In the summer of 2018, I nearly passed out on a flight from Chicago to Tampa. I was crying intensely, praying compulsively, and nearly hyperventilating. In retrospect, I was probably experiencing a panic attack; but I didn’t have language for it at the time. I was deeply distressed by a recurring intrusive thought of someone I love being violently stabbed to death. This thought was entirely unwanted; it was not voluntary. It was also deeply disturbing; I could hardly stomach it. These kinds of thoughts are called “intrusive” precisely because they are disruptive, unwelcome, and threatening—like an intruder breaking into the ‘home’ of your mind. For someone with OCD, an intrusive thought quickly becomes all-consuming. After all, if an intruder is kicking down your front door, it’s hard to focus on much else. This is the ‘obsessive’ part of obsessive-compulsive disorder.
Unfortunately, the harder you try to ‘barricade the door’ and keep the thought out, the more determined it is to find a way in. Putting up a fight only reinforces the persistence of the intruder. This causes greater distress and exhaustion. It always seems to be a losing battle. Sitting in that tiny, uncomfortable middle seat on the plane, I tried with every fiber of my being to think about something, anything, other than my loved one being stabbed to death—to no avail. Eventually, I resorted to prayer. Over and over, I pleaded with God, “Please take this thought from me. Please take this thought from me. Please take this thought from me. Please take this thought from me.” The thought would not leave. My mind wasn’t put to rest until later that night, when I finally fell asleep after hours of psychological battle. Unfortunately, when I woke the next morning, the battle continued.
This particularly difficult season of my life led me to seek out professional counseling and psychiatry, through which I was formally diagnosed with OCD. As I learned more about OCD, I was finally able to give language to experiences I had been having for most of my life, including that night on the plane. OCD begins with some kind of intrusive thought, usually an irrational one, that triggers an intense feeling like fear, guilt, and/or disgust. This is actually fairly normal, and virtually everyone experiences an intrusive thought from time to time. I like to think of it as a hiccup in the brain. In people with OCD, these intrusive thoughts are often ‘ego-dystonic’—which is a fancy way of saying that they don’t align with who you are, what you believe, and/or what you value. In other words, OCD can take the things you care about the most and turn them into a source of agony. That night on the plane, I was seeing someone I deeply love being hurt. As a squeamish and even-tempered pacifist, I can hardly entertain any thoughts of violence—not least those involving people I love and care for. This intrusive thought represented everything I’m not as a person. That’s OCD at work.
For those with OCD, these kinds of intrusive thoughts, urges, and images are difficult to shake. They linger indeterminately, becoming an obsession and causing significant distress and anxiety.[1] In an effort to bring relief to the intensity of the emotional response (e.g., fear/guilt/disgust), those with OCD perform compulsions intended to bring relief. People think of compulsions as quirky and irrational—and they can be (e.g. flipping a light switch 17 times believing it will prevent some kind of unwanted outcome). But often, compulsions are more discrete. They can look like:
- seeking reassurance from a trusted individual
- information-seeking
- confessing
- praying
- avoiding situations that may trigger obsessions
And this is only a small sampling. There are dozens of common compulsions, all of which vary depending on the kind of intrusive thought being addressed. Unfortunately, engaging in compulsive behavior activates a vicious cycle. Compulsions bring temporary relief but not lasting relief; they serve instead to reinforce the obsessive-compulsive behavior. They legitimize both the anxiety and the compulsions rather than recognizing them as irrational.
Because intrusive thoughts are so often ego-dystonic and in tension with one’s identity, beliefs, and values, religious individuals with OCD often experience intrusive thoughts and obsessions related to their faith. This is a particularly distressing form of OCD called moral OCD or scrupulosity. Those with scrupulosity may fear that they have blasphemed God, that they have committed a grave sin, that they have not adequately repented of sin and are therefore not forgiven, or that their very belief in God is not strong enough. Even if there is no memory or evidence of blasphemy or grave sin, a person with scrupulosity might fear that they committed such an offense in the past, out of ignorance, and that they simply don’t remember doing so. Even more, they may experience intrusive thoughts that are blasphemous in nature—which causes great distress, because they fear they are morally culpable for such thoughts. Those with scrupulosity often strive obsessively for moral purity, and for certainty in their theological beliefs. When faced with distressing moral obsessions, they may respond by seeking reassurance from faith leaders, excessively confessing wrong-doing (or imagined wrong-doing), and/or neurotically praying for forgiveness.
