Chapter 5
Case Study: Jordan
19 year old BYU student who had just received her mission call
Daughter of a bishop, very active in the church her entire life
Struggled with compulsive prayer (up to 20 times per hour), excessive feelings of unworthiness, and rereading religious texts
Y-BOCS 19, PIOS-R 38
Treatment included introduction of a high dose of an SSRI and a three month course of ERP
ERP focused on response prevention to delay and eventually curtail excessive prayer and imaginal exposures that explored the fear underlying her anxieties about worthiness
Client is now on her mission and doing well
Case Study: Jack
21 year old male who recently returned from his mission and enrolled at BYU
Client was bothered by memories of past events and believed he had not repented properly for things that had happened before his mission (despite the fact that he had spoken with multiple priesthood leaders who told him otherwise)
Client had repeatedly approached his current bishop about these concerns and had been told he should move on.
Treatment included introduction of a high dose of an SSRI and 12 weeks of I-CBT
I-CBT helped the client recognize how underlying doubts about his worthiness fueled obsessional narratives and led him to distrust reality-based evidence that he had adequately repented.
Concluding thoughts
- Scrupulosity is a form of OCD and a problem of anxiety not of faith, morality, sexual orientation, or anything related to the content of specific obsessive thoughts
- The most effective treatment for scrupulosity is medication + exposure and response prevention
- OCD symptoms are not a sin. You don’t need to repent for them. You need to get evidence-based mental health treatment.
- Look for an OCD specialist in your state using the International OCD Foundation Provider Directory.