If you have read the previous pages you are now ready to further examine the medical side of this most upsetting affliction.

It is tragically common for doctors to misdiagnose people with OCD as having depression, bipolar disorder, ADHD, autism or schizophrenia. In the USA it is said to take an average of nine years from the onset of Obsessive Compulsive Disorder for people to receive even a correct diagnosis and, amazingly, a further eight years before they are suitably treated. But if having the courage and knowledge to find treatment is difficult with general OCD, it is usually significantly harder with scrupulosity. Few people suffering from religious OCD even realize they have a medical or psychological problem.

It is much easier, for example, to recognize that washing your hands fifty times a day is abnormal and undesirable than if OCD manifests itself as an overly sensitive conscience or feeling the need to pray or witness for hours each day. In fact, people with scrupulosity usually mistake their out-of-whack, condemning conscience for their loving Savior. They feel driven to excessive devotion that leads only to feelings of inadequacy and burnout, or to mistakenly supposing that the Bible condemns them as unforgivable and because anxiety feels like an unappeasable guilty conscience, they are likely to stubbornly cling to this delusion, no matter how many pastors, theologians or spiritual advisors tell them otherwise. Similarly, it is easier to realize you have a purely psychological affliction if you feel compelled to keep checking locks, than if you feel compelled to cuss the Holy Spirit. These serious hindrances to seeking treatment are further magnified by some Christians, who have no qualms about seeking human help if they have a plumbing problem, but somehow fear it might be unspiritual or a lack of faith to seek human help for a medical or mental problem.

As a man of science, and someone who has devoted his entire life to serving people without charge, I find it annoying that almost every possible natural cure for anything has been less rigorously researched and tested than substances that drug companies could make money out of. There is much scientifically based evidence that there are medications that can help OCD (although, because everyone reacts differently, finding the exact medication that best suits you is likely to take patience and trial and error). However, there is some scientific evidence that there are some simple things like vitamins that can be equally effective, often at lower cost and with fewer side effects. Since I am not medically trained, I urge you to consult a doctor before trying even vitamins but if you have not yet tried medication, I suggest you seek medical advice about first trying inositol, an essential, apparently harmless, naturally occurring substance found in every cell of your body. Although the current amount of scientific proof is less compelling for the effectiveness of inositol than for certain medication, it is also less likely to have any side effects. Information about inositol and other simple, natural cures is provided in another webpage (Natural Cures for Anxiety-Related Illnesses) but I suggest that for the moment you keep reading and turn to that page later.

When I mention medication, don’t for a moment suppose this is to drug you or in any way make you less mentally alert. I want your thinking sharpened, not dulled, and the way to facilitate mental clarity is for you to be in peak health and especially to correct any bodily abnormalities and imbalances that have the potential to distort one’s thinking and perceptions.

Our bodies are highly complex and dependent upon a vast number of factors. If some imbalance prevents our bodies from functioning normally, it could affect not only our physical well-being but our feelings, emotions, perceptions and clarity of thinking.

Here are some well-known examples:

* Low blood sugar can cause impaired mental functioning, irritability, confusion, difficulty speaking, anxiety, paranoia and/or aggression.

* Insufficient oxygen (such as in altitude sickness) can cause confusion, clumsiness, and stumbling. The first signs may be uncharacteristic behavior such as laziness, excessive emotion or violence.

* Insufficient sunlight can cause depression (Seasonal Affective Disorder, for example).

* Sleep deprivation can cause learning, concentration and memory difficulties, mood changes, lowered ability to tolerate stress, and make you error/accident-prone. Severe sleep deprivation often results in hallucinations.

* Hormonal imbalance can cause all sorts of mood changes, including postnatal (postpartum) depression.

If your body were lacking in iron and it were affecting your health, would you refuse to take an iron supplement? Providing a doctor confirms you will benefit from an iron supplement, I believe it would be sinful to refuse because:

1. Our bodies are the temple of the Holy Spirit and so should be looked after.

2. As in the parable of the talents, we have a responsibility before God to develop responsibly what God has entrusted to us.

If someone kindly gave you a new car it would be disrespectful to the giver to let the car deteriorate by not changing the oil and so on. Likewise, it is disrespectful to the One who gave us our bodies not to do what we can to keep ourselves in peak health. We will one day have to give account to God if we achieve less in life because we have let ourselves be physically run down.

