When I was a kid, my parents had their driveway repaved and this left a glorious mound of dirt at the top of it for a few days. It was probably ten feet tall and I was clearly told not to play on it, but the moment my mom and dad were off running an errand, I was all over that thing. It was a lot of fun for my toy soldiers and trucks, not to mention the full-body dirt-sledding. The second my mom came home, I felt something in my chest and my throat that I knew immediately I could not tolerate feeling for very long. I could not wait to tell her what I had done.  Oh the sweet relief of confession!  She was upset with me, but what I remember most was that she was put off by the confession itself as much as by the misdeed. It was bad that I broke a rule, but she didn’t get why I would go out of my way to tell her. Maybe she thought I was gloating, but I remember thinking it could not have possibly gone down any other way.  I was not going to feel like a bad kid for a second longer, even if it made me look like a jerk.

Moral scrupulosity OCD often cuts much deeper than this.

  • A child may keep repeating the details of an event at school for fear that she left something out that would render the story less than perfectly honest.
  • A woman may feel completely frozen in guilt for days for allowing herself to laugh at a funny movie, forgetting for a moment that she was grieving the loss of a loved one.
  • A man may desperately avoid being in the same supermarket aisle as an attractive woman and then repeatedly confess to his wife that he found someone attractive – all so he can feel moral about his wife having full disclosure as to who she really married.
  • A woman may donate large sums of money to any organization that solicits it or she may force herself to do favors for anyone who asks even when she doesn’t have the time – all out of fear of being or appearing selfish.
  • A man may think an actress in a pornographic video looks disturbingly young and devote endless energy to trying to find out if he’s committed a crime (legal or moral) for having seen it.
  • A woman may suddenly remember a comment she made to a colleague last year and wonder if it could have been perceived as racially insensitive, then get stuck endlessly seeking reassurance about it from friends and the internet.
  • A mom may engage in endless mental rituals going back and forth between self-criticism and rationalization over having let her child hear a song with age-inappropriate lyrics.
  • A teen may step in a parking lot puddle and spend days crying, concerned that she might have tracked something harmful into the house that could harm her pet.
  • A man may suddenly remember a time his former girlfriend turned down a sexual gesture and spend every waking moment trying to remember if he coerced her in any way, including scouring the internet for any potential condemning references from that time period.
  • A young athlete may have a thought about his competitor getting injured and become consumed with guilt as he racks his brain for certainty that he would never really want that to happen.

These are just a few examples of how OCD can work its way into the moral universe.  If it’s not your obsession, it can just look like taking oneself too seriously.  But if it is your obsession, something as subtle as a sliver of doubt about moral intention can make it seem like your life is on the line.  Nothing could seem more important than this.  After all, don’t we all want to know in the end that we were one of the good ones?

In the previous installment of this series on Moral Scrupulosity OCD, we defined many of the ways it manifests and how it can be treated with exposure with response prevention (ERP). Let’s take a look now at the roles played by mindfulness, cognitive therapy, and self-compassion.

Can’t Do Anything Immoral If I Just Sit Here, Right?

The most important thing to understand about mindfulness is that it is an invitation to delineate between what is real and what is a story. To be mindful is to report objectively on the items that arise in consciousness. For example, right now you are absolutely, 100% definitely, without a question experiencing the words in front of you. They are simply there, in your field of vision. What they mean, well, that’s a story. It could be a true story, or could be fiction, but nonetheless the story is not objectively there. Just a bunch of thoughts. You are also feeling whatever you’re feeling in your body, hearing whatever sounds are available to hear, and you may be tasting something or smelling something as well.

Besides your five senses, you are aware of the presence of some thoughts. These thoughts are definitely occurring. But how are they any different than the visual of these words or the other information coming in through your other senses? They all land in the same place, your awareness.  To be mindful of your thoughts is to read them like you read this blog, a string of words that you make meaning from. But they are not born with that meaning. If you can’t read, these words don’t make any sense to you.

When we lose sight of thoughts as thoughts and start to get lost in a web of stories, this is the OCD’s domain. “That was bad. I am bad. I shouldn’t be bad. I’m a failure. I am wrong. I hurt people. I am a deviant. I am dysfunctional. I must prove otherwise. I must be good.” These stories sweep you up and take you away from the present moment (where you would otherwise see them as just thoughts). Understanding that a story about your morality is not the same thing as an objective reality (you’re having thoughts and feelings, which aren’t the same thing as threats or facts) is key for liberating yourself from OCD.

But mindfulness isn’t easy.  To “mind less” that these thoughts and feelings arise is to take a huge risk that you haven’t tried hard enough to be moral, that you could be wrong.  Maybe this thought is the one you were supposed to wrestle to the ground and pummel!  Being mindful is viewing OCD as simply a storyteller that weaves thoughts together to trick you into forgetting that they’re just thoughts, and viewing it this way is the ultimate exposure.

