The Truth About OCD

OCD: More than just repeated hand-washing

What do you think of when you think of Obsessive-Compulsive Disorder (OCD)? In contrast to cleanliness, health, or order, there are people who obsess over issues that are specifically moral or spiritual in nature, like obsessing over whether something they are doing is sinful or whether they will commit a sin that they are particularly disturbed by. This kind of OCD has been called Religious OCD or Scrupulosity (think “scruples”).

Definitions of “obsession” and “compulsion”

To help us understand OCD in general, let’s first consider the definitions of “obsession” and “compulsion”. Michael Emlet, a faculty member with CCEF (Christian Counseling and Education Foundation), says, “An obsession is a persistent thought, impulse, or image that you find intrusive, inappropriate, and anxiety-inducing”. A compulsion is a response to this obsession, which Emlet says is using “ritualistic behavior or mental processes to temporarily ‘neutralize’ or reduce the anxiety associated with your obsession”.

Having covered the “O” and “C” in OCD, let me now say something about the “D” – “Disorder”. For the purpose of giving biblical counseling, the term disorder has serious ramifications. Calling this a disorder denies the moral and spiritual reality of the problem and also erases, or at least reduces, the responsibility of the individual to admit any fault and move toward bearing the fruit of repentance. Therefore, as I will use the acronym “OCD”, I do not hold to all the implications of that label.

Specific obsessions and compulsions for Religious OCD

With that being said, it would help us to see some examples of obsessions and compulsions for someone who tends toward Religious OCD:

Obsessions:
Intrusive thoughts of punching someone in the face when angry at him/her.
A person thinking that he/she has lusted simply because they saw an attractive person.
Persistent speculation about whether it’s a sin to enjoy some of God’s gifts — food, recreation, etc.

Compulsions:
Ritualistic confession of sin, whether he/she is convinced of sin or not
Morbid introspection — deep self-examination and analysis of motives and desires.
Repeatedly checking to see if he/she is guilty of sinning against someone. This may include persistently asking questions of others or asking forgiveness just in case sin has been committed.
 
The Heart of Religious OCD

The heart of Religious OCD is complex, and so, much could be said here. I want to talk about one attribute of the heart of this struggle and then a biblical remedy.

A person who tends toward Religious OCD is often characterized by a demand for certainty. This person finds ambiguity intolerable, especially with reference to whether he has done something wrong. Scrupulosity, as Michael Emlet says, “is a tender conscience on steroids”. Therefore, any suggestion in this person’s thoughts or actions that might suggest he has committed sin (the obsession), sends him into a feverish hunt for whether he has, in fact, done something immoral (the compulsion). If it is unclear to him whether he has sinned, then, to one degree or another, he is crippled from activity and responsibility until either he convinces himself that he has not sinned or, if he has, that he has performed the proper duties to make things “right”. But if the person can’t make this determination, then deeper levels of fear, anxiety, and neglect of duties often results.  

A Biblical Remedy

As with many of the idolatries of the heart, the person who tends toward Religious OCD wants what God alone possesses: omniscience — to know all. The scrupulous person needs to remind himself each morning that God exists and that he is not him. When he demands certainty and compulsively searches for it, then trust in God has flown out the window and it has been replaced with self-trust. On these occasions, the scrupulous person has put himself in his own dreadfully incapable hands instead of the hands of the God who executes all that he plans, which means that God’s hands cannot fail.

The scrupulous person must be counseled to trust in God’s comprehensive knowledge and care. God knows all the things that the scrupulous person does not know about himself. From the ambiguity of his motives in engaging in certain activities to whether he is guilty of committing specific sins, God knows it all. And because “God is light and in him there is no darkness at all” (1 Jn 1:5), this struggling saint can trust God to always use that knowledge faithfully, for his good in becoming more like Christ (Rom 8:28-29).

In Psalm 139, David expresses God’s comprehensive knowledge. Not only does God know our lives with great intimacy, but he has also ordained every day of our lives before we ever live them. This psalm also conveys God’s care that accompanies his exhaustive knowledge of us (v5). This means that God applies sovereign care to our lives. He hems us in by putting limitations on our lives to protect us and directs us with his providential hand. The scrupulous person needs to cling to this reality.

There is likely an unspoken lie that the he believes which says, “It will be better if I have all the information. I will know what to do with it. I understand that God knows it all, but that’s not good enough. I need to know. I must know.” To that lie, the scrupulous person needs to preach Psalm 139 to himself.

In the sufficiency of God’s Word, we also find something highly practical for the scrupulous person in this psalm. David grasps the fact that God is everywhere, that he knows everything, and that he is sovereign (vv. 23-24). This is a prayer for the scrupulous person to memorize and use often in the battle against sinful doubt and the lust of certainty. With this prayer, he can leave his uncertainty with the one who has all certainty, and move on to what is certain for him: That he should walk in obedience to all the clear commands that he’s been given in Scripture while filling his mind with all of the clear promises of God that are his in Christ. The scrupulous person can pray David’s prayer and then move on to what God clearly wants him to do, trusting God to reveal sin and lead him in the direction that brings him glory.

Concluding thoughts

When a person is grieved by the patterns of Religious OCD, he needs to realize that some of the heart issues that must be addressed are a lust for certainty and then a futile trust in self to provide that certainty. Of course, we are describing sin here. To desire something in the place of God and to trust something in the place of God characterizes idolatry. This is ironic since the obsession for the scrupulous person centers around whether or not he has sinned. The reality is that he is sinning in trying to determine if he’s sinned. Certainly, it is not wrong that he is trying to determine this, but for the scrupulous person, this has reached a level of demand, and when that is true, he must set himself on a course of repentance. Repentance in this case looks like turning to belief in God’s comprehensive knowledge and care and then moving to the next choice that will honor him.

There is much more that can be said with regard to searching out the heart of a person struggling with Religious OCD and bringing hope to this specific problem, so please look forward to future posts on the topic.

Note: This article originally appeared on thecbcd.org. We encourage you to visit the Center for Biblical Discipleship and Counseling where you can find helpful, biblical resources by a number of trusted pastors and authors.
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1. From the article, Living with Obsessive-Compulsive Disorder on familylife.com.

2. From the article, Living with Obsessive-Compulsive Disorder from familylife.com.

3. CCEF conference message: Religious OCD: Help for the Obsessively Christian.