The same would apply if we achieve less in life than we are capable of because we let ourselves be psychologically run down by not taking dietary supplements if we have a deficiency. Just as being intoxicated creates a chemical imbalance that lowers one’s ability to think clearly and resist temptation, so do a number of other chemical imbalances that can occur within the body.

Religious OCD sufferers either feel spiritually inferior to most Christians or realize that they have it harder than most Christians. Few realize that the primary reason is not spiritual but physical. Correcting a physical imbalance that affects one’s thinking gives people a head start (pun intended) relative to where they would be if they kept suffering the disorder but it is no head start relative to where healthy people are. Knowingly maintaining the handicap by refusing to correct an imbalance is as spiritually irresponsible as deliberately choosing to expose oneself to horrific temptation. Like being sober, correcting an imbalance in no way eliminates the need for spiritual weapons, spiritual graces and so on; it simply allows a person to have more of the basic resources that help other Christians cope with trials.

To refuse whatever it takes to have a properly functioning body is neither being spiritual nor macho. It is simply being irresponsible. What would you think of a porn addict who is deeply ashamed of his addiction and keeps praying to be delivered but insists on keeping his porn collection? Just as it is dishonoring to God for someone to want sexual purity and yet, for some twisted reason, refuse to lessen the temptation by getting rid of his hoard of porn, so it dishonors God to refuse medical help for lessening religious OCD. Unless you have solid medical advice that you are in the rare situation of your body having a severe adverse reaction to every appropriate medication, you owe it to God to doggedly pursue every medical possibility of lowering the severity of religious OCD.

There is not a Christian on the planet who is not tempted and, as already hinted, it seems logical to assume that demons play a role in most temptation. Certainly Satan does not have the divine power to be everywhere at once, so if he is involved, it could only be through his underlings. Demons are nothing to be freaked out about; we should simply seek to expose and resist their attempts to deceive us. With this in mind, sober thought and experience with literally hundreds of people suffering from religious OCD has forced me to conclude that the temptation to not do whatever one can to correct a bodily chemical imbalance is not just illogical, it is demonically inspired. It is undeniable that demons have much to gain and the kingdom of God much to lose by keeping Christians from anything that would allow them to think more clearly.

Taking medication is putting your faith into action. It is a bold statement to the spirit world that through Christ you are accepted and cleansed and that your problem is therefore physical, not spiritual – a medical issue, not an indication that Christ is unable or unwilling to save.

Serotonin is a bodily substance essential for health. As a neurotransmitter it plays a vital role in brain function. Medications usually prescribed for Obsessive Compulsive Disorder are intended to affect serotonin levels and are technically known as Selective Serotonin Reuptake Inhibitors (SSRIs). Confusingly, they are often popularly referred to as antidepressants. (It is not uncommon for a single medication to be prescribed for a diverse range of illnesses. For example, quinine was the first effective treatment for malaria and yet it is used to treat arthritis and also lupus.) Certain medications that help people with OCD might happen to also benefit some people who are depressed, but their primary function is to correct a serotonin imbalance in the brain. This chemical imbalance seems to be a key factor in OCD and associated deceptive guilt feelings and unwanted thoughts. Sometimes a higher dosage is needed to treat OCD than to treat depression. It is vital, however, to seek skilled medical advice before taking medication or natural cures. For example, it is quite possible to have undiagnosed bipolar disorder, and many of the antidepressants that are commonly used to treat OCD can make this affliction worse.

Interestingly, in trials involving placebos, a high proportion of depressed people reported less depression after taking fake pills, but very few people with OCD responded to fake pills.

Treatment of Obsessive Compulsive Disorder has sometimes been found even more effective when two or more medications are combined. If, with a particular OCD sufferer, a prescribed medication has an unwanted side effect, there is often an alternative medication that is just as effective and for that person does not have the side effect. In fact, my mother’s doctor told her there are four different classes of Selective Serotonin Reuptake Inhibitors. She had to try all four until finally finding one that suited her. Abruptly ceasing medication can cause additional problems, such as withdrawal symptoms.

So if dissatisfied with the medication, there are good reasons for seeking further medical advice. A general doctor could get you started but for maximum effectiveness it might be best to see a doctor who specializes in this type of medication. These medical specialists are psychiatrists. They should not be confused with psychotherapists – the type popularly portrayed as getting you to lie on a couch and talk about your childhood. Neither should they be confused with psychologists. In contrast to psychiatrists, psychologists are not qualified as medical doctors and so cannot prescribe medication. Psychologists usually specialize in cognitive-behavior therapy, which we will discuss shortly.

