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The Doubting Disease: Help for Scrupulosity and Religious Compulsions
The Doubting Disease by Joseph W. Ciarrocchi brings to the fore the most current information available today on religion and scruples, scrupulosity, and obsessive-compulsive disorders (OCD). In this book he helps us clearly appreciate the interior anguish suffered by thousands of people of faith who have this symptomatology and what we can do about it. As well as offering a concise, helpful understanding of the demographics, etiology and treatment of scrupulosity and OCD, in the Doubting Disease he also addresses the *How does scrupulosity develop? *What are the differences between common and uncommon scrupulosity? *What are some classic and contemporary models of religious scrupulosity? *Where does the issue of scrupulosity fit into the history of pastoral care? *What are some practical ways to target scruples and increase motivation for reduction of scrupulosity and compulsivity? *How and when should persons get help for scrupulosity and OCD? Essential for all persons involved in general ministry, pastoral counseling, and the treatment of religious persons suffering from scrupulosity and OCD, I believe this book will also be of great service for anyone interested in the psychology of religion and the theological topics of "conversion," "discernment," and "sin." ―-Robert J. Wicks Series Editor †
192 pages, Paperback
First published March 1, 1995
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Displaying 1 - 11 of 11 reviews
November 17, 2025
A helpful introduction to scrupulosity, but there is far more information surrounding it than help for treatment. Ciarrocchi also seemed to focus more on Catholic issues, including proposing a treatment in which a patient/client is compelled by “church rules” to comply and resist obsessional scruples.
I think the combination of OCD and religiosity is a severely underreported and under identified issue in churches. Being in a pastoral role means these types of challenges have come across my desk from time to time. This book was helpful in identifying but less helpful in counteracting.
I think the combination of OCD and religiosity is a severely underreported and under identified issue in churches. Being in a pastoral role means these types of challenges have come across my desk from time to time. This book was helpful in identifying but less helpful in counteracting.
May 6, 2013
Well worth the read, particularly for a general understanding of scrupulosity, its history (Martin Luther, St. Ignatius Loyola-founder of the Jesuits, and John Bunyan all suffered from it), and a practical treatment method.
December 14, 2017
The tools in this book are priceless! I found it hard to sit and read the book, probably because a lot of the language is over my head, but it did help me understand scruples better and the worksheets have helped a lot in my sons treatment!
June 15, 2026
Well I didn’t exactly intend to read this cover to cover but here we are.
I was talking with a coworker about the intersection between religion and mental health—specifically, things like “following the Holy Spirit” and “conviction” can seem to easily stem from anxiety or just random thoughts given too much weight rather than a genuine spiritual experience. Lo and behold, the very next day my coworker was shelving the self help section and found this book. It’s weird to think of being ‘sucked in’ by such a technical, specific non-fiction read, but I truly couldn’t put this down.
I’m particularly interested in this topic since the background I was raised in had, in retrospect, many people who used religion to bandaid over certain mental health struggles (and I definitely still know of people who do that now). And there were a few practices by some people that I remember being held up as “look at how faithful this person is!” when in reality, it seemed like a deeply unhealthy way of living. It’s tough—even now—to fully sort through what is countercultural faithfulness and discipline, and true supernatural experiences, and what crosses the line into compulsion and distraction from the Gospel.
While I don’t particularly struggle with this myself, I do definitely lack the vocabulary to articulate the struggle and why I’m wary of certain practices I see, especially when talking to people who grew up differently than me.
The author is Catholic, but in my (admittedly, biased) opinion, does a good job at being primarily neutral and applicable to some other faiths as well (he uses Judaism and non-Catholic Christianity as examples).
The author lays out 3 types of ‘scrupulosity.’ First, developmental scrupulosity, which is a brief development of certain scruples due to a particular moment in time, such as adolescence or a conversion to a religion. This often coincides with someone “making their faith their own” as they figure themselves out. Second, there’s milieu-influenced scruples, which are taught by some outside influence. Often, it involves a significant authority figure who transmits a fear component in their message. The third is clinical scrupulosity, which goes along with symptoms of OCD.
I liked how the author listed 5 ways to distinguish normal religious principles from pathological ones.
I thought the “white bear” phenomenon was fascinating. People who were told not to think of a white bear actually thought of it more than people who were told to think of one. “Thoughts actually accelerate after we try to suppress them.”
One footnote said that “Recent work... suggests that believers who are under high stress and see themselves as working with God toward solutions have fewer depressive symptoms than those who believe it all depends on themselves or it all depends on God.”
One part that stood out to me was the importance of someone pointing out that the scrupulous person was wrong. In general, in Christianity it’s taught that if we feel convicted of something, we should listen to that ‘still, small voice.’ However, “Labeling a scrupulous conscience as erroneous was liberating for the person. Since an erroneous conscience could not “bind” a person to follow its direction, a scrupulous person is free to act without resolving the doubt.”
There was also discussion of someone dealing with a particular scrupulosity being freed from the obligations that normally would be imposed on believers. For example, “[In confession,] they alone are permitted to describe their serious sins in a general way without a number count.” It’s nice to know that there’s some flexibility in how to practice faith.