Everything I Do Is Wrong, Including Thinking About Being Wrong All the Time

It’s hard to discuss moral scrupulosity without getting into metacognitive and meta-metacognitive spirals. Moral scrupulosity is, by definition, very much about how we think about ourselves, so exploring whether we may be thinking about ourselves in unhealthy or unskillful ways necessarily involves still, well, thinking about ourselves. Even trying to navigate that sentence is a chore. Putting it more simply, moral scrupulosity is a form of OCD that emphasizes a fear of being immoral or morally contaminated. When we think “I am immoral” or “that was immoral”, we are making judgments about the self. We have a story about the self and if we think the story has been damaged, or poorly written, OCD tells us it needs a rewrite. But often we come to the conclusion that the story has been damaged because we are thinking unskillfully about our experiences. Put another way, we may be misinterpreting what we’re reading.

Cognitive therapy approaches to OCD involve stepping back and taking a look at the way we read our stories and then invites us to consider applying a more skillful, objective, or rational lens. It can very easily devolve into more ritualizing, more mental efforts to prove we’re good or disprove we’re bad. But done delicately, cognitive restructuring of moral scrupulosity obsessions can remind us that compulsions are not the moral mandates they appear as. Rather, compulsions are just recipes for short-term delusion and longer term suffering. Here are some unskillful thinking styles, or cognitive distortions, that apply to Moral Scrupulosity OCD.

Thought Action Fusion

A common cognitive error in all forms of OCD is to attribute powers to thoughts that they do not have and to confuse those fictional powers with actual actions or events. For example, I may have a thought about whether or not I committed an immoral act. Maybe I think I could have emotionally scarred someone by some action I remember taking in their presence. From there, it may splinter into one of two problems. I may come to believe that if I think about this action too much, it increases the likelihood that it caused harm. In other words, the more I think something, the greater the probability of its truth. Or, I may believe that the act of thinking it is, in and of itself, an immoral act (e.g. thinking about hurting someone is wrong and an act of oppression itself). In either case the problem is based on a confusion, or fusion, of thoughts and actions in the mind.

All-or-nothing thinking

Seeing the world in black and white is not seeing the world clearly. This is not an appeal to moral relativism, but to reality itself. Life is complicated and simplifying it into only two categories (the way OCD likes it), makes it too easy to slip into mindless compulsive reacting. In the world of moral scrupulosity, this means dividing the self into two categories of good and bad. If I do or think or intend for a bad thing, even for a second, even if based on a misunderstanding, then I am a bad person. If I can’t prove 100% that I am a good person, I must assume I am bad. To be sorta kinda ok on the moral front is unacceptable. Well, the truth is, good guys and bad guys make for decent 80’s cop movies, but not for much else.

Magnifying

If you have moral scrupulosity, making a big deal out of every real or imagined moral misstep doesn’t seem like magnifying. It seems like compensating for bad behavior. People with moral scrupulosity tend to purposely blow up their real and imagined transgressions as a form of compulsive reassurance that they are taking ownership of wrongdoing (and therefore must be supremely moral). The antidote to this is seeing things as they are in the moment (here he is with the mindfulness again). Maybe you made a mistake. Maybe you are having thoughts about having made a mistake. Maybe one choice wasn’t your most heroic. Working with that, the way things actually are, gives you a fighting chance against the OCD. Ballooning up uncertainty about your morals into giant acts of evil is just an invitation to do compulsions.

Discounting/disqualifying the positive

If you’re sitting tied to a post surrounded by angry torch-wielding locals who are shouting at you, then disregard this paragraph. If you’re just a person reading a blog about OCD, then the universe is telling you a lot already about your moral worth. The universe is often telling us that everything is fine. It’s this disconnect between the appearance of things being fine and the brutal intrusive thoughts and emotions telling us we’re bad people that makes OCD so frustrating. Rather than trying to push away information that contradicts your OCD, a better strategy would be to accept it when you see it.

Tunnel vision/selective abstraction

Like disqualifying the positive, tunnel vision is a way of thinking that emboldens our obsessions. It says that the things we notice in the universe that could be related to our obsessions are proof of the importance of those obsessions. So if you see moral quandaries everywhere, you determine this must mean moral failing on your part. How easily we forget that we notice what we look for and we look for what we are obsessed with!

Emotional reasoning

People with all forms of OCD often wake up with and walk around with a lot of free-floating guilt and shame. Since moral scrupulosity is, by definition, an obsession with self-worth or “goodness”, it should come as no surprise that OCD promotes these painful feelings as bait to start doing compulsions. Guilt proves nothing.  Recognizing that feelings are not reliable evidence of facts can take some of the power away from OCD’s claim.

Overestimation of responsibility

Moral scrupulosity OCD will tell you that your awareness of a potential moral quandary is the same thing as signing a contract to solve the moral quandary.  This not only applies to yourself and the all of the compulsions it tells you to do to prove that you are morally clean, but often to others as well.  For example, you may feel that someone else’s moral misstep (real or imagined) is up to you and you alone to undo or stop from being repeated.  This can lead to over-controlling behavior towards others that can appear nosy or pushy, when in fact it is just driven by a fear of your own guilt.  It can also lead to extreme safety measures, such as removing objects from a street that your OCD says might be distracting to a driver and leaving you responsible for their potential accident.

