Moral scrupulosity OCD, or the relentless pursuit of certainty about one’s morality, can feel like a truly impossible situation.  You have a thought about something you did or thought about doing, or felt an urge to do, and so forth, and because this experience doesn’t line up with your presumed identity as a moral person, you feel bad.  Because you feel bad, you try to get the feeling to stop. You may seek reassurance, try to make sure you’re not doing bad things, check to see if you have, and engage in other compulsions.  You set up a series of rigid rules that apply only to you to guarantee you’ll never do a bad thing, but since these rules are impossible to follow perfectly, they also make you feel bad. 

What’s worse, ceasing to feel bad makes you feel like you’re getting away with something, like you stopped caring about your moral compass.  Bad feelings at least reminded you that you care and reassure you that you would never intentionally be immoral.  So you find yourself trying to get away from the pain of bad feelings while at the same time clinging to those bad feelings for proof of inherent goodness.  Ultimately, this compulsive relationship to moral doubt sends the message to your brain that thoughts about morality are codes to be cracked, problems to be solved.  So, the brain faithfully performs its duty to help you by sending more intrusive thoughts and feelings your way.

Getting Your Moral Hands Dirty

Exposure and response prevention (ERP) therapy for moral obsessions can easily miss the mark if no attention is paid to compulsive guilt.  It may appear as if ERP for moral scrupulosity is just about bumming yourself out all the time. But for ERP to be at its most effective, you have to expose both to the fear that you may be morally imperfect and also to the fear that you have inadequately addressed it.  It’s this second part that people sometimes forget to engage in treatment. In other words, telling yourself that you may have done something immoral can bring up painful feelings, but what you do next is what teaches the brain to change its perspective on how to handle that idea.  If you take that pain and beat yourself over the head with it, you’re doing the E of exposure by telling yourself you may have done a bad thing, but not the RP, the response prevention, of behaving like a person whose morality is not in question.

Sometimes this concept is easier to understand by switching it out with another common obsession, like contamination.  ERP for contamination fears involves exposing to triggering experiences (E) to generate the feeling of being dirty, but then intentionally behaving like someone who is clean (not washing hands and also cross-contaminating to other objects and environments).   So you get the dirty feeling, but you pair it with the behavior of a person who feels clean.  In terms of moral scrupulosity, you want to generate in your exposures the difficult feelings you connect to morality, that sense of moral contamination, and pair it with the behavior of a person who is confident in their moral cleanliness. 

So what does this really look like?  Here are some mock examples (not mocking examples, which would be wrong):

The “I Shouldn’t Think That” Thinker

You get intrusive thoughts about people that you believe are immoral to think or would be immoral to say (e.g. racist or misogynist thoughts).  It makes you feel guilty around triggering people and leads to a back and forth in your head of self-reassuring that you would never mean those things and self-punishing for having thought them in case you meant them for a second.

Exposure:

  • Intentionally think the thoughts around triggering people
  • Read about people who like these thoughts and tell yourself you could be like them
  • Write scripts describing yourself believing the thoughts and the implications about you that come with this

Response prevention:

  • Don’t avoid triggering people, continue to interact and be friendly
  • No reassurance-seeking regarding your beliefs about the thoughts
  • Label self-criticism for having the thoughts as compulsive and congratulate yourself for coming up with such a creative obscenity.  Actively try to enjoy them if any part of you thinks they’re funny, even if it would horrify your sensibilities to say them.

The “I Did a Bad Thing” Thinker

You made a poor choice at some point and now your OCD says you have to be certain that you learned from it and that it will never happen again.  Sometimes you want to be certain you’ll get over it, but sometimes you’re afraid to get over it because being obsessed with it feels like it may protect you from doing it again or at least give you certainty that you’re not the kind of person who would if given the chance.  You may want to forgive yourself, but rationalizing what you remember about your experience just makes the OCD worse.  Or you may refuse to forgive yourself because compulsively clinging to guilt means you haven’t forgotten what you’ve done.

Exposure:

  • Intentionally be around people or places that are associated with the memory
  • Write scripts describing the event in a facts-only way (no analysis of the meaning or context of the event) and describe how awareness of the event may be a permanent fixture in your life or how getting over the event may lead to negative outcomes

Response prevention:

  • Catch and abandon any mental review of the event, especially any rationalizing over why the event occurred or why it won’t be repeated
  • Seek no reassurance about the meaning of the event or your character
  • Fully engage in the present by actually allowing yourself to enjoy something (mindfulness is a major asset here).  Remember, OCD wants you clinging to guilt, so embracing a joyful moment is an act of rebellion.
  • Find activities to do that you imagine people do when they believe themselves to be good, innocent, or having served their time.

The “Doing No Harm” Thinker

You may avoid doing things where there is a slight chance of inadvertently harming others in the process (e.g. any task involving chemicals that could go astray).  When you try to engage in these tasks, something always comes up where your mind can make an argument that the potential of a problem means you need to be excessively responsible (e.g. thinking that if you don’t remove the shiny object from the street, an accident caused by a driver being distracted by it would be your fault).  See the previous installment in this blog series for a list of cognitive distortions that make this way of thinking possible.

Exposure:

  • Do things you genuinely want to do even if it means interacting with calculated risk (e.g. the safest driver still takes on risk)
  • Write scripts about having possibly missed a detail or failed to engage a safety measure and the unwanted consequences thereof
  • Interact with objects and environments where it is not totally clear how to do it “right” or where you are less certain you’ve followed each step correctly (e.g. move quicker through an activity, allow yourself to be slightly distracted by music or conversation)

Response prevention:

  • No rationalizing why it was ok to do the exposure
  • No reassurance seeking about the likelihood of negative consequences having occurred or potentially occurring
  • No checking to make sure unwanted events haven’t occurred or that all safety measures have been done
  • Actively celebrate the completed task even while having thoughts about having done it irresponsibly (e.g. brag about your bratwurst while knowing you may have spilled a little lighter fluid on the ground by the barbecue)

For Goodness Sake

Part One of this series includes a decent sized list of moral obsessions that people struggle with.  Obviously, that doesn’t get at every one.  For one thing, our morals evolve over time, so we keep finding new ways to obsess about them.  In the end, the most important thing to understand about moral scrupulosity is that we’re all in the same boat.  We’re all grappling with moral uncertainty and striving to be more confident in our “goodness” in society.  We can argue over whether or not your morals and mine are both right even when they may be different, but we have to admit in the end, we are both guessing. 

OCD tries to make it seem like it’s not ok to guess, like there’s some way you can be certain you’re always doing the right thing, and that if you haven’t identified what that way is, then you’re already a moral failure.  Like the metaphor of putting your oxygen mask on before your child’s during a plane emergency, you can make the choice to put first your enjoyment of life, engagement with family, presence of attention to the big-ticket items in your story that you really care about.  Maybe that’s all ERP is really about, taking the risk of putting yourself first. This is what leads you toward being the most positive contributor to the world around you, presence and connection. 

OCD claims that you must first be certain of your morality and you must hold on to guilt for any misdeeds, real or imagined, as proof of purchase in this agreement.  It wouldn’t be the first thing OCD is wrong about.

Click HERE to read Moral Scrupulosity: Part Two

Click HERE to read Moral Scrupulosity: Part One

Jon Hershfield, MFT is a psychotherapist in director of The OCD and Anxiety Center of Greater Baltimore.  Follow him on Twitter and Facebook