A common mistake that even some doctors make is to underestimate how long it will take for the medication to begin to lessen the symptoms of OCD. Although medication often takes just a few weeks to begin to work, in some cases it could take up to three months. It is also important to realize that treatment is expected to reduce the severity of OCD rather than a complete removal of all symptoms.

Although response to attempts to correct the chemical imbalance varies considerably from person to person, Clifton’s experience might prove helpful for some readers. For several months, he found relief through taking 12 mg of inositol daily. In his case, however, the benefits eventually faded to the point where he needed to replace it with an antidepressant (Prozac). Clifton was already taking 1800 mg of omega 3 to help another medical condition. When researching OCD he learned that studies suggest fish oil can produce benefits similar to antidepressants but he took little notice as he knew that with fish oil alone his OCD was quite bad. When he later stopped taking fish oil, however, he discovered the benefits of fish oil. When combined with the antidepressant, the result was considerably better in combating OCD than with Prozac alone. Research suggests that fish oil has a multitude of positive effects and yet even fish oil can have negative effects in some people, such as thinning the blood too much. So, as with all “natural cures,” I strongly advise medical supervision.

Please be aware that if you cease the medication, symptoms could return to pretreatment levels. In fact, Professor of Psychology, Henry A. Virkler wrote the following in The Journal of Psychology and Christianity (Vol. 18, No.3, 1999, page 269), I quote it because it might also apply when these same medications are used to treat OCD.

Persons with major depression who stop antidepressants too quickly may experience a recurrence of the depression, and it may not respond to a second round of antidepressants as rapidly or fully as it did to the first round. Similarly, for those with bipolar disorder, current treatment guidelines recommend permanent use of mood-stabilizing medication, for without it each manic or depressive episode tends to become more serious and difficult to treat.

A woman shared the following with me and has allowed me to quote her. Her experience of medication helping but not eliminating the problem is what I expect to be fairly typical.

I have suffered from scrupulosity practically all my life. It started with blasphemous thoughts while I was in church when I was 12 years old, and I am now a bit beyond middle-aged. Ultimately I stopped going to church because of the guilt. I felt as if I were possessed. Shortly after the thoughts, I began washing my hands a lot as if to “cleanse” the guilt. I also started checking things a lot.

I basically suffered in silence and was not diagnosed until many years later. Then I was put on Prozac and later Zoloft. The medication helped quite a bit with the thoughts and cleansing rituals. The thoughts are still there, but more like background noise and less guilt-inducing. The hand washing is pretty much gone, and the checking is under better control – only at times of stress does it resurface.

The only thing that still plagues me is an overwhelming feeling of responsibility, as well as feeling guilt over things I enjoy.

It is clear that she still has challenges – medication is not the wimp’s way out – but like carving an occasional foothold into a cliff face, it helps.

Please don’t be reluctant to get help. You owe it to God to seek the best treatment.

Alternative Treatments

No matter how apparently safe or well-documented the research behind any treatment regime, we should always seek God regarding it. Consider John:

For nineteen years, John suffered horrifically from OCD, and SSRIs (commonly known as antidepressants) brought him no relief at all. After six months of near miraculous relief, however, he wrote to me saying, “I tried doctors, psychiatrists, therapists, SSRIs, antipsychotics, Benzodiazepines. I prayed night and day and Jesus led me to take L-Tryptophan every morning.”

I was excited to read of John’s breakthrough and was keen to share it with you, but a very superficial investigation dulled my enthusiasm. There is little research indicating that it works, and plenty of suggestions that for some people it could be dangerous. It is said to be linked to 37 deaths and over 1500 reports of eosinophilia-myalgia syndrome (causing many to be permanently disabled). Most of these cases were from a single manufacturer, suggesting that contamination might have been involved but there are other reasons for concern. It can also interact badly with quite a range of medications. Perhaps the risks are not as enormous as I initially thought but I urge extreme caution with anything that has not been subjected to extensive medical trials and has your doctor’s approval. L-Tryptophan seems to have proved to be safe and effective for John but whether it will work out that way for you is your chance to play Russian Roulette.

John’s experience proves the importance of persistently seeking God’s leading and that what works for an individual can be quite surprising. No matter how life-changing it was for John and how much he might have been led of God, however, it in no way proves that it will be effective or even safe for you.

John agrees that with those advocating SSRIs that OCD is a serotonin deficiency disorder. He says L-Tryptophan must be taken on an empty stomach, accompanied with a carbohydrate drink and that the brain converts it into serotonin.

