process, essentially encouraging them to ruminate out loud. It draws too much attention to obsessions and fears, making them the center of attention and the star of the show. 

The best course of treatment for religious or scrupulosity OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been found for up to 80% of people. As part of ERP therapy, people work with a specially-trained ERP therapist to slowly put themselves into situations that bring on obsessions and distress, providing the opportunity for them to resist their compulsions. Over time, ERP allows you to learn new ways to respond that don’t rely on unnecessary compulsions, often leading to a noticeable reduction in your anxiety. 

People with religious OCD sometimes worry that this type of therapy will make them unfaithful to their religion. They are usually relieved to learn that working with a trained therapist who understands their faith and its importance to them can give them the confidence they need to separate their religion from their OCD. 

If you’re interested in learning about religious or scrupulosity OCD and how it’s treated with ERP, you can schedule a free call with the NOCD Care team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training. Many of them, like me, have dealt with OCD themselves and understand how crucial ERP therapy is. 

The bottom line

There are ways to uphold your faith and also not give into your OCD fears. I am an example of that. I consider myself someone of strong faith, but I no longer live in constant fear of things like heaven and hell, or not protecting loved ones with my prayers, or making mistakes that are unforgivable. By stepping away from my compulsions, I’ve found that I’ve grown more in my faith, and I believe that the same is possible for anyone who wants help.