“Did I say anything to make her mad? She got quiet, like she was offended? What did I say? Let me think. I better go ask if she’s angry with me. I’ll start with an apology too, just in case. That’s what a good person would do.”
We all want to be the type of person we’d consider “good”. Yet we also all make mistakes. For many of us, life is a balancing act between doing our best, apologizing for when we are at our worst, and extending ourselves and others grace.
For people with moral scrupulosity OCD, life can feel like a minefield of moments where you might do something wrong or immoral and reveal you’re actually a terrible person. The self-judgment and shame can feel overwhelming, leading you to compulsively try to ease your anxiety.
You end up doing all you can to make sure you aren’t the problem, when really, doubt from OCD is the problem!
What can moral scrupulosity intrusive thoughts be like?
With moral scrupulosity OCD, your intrusive thoughts center around being an immoral, bad, or wrong person. They can be religious or secular, or both. These thoughts can include fears you:
- Are going to harm people (even just from being around them)
- Have lied or misled someone
- Will lose control one day and start doing terrible things
- Have secretly tricked everyone around you into liking you or thinking you’re a good person
- Are being unfair, unkind, or immoral
- Have sinned
- Are guilty or shameful
- Aren’t a real believer
- Have slipped up or missed something
- Are just no good, like there’s something inherently wrong with you
Moral scrupulosity OCD can be particularly tricky because you can feel like a bad person simply because you experience intrusive thoughts (even though everyone has them from time to time, and you don’t have control over the thoughts that pop into your head)!
Compulsions are an ineffective attempt to soothe the anxiety of OCD
While everyone experiences intrusive thoughts sometimes, people with OCD experience them more often and have particularly strong responses to them. The doubt and fear of intrusive thoughts can feel intolerable, and if you don’t have the tools to manage your anxiety, you resort to compulsive behaviors that temporarily reduce your anxiety.
The anxiety always comes back, and often returns stronger, so you get caught up in compulsive behaviors more and more often, robbing you of time and energy you could spend living life.
Common moral scrupulosity compulsions include:
- Immediately replacing “bad” thoughts with “good” ones
- Avoiding situations where you fear doing the “wrong” thing
- Self-monitoring to see if you’re thinking or behaving immorally
- Reviewing conversations and experiences over and over
- Rehearsing scenarios over and over
- Mentally punishing or insulting yourself for perceived failures
- Staying away from people for fear of causing problems for them
- Asking for reassurance you haven’t caused a problem, or aren’t a bad person
- A need to confess thoughts or feelings you’ve had
- Over-apologizing or over-explaining
- Constantly checking to see if you’re thinking, praying, or doing something “correctly”
- Constant prayer or asking forgiveness
Is it OCD or is it just wanting to do the right thing?
How can you tell if you’re dealing with a disordered thought pattern versus a genuine desire to do the right thing? Ask yourself: when a thought pops into your head, does it align with who you want to be?
Here’s an example: a thought enters your head that you might have been inaccurate when telling someone something recently, which makes you a liar. Maybe you lied on purpose! Maybe you misled people, and you’re actually a bad person!
Intrusive thoughts are scary because they’re not in line with who you want to be
Do you want to be a liar who misleads people? No! This intrusive thought upsets you because it’s not who you want to be. It’s an ego-dystonic thought, or a thought that goes against how you understand yourself.
When you experience intrusive thoughts, it’s understandable that you assume that means you agree with the thoughts, and that they’re what you want. But with OCD, the thoughts that intrude on your day are actually showing you the opposite, things you do not want to happen.
When a thought like this stresses you out, the OCD cycle kicks in. You don’t want to be a liar, and the thought is making you doubt yourself. The doubt and uncertainty feel intolerable; it’s not enough to know that you try to be truthful and didn’t deliberately mislead anyone; OCD demands that you be certain:
- You run the conversation through your head over and over, to try to suss out where you might have lied.
- You apologize about the conversation and over-explain, trying to reassure yourself that you aren’t that kind of person.
- You kick yourself mentally, insulting yourself and reviewing your thoughts to try to find the one that will prove you’re the problem.