In the past, my struggle with scrupulosity has been immense. Virtually everything I wrote in the above paragraph comes from a place of personal experience. At several points between 2018 and 2020, I had seasons where I feared that I blasphemed the Holy Spirit—a sin that Jesus calls “unforgiveable” (Matt 12:31–32; Mark 3:29). It’s not difficult to see how such a fear might be distressing for someone who believes Jesus will come again to judge the living and the dead. The fear that I had blasphemed the Spirit and thus committed the unforgivable sin led me to perform several compulsions, such as:
- reaching out to preachers, professors, and other spiritual mentors for reassurance that I hadn’t blasphemed the Spirit (seeking reassurance)
- obsessively reading commentaries and combing through articles/videos/message boards online about blasphemy of the Spirit, in an attempt to convince myself that I wasn’t guilty of it (information-seeking)
- begging for forgiveness in prayer, in the event that I had inadvertently blasphemed the Spirit (neurotic prayer).
- Skipping over passages about blasphemy of the Spirit in my bible reading to avoid panic (trigger avoidance)
As you can see, this experience maps perfectly onto OCD symptomology:
- Intrusive Thought: “What if I blasphemed the Spirit?”
- Emotional Response: Fear, guilt, anxiety
- Compulsions: Seeking reassurance, information-seeking, prayer, trigger avoidance
Scrupulosity takes many forms, and my own scrupulosity has manifested in ways beyond just fear of blasphemy. As a more charismatic Christian, I have also had intrusive thoughts related to demon possession (e.g., “What if I’m experiencing health issues because I’m under demonic attack?”). Such intrusive thoughts have become obsessive and have led to additional fears, like the fear that a prayer of deliverance might not have worked because it wasn’t carried out correctly. These kinds of fears have led me to many of the same compulsive behaviors noted above: neurotic prayer, reassurance-seeking, information-seeking, etc.
Because I have been fairly open about my struggles with OCD and with scrupulosity, I have had several friends with similar struggles reach out to me for advice on how to navigate the struggle. In what follows, I do not intend to speak as an authority on the topic (I have no formal training in psychiatry or mental health counseling). Rather, I intend to share my “experience, strength, and hope” (to borrow a phrase often used in 12-step recovery programs). For Christians struggling with OCD, and with scrupulosity in particular, I have four suggestions—all of which are rooted in my own personal experience of healing.[2]
First, don’t mistake your intrusive thoughts for who you are. There is healing that comes from simply knowing what OCD is and how it works. Being able to identify an intrusive thought as an intrusive thought helps disentangle it from our self-conception. As I have noted above, intrusive thoughts and obsessions are often ego-dystonic by their very nature, meaning they represent the opposite of who we are, what we believe, and/or what we value. This is why the thoughts disturb us so deeply in the first place. The fact that I am distressed by the thought of a loved one being stabbed, or by the idea of blaspheming the Holy Spirit, is evidence that such thoughts are antithetical to who I am as a person. I need to refuse the temptation to identify myself with such thoughts.
Second, seek professional care. OCD is a serious mental condition, and it is often debilitating. During some particularly difficult seasons, I have spent several hours a day engaging in compulsions. There are certain psychotherapies and medication regimens that are proven to significantly improve symptoms. ERP (exposure and response prevention) is a first-line, evidence-based therapeutic approach that is particularly effective.[3] In ERP, you are gradually exposed to triggers but prevented from responding compulsively. Eventually, this trains your brain to understand that anxieties are manageable without compulsions. Instead of feeding the compulsive behavior, you starve it until it dies.