I was also shocked to find out that as early as the 16th and 17th century, spiritual leaders were using very similar methods to handle scruples as are now recommended by modern mental health experts (at least, as of the writing of this book). With my background, it can be easy to feel like you have to sacrifice some religious principles to get treatment, but they were never at odds with each other. It also was so, so recently that I started being explicitly taught about the literary style of biblical authors. It was kind of a general “yes the Bible is the literal truth, except of course the Psalms are poetry and fun fact, the letters were written as letters!” But this book discusses the importance of Biblical language, and how “The scrupulous are unable to discern the guiding, educative role of maxims and biblical sayings. Once again, in their drive for absolute certainty, the maxims become universal laws admitting no exception.”
Most of the focus of the book was on the third type of scrupulosity, and spent a chapter explaining OCD in depth. I, personally, wanted to know more about the first two types of scrupulosity. I also wish that there was more discussion of how to navigate the exposure and blocking parts of treatment practice with the idea that the actual thought or emotion itself is the sin. Most of the advice boiled down to “work with a trusted spiritual mentor.” Which, on the one hand, was probably the right call since it allows this book to be applicable to a much broader range of faith/circumstance backgrounds, but I was definitely curious about that particular struggle.
I thought it was particularly valuable how the author pointed out the difference between overvalued ideas (obsessions that overemphasize something that’s true, or at least, embraced by the person when healthy) versus delusions (which are just factually incorrect). He says, “My opinion, based on the clinical and theoretical aspects of scruples, is that scruples are resistant to change because their religious nature places many of them in the domain of overvalued ideas. In other words, the person sees that the stakes are so high in religious doubt ... that the senselessness of the behavior is less evident.”
I do wish that I’d known about the “report” stage of dealing with unwanted thoughts/feelings—how neutrally describing the situation to yourself regulates things wayy better than just telling yourself that what you’re doing is wrong, which is what I was taught by the general zeitgeist (I definitely don’t blame any one person or institution! It was more the general culture as a whole left me with a specific impression). I wonder how this quote, too, would have been received in certain circles. “Clients are often shocked when I suggest that they need to accept their impulses. Often the impulses are repulsive, disgusting and immoral. One does not have to like or enjoy the impulses; one has to accept their existence calmly.”
Also, I was very aware that this book was published three decades ago. While everything seemed well-supported and it was clear where the research was coming from and the limits of said research, it does make me wonder if there’s an updated version of this book out there, or one like it. For example, OCD was labeled as an anxiety disorder, which it no longer is. With that being said, since I wasn’t reading this as a self-help book for myself or a specific situation, it provided enough of an overview for the topic to satisfy my long-held curiosity.
I was talking with a coworker about the intersection between religion and mental health—specifically, things like “following the Holy Spirit” and “conviction” can seem to easily stem from anxiety or just random thoughts given too much weight rather than a genuine spiritual experience. Lo and behold, the very next day my coworker was shelving the self help section and found this book. It’s weird to think of being ‘sucked in’ by such a technical, specific non-fiction read, but I truly couldn’t put this down.
I’m particularly interested in this topic since the background I was raised in had, in retrospect, many people who used religion to bandaid over certain mental health struggles (and I definitely still know of people who do that now). And there were a few practices by some people that I remember being held up as “look at how faithful this person is!” when in reality, it seemed like a deeply unhealthy way of living. It’s tough—even now—to fully sort through what is countercultural faithfulness and discipline, and true supernatural experiences, and what crosses the line into compulsion and distraction from the Gospel.
While I don’t particularly struggle with this myself, I do definitely lack the vocabulary to articulate the struggle and why I’m wary of certain practices I see, especially when talking to people who grew up differently than me.
The author is Catholic, but in my (admittedly, biased) opinion, does a good job at being primarily neutral and applicable to some other faiths as well (he uses Judaism and non-Catholic Christianity as examples).
The author lays out 3 types of ‘scrupulosity.’ First, developmental scrupulosity, which is a brief development of certain scruples due to a particular moment in time, such as adolescence or a conversion to a religion. This often coincides with someone “making their faith their own” as they figure themselves out. Second, there’s milieu-influenced scruples, which are taught by some outside influence. Often, it involves a significant authority figure who transmits a fear component in their message. The third is clinical scrupulosity, which goes along with symptoms of OCD.
I liked how the author listed 5 ways to distinguish normal religious principles from pathological ones.
I thought the “white bear” phenomenon was fascinating. People who were told not to think of a white bear actually thought of it more than people who were told to think of one. “Thoughts actually accelerate after we try to suppress them.”
One footnote said that “Recent work... suggests that believers who are under high stress and see themselves as working with God toward solutions have fewer depressive symptoms than those who believe it all depends on themselves or it all depends on God.”
