Written by Dr Liza Chervonsky, Director and Principal Clinical Psychologist at Inlight Psychology, Bondi Junction.
** Research contributions by Daphne Ly, a UNSW psychology undergraduate completing an internship at Inlight Psychology.
What makes a person “good” and virtuous? Are you a moral and ethical person or do you lean more towards immorality and evil? And how do you make sense of what is right or wrong in an ever-changing society and world? These are interesting questions, which can provoke quiet introspection or spark heated debates over a social gathering. The answers may vary greatly, as they are guided by differing personal and religious beliefs and values. One thing is clear, however. As human beings are highly complex, the answers are not and cannot be simple.
For many people, it is not common practice to frequently reflect deeply on one’s moral character and goodness. Often, people follow automatic habits and behavioural patterns, and feel justified in their thoughts, opinions, and actions. It takes mental and emotional effort to consider an alternative viewpoint and it is unpleasant to consider that one has done something that is on the wrong side of justice, and so, this sort of reflection is often avoided. This is not to say that people are incapable of considering their wrongdoings. They simply, don’t like to stay there for too long and usually try to rectify the situation quickly and move on.
There are, however, certain people that are riddled with insecurity and deep uncertainty about their moral character and goodness. Instead of momentary healthy reflection in this space, they find themselves ruminating and obsessing over their thoughts, intentions, and actions. It becomes a dominant and consuming thought process, making it hard to engage with others and the world, without continously questioning one’s own goodness or intention in each of those moments. It is absolutely exhausting.
A preoccupation with one’s own moral character occurs frequently within the context of obsessive-compulsive disorder (OCD) and is often one of the driving forces of obsessions and compulsions. People with OCD experience intrusive or unwanted thoughts, which in turn provoke great distress due to the belief that the presence of such cognitions have deep moral implications. For example, in the “harm” subtype of OCD, a person might experience an intrusive thought about punching someone. This in turn can trigger deep distress that the fact that they have had such a thought means that they are truly a violent and evil person. People with OCD find it difficult to distinguish between thought, intention, and action, and often equate all three when placing moral judgment on themselves.
Moral OCD
There is one particular subtype of OCD where the preoccupation with one’s morality and “goodness” is the dominant feature of this condition. This can be referred to as “moral OCD” or “scrupulosity disorder”. Although this subtype often occurs within religious contexts, the preoccupation with one’s morality can and absolutely does occur without any religious underpinnings, and it is important to review this subtype of OCD in both contexts.
The list below outlines some common features of moral OCD:
Obsessional thinking and questioning of one’s moral character.
Frequently reviewing one’s thoughts, intentions, and actions, and questioning the morality or goodness of them.
Reviewing and obsessing over past thoughts or actions, and whether one’s intentions were “impure”.
Self-criticism and judgment.
Cognitive distortions (e.g. black-or-white or binary beliefs and thinking).
Rigidity in beliefs and thinking.
Intolerance of uncertainty and craving certainty.
Distress, anxiety, and panic over these concerns of morality.
In non-religious moral OCD, people’s obsessions may revolve around themes of their goodness/badness, selfishness, being rude or offensive, being socially inappropriate, questioning the purity of their intentions, and/or whether they are being manipulative or deceitful. There may also be obsessions over whether one is being considerate enough or doing enough for important social, political, and environmental causes. In religious moral OCD, people’s obsessions are influenced by their specific religious beliefs and practices. Common obsessional themes that may arise within this context include distress over blasphemous thoughts, fears of offending god or going to hell, fears about violating religious practices or incorrectly interpreting religious texts, and concerns about one’s level of faith or belief in their religion. Importantly, the thoughts around these themes are at an obsessional level, which cause great distress and anxiety. This is very different to experiencing healthy, purposeful thoughts about one's moral character, which might lead to productive self-reflection and reparative action (if it is needed).
Given the level of distress, it is understandable that people with moral OCD are desperate to do something about their "immoral" situation. As is common in other subtypes of OCD, people with moral OCD engage in compulsions to neutralise, avoid, or “make up for” their immorality. There is also a strong compulsion to obtain more certainty or clarity over the situation, in hope that this may reduce their anxiety and provide them with some relief over their uncertainty. However, this almost always backfires, with people finding themselves even more uncertain and distressed than prior to engaging in a compulsion.
In non-religious moral OCD, common compulsions may include excessively reviewing actions they have taken and also testing themselves by theorising what they might do in a future hypothetical moral situation. They may also feel compelled to confess their “immoral actions” and to seek reassurance around their morality. People with religious moral OCD might engage in some of the examples listed above. However, they will also engage in compulsions specific to their religion, such as repetitive prayer or rituals beyond what would be considered a reasonable expectation within that religion. They might also continuously review and check that their thoughts and feelings about their religion or god are still “good” or strong. They could also avoid places that may trigger any “immoral” thoughts or feelings.
Treatment of moral-OCD
OCD is a difficult disorder to treat and it is strongly advised that one obtains therapy from a psychologist with a high level of expertise in this area. OCD is often treated using several therapeutic modalities, including CBT, ACT, DBT, and Schema therapy, which may target the OCD directly or indirectly by addressing other components feeding into the OCD. However, one of the most important and crucial components of OCD treatment is Exposure and Response Prevention (ERP). ERP involves the practice of holding oneself back from compulsions and practising an acceptance of the discomfort and uncertainty that arises in its place. Over time, it is expected that ERP would lead to reductions in the intensity and frequency of compulsion urges, as well as increased comfort with uncertainty. Interestingly, one may also feel a greater level of certainty over time, when they learn to disengage from their obsessions and compulsions.
Of note, in the context of religious beliefs, it is important to distinguish between “normal” or expected behaviours within a religious context and OCD-related obsessions and compulsions that cause significant distress. In such cases, it may be important to involve both a psychologist and religious/spiritual leader in the treatment of OCD. The aim of this treatment is not to take away one’s religious beliefs or faith, but rather to disentangle the OCD from one’s religious practice. Often, OCD-related beliefs are much stricter and inflexible compared to what is normally practised by others within their faith. Those with moral OCD may also be more ineffective at truly making up for any religious or moral wrongdoings, as they find themselves consumed in repetitive thoughts and actions, rather than effective problem-solving.
Next steps and treatment expectations
If this is your first time recognising symptoms of OCD within yourself or someone you care about, or if you are somewhere along the journey of OCD recovery, know that effective treatment is available. OCD can be particularly sneaky and it can take a bit of time to really feel like you are back on track in life. The greatest challenge in OCD is a true acceptance of one’s thoughts, emotions, complexities and imperfections. Sometimes when symptoms start reducing, it can be tempting to avoid treatment and hope for the best. However, this often only reinforces the fear of OCD and its power over you. It is important to stick it out and have faith in the therapeutic process.
INLIGHT PSYCHOLOGY | BONDI JUNCTION
Inlight Psychology has a team of psychologists trained in the treatment of OCD and its subtypes. To book an appointment, call our reception on (02) 8320 0566 or email to contact@inlightpsychology.com.au.
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