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Julie Murdock Painley, PsyD, is a 2024 graduate of the PsyD Program in Clinical Psychology at Antioch University, Seattle.

Dissertation Committee

Mark Russell, PhD, Committee Chair

Lindsey Gay, PhD, Committee Member

William Heusler, PsyD, Committee Member

Keywords

scrupulosity, obsessive-compulsive disorder, OCD, religious OCD, moral OCD, taboo thoughts

Document Type

Dissertation

Publication Date

2025

Abstract

This dissertation presents a comprehensive analysis of the current research on scrupulosity, a subtype of obsessive–compulsive disorder (OCD) characterized by intrusive thoughts and compulsive behaviors related to religious and moral concerns. The dissertation identifies key similarities and differences from OCD, and directs focus to thematically related yet unsubstantiated theoretical work in psychology that helps elucidate the core features and etiological factors of scrupulosity as differentiated from other OCD subtypes. The study addresses the critical dearth of research on scrupulosity, aiming to fill significant gaps in the literature regarding its historical context, varied presentation and prevalence in different cultural contexts, and potentially effective treatment approaches to address better the needs of a significant number of people worldwide. Beginning with an exploration of historical conceptualizations from the 2nd through the early 21st centuries, the dissertation traces the recognition of scrupulosity and recommendations for treatment across various cultural traditions and major world religions including Islam, Judaism, Hinduism, Buddhism, and Christianity, from both Protestant and Catholic sources, as well as non-religious belief systems. It highlights notable historical figures who exhibited scrupulous behaviors contextualizing them with a modern psychological lens. As the leading theologians of their faiths, they often ironically v advised its treatment from their own experience as the most influential theologians of each of their faiths. These historical writings still have wisdom to impart today. The history of scrupulosity is, in many ways, a history of religion across time and culture, as well as of the birth and first 150 years of psychology itself. Key schools of psychological thought are explored for relevance to developing contemporary evidence-based treatments. Due to few qualitative or quantitative studies on scrupulosity compared to other OCD subtypes, the dissertation reviews key research on OCD symptoms, prevalence, neurobiology, and heritability. It locates scrupulosity both within and outside of the characteristic features and symptoms of OCD subtypes, highlighting areas ripe for future research. From this descriptive basis, analysis is made of its potential placement within an emerging synthesized spectrum of obsessional, attentional, and thought-disordered psychopathology. An analysis of intrapersonal and sociocultural factors identifies cognitive distortions, personality features, attachment styles, and societal influences that contribute to the development of scrupulosity. Findings reveal scrupulosity as a distinct phenotype of OCD, with unique prevalence patterns and treatment considerations across cultures in religious and secular contexts. The dissertation includes novel, theoretically integrated treatment strategies that respect individuals’ religious beliefs while effectively addressing the psychological aspects of scrupulosity. This work advances the understanding of scrupulosity within the OCD spectrum and emphasizes key directions for future research to further refine diagnostic criteria and therapeutic interventions.

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Julie Murdock Painley, PsyD, 2025

ORCID Scholar No. 0009-0004-6667-5112

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