One part that stood out to me was the importance of someone pointing out that the scrupulous person was wrong. In general, in Christianity it’s taught that if we feel convicted of something, we should listen to that ‘still, small voice.’ However, “Labeling a scrupulous conscience as erroneous was liberating for the person. Since an erroneous conscience could not “bind” a person to follow its direction, a scrupulous person is free to act without resolving the doubt.”
There was also discussion of someone dealing with a particular scrupulosity being freed from the obligations that normally would be imposed on believers. For example, “[In confession,] they alone are permitted to describe their serious sins in a general way without a number count.” It’s nice to know that there’s some flexibility in how to practice faith.
I was also shocked to find out that as early as the 16th and 17th century, spiritual leaders were using very similar methods to handle scruples as are now recommended by modern mental health experts (at least, as of the writing of this book). With my background, it can be easy to feel like you have to sacrifice some religious principles to get treatment, but they were never at odds with each other. It also was so, so recently that I started being explicitly taught about the literary style of biblical authors. It was kind of a general “yes the Bible is the literal truth, except of course the Psalms are poetry and fun fact, the letters were written as letters!” But this book discusses the importance of Biblical language, and how “The scrupulous are unable to discern the guiding, educative role of maxims and biblical sayings. Once again, in their drive for absolute certainty, the maxims become universal laws admitting no exception.”
Most of the focus of the book was on the third type of scrupulosity, and spent a chapter explaining OCD in depth. I, personally, wanted to know more about the first two types of scrupulosity. I also wish that there was more discussion of how to navigate the exposure and blocking parts of treatment practice with the idea that the actual thought or emotion itself is the sin. Most of the advice boiled down to “work with a trusted spiritual mentor.” Which, on the one hand, was probably the right call since it allows this book to be applicable to a much broader range of faith/circumstance backgrounds, but I was definitely curious about that particular struggle.
I thought it was particularly valuable how the author pointed out the difference between overvalued ideas (obsessions that overemphasize something that’s true, or at least, embraced by the person when healthy) versus delusions (which are just factually incorrect). He says, “My opinion, based on the clinical and theoretical aspects of scruples, is that scruples are resistant to change because their religious nature places many of them in the domain of overvalued ideas. In other words, the person sees that the stakes are so high in religious doubt ... that the senselessness of the behavior is less evident.”
I do wish that I’d known about the “report” stage of dealing with unwanted thoughts/feelings—how neutrally describing the situation to yourself regulates things wayy better than just telling yourself that what you’re doing is wrong, which is what I was taught by the general zeitgeist (I definitely don’t blame any one person or institution! It was more the general culture as a whole left me with a specific impression). I wonder how this quote, too, would have been received in certain circles. “Clients are often shocked when I suggest that they need to accept their impulses. Often the impulses are repulsive, disgusting and immoral. One does not have to like or enjoy the impulses; one has to accept their existence calmly.”
Also, I was very aware that this book was published three decades ago. While everything seemed well-supported and it was clear where the research was coming from and the limits of said research, it does make me wonder if there’s an updated version of this book out there, or one like it. For example, OCD was labeled as an anxiety disorder, which it no longer is. With that being said, since I wasn’t reading this as a self-help book for myself or a specific situation, it provided enough of an overview for the topic to satisfy my long-held curiosity.
January 12, 2013
Helped us greatly in dealing with a child with scrupulosity.
June 12, 2023
Comprehensive look at OCD with a focus towards scrupulosity. Provides overview of both OCD and scruples with theological, clinical, and psychological expertise, then guides reader through step-by-step behavioral methods of treatment. Extremely helpful for sufferers of OCD/scruples, those who counsel, and friends/family of those with OCD/scruples.
I was particularly grateful to find that the author was able to provide methods of relief while also maintaining the role, significance, and beauty of religion in sufferers lives.
I was particularly grateful to find that the author was able to provide methods of relief while also maintaining the role, significance, and beauty of religion in sufferers lives.
July 12, 2022
4.25/5
A solid book on OCD for those with scruples (obsessions and/or compulsions with a religious component). Even though it's almost 30 years old, everything is still relevant and an excellent resource for someone new to the topic. As a therapist with a good bit of knowledge and experience working with Christian clients with OCD, this book served as a good guide that I'm on the right track with my treatment approach while also adding a few resources.
A solid book on OCD for those with scruples (obsessions and/or compulsions with a religious component). Even though it's almost 30 years old, everything is still relevant and an excellent resource for someone new to the topic. As a therapist with a good bit of knowledge and experience working with Christian clients with OCD, this book served as a good guide that I'm on the right track with my treatment approach while also adding a few resources.
December 31, 2023
As a person with this form of OCD I've found his book super insightful and helpful. Four stars, only because it was kind of wordy at times, but overall a great read.
June 24, 2013
A bit too technical at times for me but still very informative. Even though my mother appears to have scrupulosity as one of her forms of OCD, I had never heard the term before.
January 6, 2014
More technical than Understanding Scrupulosity by Fr. Thomas Santa but still helpful.
April 5, 2018
It was helpful to identify with some of the examples he relates. On the other hand, I got somewhat bored with much of the content. Worth the read though.
Displaying 1 - 11 of 11 reviews