This is exhausting; it hurts you and weakens your relationships, and it’s never enough. The uncertainty remains, and you get caught up in the compulsion cycle over and over. Every time you perform a compulsion, it reinforces in your mind that these thoughts are dangerous, keeping you trapped.
How does ERP help with moral scrupulosity OCD?
Exposure and response prevention, or ERP, helps you manage OCD by cutting off the compulsion cycle. It’s a form of therapy that helps you understand what’s happening when OCD kicks in, and helps you find ways to let go of compulsions so you don’t reinforce the anxiety that comes with intrusive thoughts.
Understanding your intrusive thoughts can help you reduce self-judgment
The first step in ERP is learning how to notice intrusive thoughts and figuring out what compulsions you use to try to soothe the distress of these thoughts. You and your therapist will rank your thoughts from most to least distressing, to give you a starting point (least distressing!) for exposures.
This exploration gives you clarity on how much impact moral scrupulosity has had on your life, and helps you see that these thoughts aren’t something you invite or want; they’re OCD. It’s common to feel grief at this stage, when you start to see the ways intrusive thoughts and compulsions have kept you from living your life.
You’ll also talk about your personal values; what really matters to you? What do you want out of life? This self-knowledge can help you stick with the hard work of response prevention, and you can remind yourself you’re living in line with your values when OCD tries to order you around.
Seeking out exposures gives you a chance to strengthen your distress tolerance
When you understand the intensity of your intrusive thoughts, you and your therapist can plan exposures where you start small, with your least-distressing intrusive thought, and seek out chances to trigger it. You’ll choose exposures that are in line with the life you want, focusing on experiences that OCD has taken away from you, so ERP can help you build a fulfilling life despite what OCD tries to get you to do.
As you pursue exposures, you’ll add in response prevention (see below) and practice. You’ll develop your abilities, just like building up muscles, and take on more and more difficult triggers as you work through ERP.
Like any learning process, you’ll have successes, and you’ll have times where you need to go back to the drawing board. The benefit of doing ERP with a compassionate, experienced therapist like those at Suffolk DBT is that they’ll be with you on this journey, cheering you on in your successes and helping you tap into your strength to try again when things don’t work the first time.
Exposures for moral scrupulosity could include:
- Thinking about a scenario where you accidentally do the wrong thing, then practicing non-response when your OCD is triggered by the visualization.
- Having a conversation with someone, then redirecting your thoughts when your mind tries to ruminate over whether you told the truth or not.
- In an instance where you’d usually seek out reassurance, you stop yourself and allow the uncertainty to remain.
- Participating in a faith practice that means a lot to you, but stopping yourself from checking your behaviors, ruminating over “correctness”, or praying or confessing compulsively.
Response prevention offers relief by weakening the obsession-compulsion cycle
Every time you indulge in a compulsion to try to ease your discomfort, it reinforces (and even intensifies) the cycle. Conversely, every time you choose not to perform a compulsion, you weaken the cycle and reclaim your ability to choose how you spend your time and energy.
You and your therapist will work together to figure out what you need to do to stop performing compulsions in response to moral scrupulosity intrusive thoughts. You’ll learn ways to embrace uncertainty, to withstand your anxiety, and ways to give intrusive thoughts a “non-response” instead of engaging with them.
Doing nothing when you’re used to responding to stress with compulsions is hard work! Sitting with that discomfort instead of reaching for compulsions is not easy, but it is rewarding. With time, ERP gives you back choices that OCD took from you.
ERP at Suffolk DBT can help you swap self-judgment for a life lived on your terms
ERP at Suffolk DBT can help you swap self-judgment for a life lived on your termsFor people in New York with moral scrupulosity OCD, the self-judgment, fear, and doubt from intrusive thoughts can rob you of so much time and energy. ERP for OCD at Suffolk DBT can give you back that time by helping you understand your OCD and giving you the tools to stop yourself from reaching for compulsive behaviors.
With your therapist by your side, you’ll learn that you can manage the distress of the fear without compulsions, and that living your life the way you want to is possible. To learn more and get started on ERP for OCD on Long Island, connect with us today.