I strongly suggest giving priority to more conventional, better-attested treatment. If in your case other approaches fail, it is still important not to proceed with John’s suggestion without considerable prayer and research. To get you started if you decide to go down this path, here are a few websites: L-Tryptophan. If you begin to feel persuaded to try this approach, however, I also suggest discussing it with your doctor.

For information about other non-prescription ways of improving your brain chemistry, see Natural Cures for Depression & Anxiety-Related Illnesses.

New treatments are currently being tested, such as deep brain stimulation. Trials are also underway with drugs that target the brain chemical, glutamate, that is thought to be a factor in OCD.

In cases that are both extreme and rare, brain surgery or Electro-Convulsive Shock Therapy have been suggested. However, cognitive-behavioral therapy is far more proven and safe. It is widely recommended for people with Obsessive Compulsive Disorder, often in conjunction with medication.

Cognitive-behavioral therapy is basically being skillfully guided to train yourself to lower the anxiety that causes the problem. You could think of it as overcoming a brain problem by retraining the brain. The effect is a little like what happens when, by retraining themselves, people overcome the debilitating effect of brain damage caused by a stroke.

Cognitive-behavioral therapy is usually done in a carefully controlled manner, but treatment typically involves deliberately doing the thing you fear, and refusing to engage in any compulsive “remedy.” For a compulsive hand washer, for instance, it would usually involve reaching the point of deliberately getting the hands dirty and refusing to wash for hours. At first, the anxiety over not washing would be high, but as time progresses without washing, anxiety would gradually lower. For the treatment to be effective and long lasting, anxiety merely has to be lowered, not necessarily completely eliminated.

This exact approach is awkward with religious OCD, however. It is easy to believe that you will not die or go to hell if you do not check locks thirty times a day. You will then be free to use cognitive-behavioral therapy to address the irrational anxiety you feel over not engaging in that behavior. But for cognitive-behavioral therapy to work, someone with scrupulosity must first reach the point of believing that the behavior he is anxious about – such as uncontrollably swearing at God or witnessing less – does not threaten one’s walk with God. Arriving at that belief will not automatically lower one’s anxiety – that’s where cognitive-behavioral therapy comes in. Since that belief is the starting point for cognitive-behavioral therapy, however, it must be reached by some means other than cognitive-behavioral therapy. That makes this extensive series of webpages particularly valuable.

Another problem with cognitive-behavioral therapy, however, is if the therapist wants you to train yourself to lower your anxiety by deliberately thinking blasphemous thoughts. That is certainly a way of tackling head-on one’s irrational fear of the thoughts, but it hardly seems desirable from a Christian perspective.

The next webpage in this series will introduce you to a Christian modification of cognitive-behavioral therapy that I think you will feel much more comfortable with.

Ralph shares his experience with scrupulosity:

When disgusting thoughts against the God I love first started screaming in my head, I thought I was “possessed” or crazy. Against my will, I found myself swearing at God and cursing him in the vilest manner. It was torture. I presumed I was the only one ever to have this problem. To my relief, I later found out that many others also suffer from this affliction. That helped. I now belong to a chat room called the Scrupe Group: Go to https://groups.yahoo.com/neo/groups/the_scrupe_group/info or e-mail the_scrupe_group-subscribe@yahoogroups.com The group was established by a Lutheran pastor who has scrupulosity. It really helps to talk with these people.

I’ve also read many books on this subject. (Details)

Medication has helped me, too, since Obsessive Compulsive Disorder is caused by a chemical imbalance in the brain.

I try to keep in mind that it’s a disease and that God isn’t mad at me for having it. Would he be angry with a person for having cancer or diabetes? So he’s not angry with me for having this problem. He knows I hate these horrible thoughts and doubts.

At times, I get to thinking that God is just waiting to catch me doing something wrong so he can keep me out of heaven. I have to keep reminding myself that the God of love actually wants us to spend eternity with him. I think if any of us could grasp how much God loves us, we would never worry about anything ever again.

Another consequence of scrupulosity is that throughout my day, I think I’m sinning on every little thing, and it upsets me. For example, if someone cuts me off in traffic, I might mutter to myself, “Idiot!” Then I panic. “Oh no, I’ve sinned! Father, forgive me!”

Awful thoughts about God tend to especially hit me when I’m tired, or not doing anything in particular, or if I’m uptight about something.

I just want to be pleasing to God in everything I do and it’s upsetting to me when I think I’m not. I feel the need to pray a lot, which usually is good because I’m thanking him for all the good things that happen, large and small. But I spend too much time asking for forgiveness for this and that.

