Clinical features of scrupulosity: Associated symptoms and comorbidity

Scrupulosity is a manifestation of obsessive-compulsive disorder (OCD) characterized by religious or moral core fears. Clinicians often struggle to treat scrupulosity, which may be associated with several features known to predict poor treatment outcome. The purpose of this study was to examine these features in participants with scrupulous OCD, contamination OCD, and healthy controls.

A total of 68 participants (57.4% women, age_mean  = 34.01) completed diagnostic interviews, and measures of symptoms and quality-of-life.

Relative to comparison groups, scrupulous participants had higher rates of obsessive-compulsive personality disorder, more severe schizotypal symptoms, and more severe symptoms of depression. In addition, OCD severity was strongly associated with poor insight in the scrupulous group. Both OCD groups reported poorer quality of life than did healthy controls.

Clinicians working with scrupulous individuals may enhance the efficacy of treatment in this challenging population by assessing carefully for these features, and incorporating treatment elements that address them.