Shoulding

You should not use should and if you do, you should know that shoulding is bad and you should have known better, shouldn’t you have? Got it? Good. People with moral scrupulosity often feel like slaves to the word “should.” Sometimes it can be subtle, like, I should recycle, and then the OCD promotes doubt about the efficiency or quality of your recycling efforts (for the record, I literally put things in recycling bins that I think should be recyclable, even when my confidence level on this is low). It can also be philosophical, like, I should not think harmful thoughts. Most notably, should statements can be meta or abstract, as in, I should always be certain whether or not I have been moral. It is impossible to challenge one’s distorted attachment to “should-thinking” without doing ERP. By definition, being flexible in response to “should” statements is to admit to something different from (or as OCD would frame it, less than) perfectly concrete moral reasoning.

Stop Being Such a Wimp and Be More Self-Compassionate

All of this risk-taking with moral obsessions can be an invitation to self-criticize. It is inevitable that challenging the way in which we think, even if for the wiser, leaves us vulnerable to accusations of being “bad” (whatever the OCD says that means). If our efforts to be perfectly certain about morality cause us to be compulsive, and ERP asks us to scale back that behavior, then we are going to feel, well, less moral in a way. We may try to compensate for this by engaging in self-punishment, being extra unkind to ourselves to make sure we aren’t getting away with anything. If I can at least prove that I feel bad (i.e. guilty, disgusted, self-hating) about real and imagined moral failings, then I am at least somewhat liberated from worrying about being immoral. Put simply, self-criticism is a compulsion. It often gets overlooked because we tend to think of compulsions as feeling good. In reality, compulsions simply feel better than what we imagine the alternative to be and beating yourself up sounds better than taking the risk of finding out you’re a bad person later. If only it worked.

Self-compassion isn’t for the faint of heart. It’s pretty hard exposure work, if done honestly, and takes great courage to pull off. Shala Nicely and I discuss in Everyday Mindfulness for OCD how to effectively use self-compassion as a tool to push back against OCD’s brutality. We took some inspiration here from Kristin Neff’s work on the subject (see her book Self-Compassion). Neff identifies mindfulness, common humanity, and self-kindness as three aspects of treating yourself the way you would hope to treat others. Here’s how you can think of them in terms of moral scrupulosity:

Mindfulness

I am thinking I did the wrong thing and feeling guilty. This is a mindful statement because it observes what is going on without adding additional narratives or judgments to it. Remember, mindfulness simply means observing things how they are in the present. Note that the statement does not include stories such as “I am a failure at being human.” It’s not just that this statement would be unkind, but that it is fundamentally dishonest. “Failure” is ill-defined and in reality you don’t know for certain whether or not you meet it. You think you might and you feel like you do and these thoughts and feelings are what you need to acknowledge.

Common humanity

Many people worry about doing the right thing and feel uncomfortable with uncertainty about this. This statement acknowledges simply that what you are feeling is not unique to you, despite OCD’s emphasis to the contrary. Many people do in fact worry about the same issues that those with Moral Scrupulosity OCD worry about, just not to the point of debilitation. Let go of the need to isolate yourself emotionally and instead let yourself recognize that whatever you are feeling is what humans feel. This is an important antidote to self-criticism.

Self-kindness

I’m trying my hardest not to seek reassurance or do other compulsions right now. I can give myself permission not to have all the answers and take the risk of doing my ERP homework. All you’re doing here is pointing out what you’re doing right. It could be really small, so long as it’s honest. Then, you just have to identify something that stands a chance at being useful, rather than continuing to beat yourself up.

Self-compassion is not about letting yourself off the hook or being in denial of your character flaws. It really is an exposure when you have moral scrupulosity. It entails taking the risk of being brutally and objectively honest about your experience without the compulsive or abusive commentary. It involves taking a huge risk of treating yourself as if your worth were not open to debate, skipping an opportunity to judge yourself so that you can make healthy self-serving choices in the present moment. Pretty scary stuff considering that it opens you up to the risk of remaining uncertain about your obsessions.

If treating yourself badly proved you were good and proving you’re good freed you from your OCD, I’d be all for it. Have at it. I’m awful, you’re awful, we’re all just total losers with nothing to offer! The problem is, aside from this statement being obvious nonsense, it just doesn’t treat the OCD. It’s OCD trickery.  Instead of beating yourself up, better to use CBT to kick the OCD where it counts.

In the next installment of this blog series, we’ll take a deeper look at some of the new and exciting ways we come up with to feel bad about ourselves. Huzzah! More to the point, we’ll examine further how CBT can help you gain mastery over Moral Scrupulosity OCD.

Click Here to read Moral Scrupulosity OCD: Part One

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