Although I don’t do this anymore, I often used to keep thinking I needed to ask Jesus to be my Lord and Savior “just one more time to make sure.” I read of a man who kept doing this over and over, day after day. Finally, his pastor told him, “God heard you the first time!”

It is a horrible disease to have terrifying doubts and terrible thoughts about God in my head, but I guess it’s my cross to bear. A year ago, I was barely able to function but I’m doing pretty good now.

I recently joined the net-burst.com ministry team. We receive prayer requests from needy people all over the world and I have found praying for these people most helpful in changing my focus from my own concerns to those of other people. It seems to make my own worries shrink in size.

If I could have just one dream come true when I die it is to see Jesus with his arms open for a hug, saying to me, “Well done, my good and faithful servant.”

I suggest you memorize the following:

* We are not morally responsible for the thoughts or images that come unbidden into our minds. It is no more our fault than it is Jesus’ fault that he was tempted to worship Satan.

* Disliking certain thoughts is the moral opposite of enjoying those thoughts.

* No matter how perverted or grossly insulting to God your thoughts are, normal Christians have such thoughts.

* If these thoughts torment you, the only thing distinguishing you from average Christians is that you have an excessively delicate, accusing conscience, causing these thoughts or images to alarm you. Other people would realize they are not responsible for intrusive thoughts and so remain unconcerned.

* If the thoughts keep returning, it is simply because you fear them.

* As overcoming a fear of heights, or of spiders, is very difficult, so is overcoming a fear of anti-God thoughts. God thinks the same of you, however, regardless of how successful or unsuccessful you are at overcoming the fear – and hence the repetition – of the thoughts.

* God is love. It is his very nature. For God to stop loving you he would have to stop being God. He wants you to enjoy all of eternity with him.

* Genuine, selfless love always wants to forgive. So the Almighty, for whom nothing is impossible, always wants to forgive you, no matter how gross or frequent your sins.

* Since Jesus died for the sins of the whole world, no sin is excluded from the power of God’s forgiveness.

* True love always respects the loved one’s wishes. Just as it would not be true love for a man to kidnap a woman and force her to be his wife, no matter how much he believed she would benefit from it, so it is against God’s nature to force his forgiveness on anyone.

* Since God is love, and Jesus was tortured to death to make possible the forgiveness of all sin, the only thing keeping anyone from Jesus’ forgiveness is God’s loving refusal to force forgiveness on anyone who does not want Jesus to forgive him and take away his sins.

* If you want Jesus to take away all your sins, and you trust him for forgiveness, you are not only loved of God (as everyone is), you are totally forgiven. In God’s eyes you are sinless, no matter how guilty your over-sensitive conscience makes you feel. Your loving, forgiving God is your Judge, not your fallible conscience.

Someone defeated by hypochondria will keep believing he is sick, no matter what medical tests and doctors say. Someone defeated by anorexia nervosa will keep believing she is fat, no matter what scales, mirrors and people say. Likewise, someone defeated by religious OCD will keep believing he is guilty and unforgivable, no matter what God, the Bible and pastors say. But no one has to be defeated. Anyone with religious OCD will keep suffering overwhelming feelings of guilt but no one is forced to believe his/her own feelings. It is the nature of this affliction that the feelings will be so strong and persistent that it feels that they must be true. It is ever so easy to cave into the feelings and choose to believe in them, rather than in the power of Christ, but no matter how convincing the feelings are, it is still a choice as to what we believe. Choose life! Choose to cling to faith in the forgiving power of the One who is Life (John 14:6) and gave his life for your every sin.

Scrupulosity (Religious Obsessive Compulsive Disorder) is the product of an oversensitive heart and a yearning to please God and yet the sufferer typically feels the exact opposite, worrying about having a hardened heart and fearing he/she is not godly enough.

More Help Required
People keep e-mailing me, desperate for a quick fix so that they can get the relief they crave without having to read all these webpages. They are wasting their time and mine, however, because in all my years of anguished prayer and fervent seeking, I have failed to find an alternative to having to keep reading all these webpages. Take a rest now, if required, but you will need to read more.

Not to be sold. © Copyright, 2007, 2012, 2013 Grantley Morris. Not to be copied in whole or in part without citing this entire paragraph. Many more compassionate, inspiring, sometimes hilarious writings by Grantley Morris available free at the following internet site www.net-burst.com Freely you have received, freely give.