Having an ERP-trained therapist who is also a Christian can be valuable. In the case of scrupulosity OCD, Christian therapists tend to have better discernment regarding what kinds of exposures to prescribe, when an exposure is going too far, and so on. I have heard from friends whose non-Christian therapists prescribed them outright sinful behaviors as exposures—which, of course, wasn’t particularly helpful to them. With that said, however, having a Christian therapist is not a necessity. The most effective therapist I ever had was, as far as I could tell, an atheist; but whenever we discussed potential exposures, she was more than willing to respect my conscience and religious convictions.
In addition to ERP therapy, seeing a psychiatrist for medication management can also be beneficial. Peer-reviewed studies show that there is significant improvement in symptoms when ERP is combined with medical treatment.[4] SSRIs like Prozac, Zoloft, or Lexapro seem to be particularly helpful. I’ve tried all three at different times over the last decade, but I’ve had the most success with my current prescription of Lexapro. Everyone responds to medication differently, and a psychiatrist can help determine the right medication and dosage for you.
Third, recalibrate your theology. Scrupulosity is not well served by anemic theologies that place the burden of assurance on the self. We can learn here from the wisdom of the reformers. Martin Luther suffered greatly from scrupulosity, describing his psychological struggles as “so great and so much like hell that no tongue could adequately express them, no pen could describe them, and one who had not himself experienced them could not believe them.”[5] Fortunately, Luther came to discover the beautiful truth that the ground of salvation is entirely outside of the self; it is anchored not in one’s own meritorious works of righteousness but in the grace of God and the merit of Christ (Eph 2:8–10; Tit 3:5). When his own mind turned against him, Luther could still trust in the faithful and unchanging word of God, which promises salvation by grace through faith and rests on the perfect work of Jesus. I was raised in a church environment that often emphasized human responsibility in matters of salvation and assurance. While it’s true that God’s gift of salvation is accepted through a living faith that recognizes the lordship of Christ, this does not negate the biblical truth that salvation is grounded not in ourselves but entirely in God.
Aggressively fundamentalist theologies and church environments can also be detrimental for those suffering with scrupulosity. Fundamentalism originated in the late 19th and early 20th centuries as a defensive movement aimed at protecting Christian doctrine from liberal theology, evolution, and cultural modernism.[6] This stand against liberalism is not entirely without merit; but as a defensive movement concerned with doctrinal purity, fundamentalists often engaged in “militant gatekeeping.”[7] They focused on what they were against rather than what they were for, and elevated secondary issues to the level of essential doctrines. They wanted to guard against even “the slightest doctrinal compromise.”[8] Naturally, this framework left little to no room for ambiguity or doctrinal uncertainty. To circumvent the potential for ambiguity, fundamentalists often adopted overly simplistic, “biblicist” interpretive approaches to Scripture.[9]
This same kind of fundamentalism persists in the church today. There are Christians and churches who participate in ‘militant gatekeeping’; elevate secondary issues to the level of essential doctrine; privilege simplistic interpretative methods; and offer little to no room for doctrinal uncertainty. For those struggling with scrupulosity, this can be a lethal cocktail. Such a theological system is driven by fear and a compulsive need for certainty and control; and in that way, it precisely mirrors the negative patterns of OCD. The scrupulous Christian and the fundamentalist Christian both agonize over uncertainty and so develop unhealthy patterns of behavior aimed at mitigating the anxiety and bringing about reassurance. Scrupulosity and fundamentalism are thus mutually reinforcing. A scrupulous Christian attempting to recover in a fundamentalist environment is kind of like an alcoholic trying to recover in a bar.
For this reason, I encourage those struggling with scrupulosity to reevaluate and, if necessary, recalibrate their theology. First and foremost, make sure that your trust has not been placed in yourself but in the perfect work of Christ and the faithful promise of God. Second, resist the pull of fundamentalism. For those who are inclined toward fundamentalism, my friend Gavin Ortlund has a great little book called Finding the Right Hills to Die On: The Case for Theological Triage, which models a conservative approach to ranking doctrine that avoids the pitfalls of fundamentalism on the one hand and theological liberalism on the other.[10] Ortlund’s arguments are biblical, historical, and practical; and they helpfully demonstrate that while all doctrines matter, not every issue is a salvation issue. This study may offer peace and consolation to those facing the harsh theological reality that not everything is certain.
