How to Recognize and Respond to a Child’s OCD Scrupulosity

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One of the most challenging manifestations of obsessive-compulsive disorder (OCD) involves the sufferer's religious faith and practice. Jon Grayson, in Freedom from Obsessive-Compulsive Disorder, writes:

Religious obsessions, also known as scrupulosity, arise from your awareness of unanswerable questions and inconsistencies in your behavior. The questions and ambiguities that are the basis of countless philosophical tracts become your enemy.

Anyone with a basic understanding of OCD can probably imagine how the disorder can transform religion into a compulsion—excessive prayer, pathological repetition of rituals, and confessing repeatedly. But the line between ordinary and pathological, "excessive" religious practice can be hard to identify. How much devotion is too much devotion? When you're watching someone pray, what signs indicate their practice has become neurotic and that outside intervention is necessary? And how can you quantify the extent of their symptoms when so much of their distress is likely internal, invisible to even the most caring and engaged observer? If the person is an adult, this creates an enormous obstacle between recognizing the symptoms of religious OCD and seeking clinical diagnosis and effective treatment.

But if you’re a child struggling with religious OCD, the process of recognizing your affliction and seeking help is much simpler: You don't. You don't know how to ask for help, and no one volunteers, because no one notices anything unusual about your behavior. Your original sin and eternal punishment questions are brushed aside as childish curiosity. Your fixations are laughed off or mistaken for devotion and encouraged.

A child has a limited vocabulary to describe the agony of religious obsession. When you tell a caretaker that you are "confused," "scared," or "guilty," they assume they know how you're feeling because they recognize those words, oblivious to the depth and intensity of a kind of suffering you don't have the language to effectively describe. (See "OCD Scrupulosity in the Mind of a Churchgoing Child.")

Please, do not laugh off or dismiss your child's religious anxieties. Scrupulosity is so insidious, its distortions so subtle and persuasive, that it can effectively invalidate a young person's basic sense of self over months and years. As it evolves, the only meaningful metric of your worth as a human being is that you are constantly being watched and judged by God. You are increasingly certain that He finds you utterly abhorrent.

If you suspect there is a religious component to your child's OCD, or if your undiagnosed child seems unusually anxious and distressed around the subject of religion, here are a few points to consider as you consider whether to seek treatment.

Carefully Listen and Observe

• Listen for oddly advanced or specific questions about religion and religious doctrine, especially ones related to sin, damnation, and hell. Of course, it's common for bright children to recognize the obvious tensions and ambiguities inherent in religious faith and to ask adults for help in resolving them. "Will I see my dead pet when I go to heaven?" is a totally understandable question; "Is it disrespectful to Jesus to put a cross on my pet's grave, or will my pet go to Hell if I don't?" should raise an eyebrow, especially if your child continues to ask you similar questions or continues to show distress around the issue.
• Pay attention if your child repeatedly confesses relatively benign things as a way to alleviate their guilt. Confession does not need to happen in a strictly religious context; a child with OCD may just as easily seek reassurance and validation from a parent or other authority figure. The child may "confess" to thinking about inappropriate topics, to saying forbidden words under their breath, to feeling unwanted emotions like anger, or to witnessing the inappropriate words or actions of others. If your child comes to you to ask for guidance on this sort of seemingly inconsequential non-transgression and seems to feel relief after you hear their "confession," there may be an OCD component to their behavior.

Evaluate the Role of Religion in Your Child’s Life

The last point I want to address is the most challenging because it will require you to navigate difficult questions around your faith, your responsibilities as a parent, and your child's well-being. For now, at least, it may not be possible for religion to be part of your child's life. Your responsibilities as a parent mean you can no longer take your family's religious practice for granted. If you are a devout member of a particular faith, this means that you might need to change your practice to keep your child safe and healthy–and although consulting with the leaders of your religious community might be helpful, it's also possible that they won't understand the mental health component of your child's suffering, and insist that strict religious observance is good for them.

On the other hand, if you're only an occasional parishioner, or you view your religion as a cultural thing, or you attend religious services mostly out of a sense of habit or familial obligation, you will need to ask some difficult questions about how much your religion really matters to you, and whether that justifies potential long-term damage to your child's mental health.

I think most people are basically comfortable with the role religion plays in their lives, and looking at religious practice through the lens of obsessive-compulsive disorder raises uncomfortable questions about the sometimes-unclear boundaries between faith, ritual, and neurosis. When your child suffers from religious OCD, you do not have the luxury of ignoring these issues.

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It won't be easy. But, as a parent, working through that unease and seeking professional help if appropriate are absolutely the least you can do if your child may be enduring a living hell.

Copyright Fletcher Wortmann, 2023. Please credit the original author, Fletcher Wortmann, and Psychology Today.

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