Before moving on to my final piece of advice, I want to briefly address those of you who are actively struggling with the fear that you have blasphemed the Holy Spirit. Please take comfort in knowing that your fear is itself a sure sign that you have not engaged in such blasphemy. In the context of Mark 3 and Matt 12, blasphemy of the Spirit is identified as a persistent rejection of Jesus as the Son of God. If you’re worried that you have blasphemed the Spirit, you clearly don’t have a heart that rejects Jesus.[11]
Fourth and finally, surround yourself with a supportive spiritual community. This includes but is not limited to your church. A church that walks with you and supports you is invaluable; but so too are close spiritual friendships and mentoring relationships. I like to say that every Christian should have a Paul (a mentor), a Barnabas (a peer and encourager), and a Timothy (a mentee or apprentice). I can’t remember where I was first introduced to this idea; but in my experience, cultivating this kind of well-rounded spiritual community fosters greater hope, healing, and endurance in discipleship. It invites others into your journey in a deeper, more personal way, so that you are never alone. I cannot overstate the positive impact that strong pastoral mentorship has had in my own battle with scrupulosity. When I haven’t been able to trust my own mind, I have been able to trust the minds of my mentors. I have also benefited from Celebrate Recovery (CR), a Christian recovery program designed to help people overcome “hurts, hang-ups, and habits.” They offer in-person support groups across the globe on a weekly basis, as well as online meetings for those who do not live near a CR group. If that sounds appealing to you, you can check here for CR groups in your area. Building community with others who are experiencing struggles similar to your own can be profoundly validating and life-giving.
Much more can be said, but I’ll leave it at that for now. If you are a Christian who struggles with OCD/scrupulosity, I hope this post has helped you to feel seen, and that it’s given you a better understanding the nature of our shared condition. Please rest in the fact that you are not alone, and that there is hope for healing. I pray that I’ve been able to offer some helpful tools and starting points for a journey toward recovery. The journey can be long and taxing, but it does get better. Remember to never mistake your intrusive thoughts for who you are; to seek professional care in the form of therapy and medication; to recalibrate your theology so that it is centered on the matchless grace and sure promises of God; and to surround yourself with a supportive spiritual community. Remember that when your mind turns against you, you can safely place your trust in the good and unchanging God of all creation. May the grace of the Lord Jesus Christ, and the love of God, and the fellowship of the Holy Spirit be with you. Amen.
[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Association, 2013), 237.
[2] To be clear, my OCD and scrupulosity have not gone away entirely; but I have had significant success in ameliorating their negative effects.
[3] Courtney Law and Jonathan S. Abramowitz, “Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder,” Psychiatry Research 2019, https://pmc.ncbi.nlm.nih.gov/articles/PMC6935308/.
[4] Lingyun Mao et al., “The Effectiveness of Exposure and Response Prevention Combined with Pharmacotherapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis,” Frontiers in Psychiatry 13 (2022): 973838, https://doi.org/10.3389/fpsyt.2022.973838.
[5] Martin Luther, Luther’s Works, vol. 31, Career of the Reformer I, ed. Jaroslav Jan Pelikan et al. (Philadelphia: Fortress Press, 1999), 129.
[6] George M. Marsden, “The Rise of Fundamentalism,” in Turning Points in the History of American Evangelicalism, ed. Heath W. Carter and Laura Rominger Porter (Grand Rapids, MI: William B. Eerdmans Publishing Company, 2017), 133–53.
[7] Ibid., 148.
[8] Ibid.
[9] Ibid., 135. For information on the difficulties of biblicism, see Christian Smith, The Bible Made Impossible: Why Biblicism Is Not a Truly Evangelical Reading of Scripture (Grand Rapids: Brazos Press, 2011).
[10] Gavin Ortlund, Finding the Right Hills to Die On: The Case for Theological Triage (Wheaton, IL: Crossway, 2020).
[11] For more on this, see the helpful blog post by my friend John Mark Hicks, “Mark 3:20–35 — Blaspheming the Holy Spirit,” John Mark Hicks, October 24, 2011, https://johnmarkhicks.com/2011/10/24/mark-320-35-blaspheming-the-holy-spirit/.
Jared Dale Greer 
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