Breaking free from scrupulosity

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When OCD Gets Religious الوسواس القهرى الدينى:

When OCD Gets Religious الوسواس القهرى الدينى

What is scrupulosity?:

What is scrupulosity? Extremely careful to do the precisely right, proper, or correct thing in every last detail; most punctilious متمسّك بالشكليات . Showing extreme care, precision, and punctiliousness Full of scruples وساوس-حيرة-تردد , hesitant, doubtful, or uneasy, constantly and obsessively in deciding what is right or wrong

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The condition of “seeing sin where there is none” The Roman Catholic and protestant churches John Bunyan Martin Luther البلخي إبن القيم ابن الجوزي

What it is like to have scrupulosity :

What it is like to have scrupulosity People with religious obsessions and compulsions are ruled by an overly strict and rigid code of religious, moral, or ethnical conduct. Rather than subscribing to religious precepts النصائح and laws as guides for living a richer , more peaceful and spiritually fulfilled life, people with scrupulosity become victims of their own beliefs. Their scrupulous behavior robs يَسْرقُ them of peace of mind.

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They live in a relentless عَنيد tortured state of vigilance , always alert to the possibility of committing some immoral or blasphemous act كفرية and being punished harshly for it.

Some examples of scrupulosity :

Some examples of scrupulosity Repeatedly attending confession to request forgiveness Excessively worrying about having a sexual thought while looking at another person's spouse, or حتى لطفل أو نظرة من رجل لرجل أو من إمرأة لإمرأة . Repeatedly reciting the Lord's prayer over and over للتأكد من نطق كل كلمة بدقة وتركيز وخشوع وتدبر وبدون سرحان وبدون أي خطأ في التشكيل أو النطق أو التجويد

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Constantly checking the ground to make sure one has not stepped on an object resembling the sign of the cross and thus desecrating an important sympol Meticulously avoiding swallowing one's own saliva in order to follow the requirement to abstain from eating or drinking during the Jewish celebration of Yom Kippur. Some examples of scrupulosity

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عند المسلمين: البصق طول النهار الامتناع عن الاستنشاق والمضمضمة في الوضوء تنشيف الفم دائماً بخرقة أو فوطة عدم دخول المطبخ أبداً خلال الصيام خوفاً من تعمد الأكل والشرب عدم الاقتراب مطلقاً من أي مصدر مياه حتى لا تصل أي طرطشة أو نقطة إلى الفم إعادة أيام الصيام طوال السنة Some examples of scrupulosity

Differentiating between strong religious beliefs and scrupulosity:

Differentiating between strong religious beliefs and scrupulosity 1 .parctices that go far beyond the requirements of religious law and custom, when members act "more Catholic than the Pope." For example, if a ritual requires abstaining from food and drink , the scrupulous person may feel that swallowing saliva is sinful.

Differentiating between strong religious beliefs and scrupulosity:

Differentiating between strong religious beliefs and scrupulosity 2.Beliefs or practices that have an overly narrow , trivial focus, or excessive attention paid in prayer to "saying it right" or " perfectly" rather than as a way of developing a relationship with God.

Differentiating between strong religious beliefs and scrupulosity:

Differentiating between strong religious beliefs and scrupulosity 3. Healthy religious beliefs don't interfere with the normal practice of the religion. Scrupulosity OCD, on the other hand , frequently interferes with practice of the religion, for example , when a person with blasphemous thoughts avoids going to church altogether.

Differentiating between strong religious beliefs and scrupulosity:

Differentiating between strong religious beliefs and scrupulosity 4. the person with scrupulosity spends excessive time and energy on minute, trivial aspects of religious observance, often ignoring more important aspects of spiritual life such as charity for the less fortunate.

Differentiating between strong religious beliefs and scrupulosity:

Differentiating between strong religious beliefs and scrupulosity 5. The excessive preoccupation with doing religious rituals until they are " just right ," repetitive praying, and unnecessary confessing seen in scrupulosity resemble the typical symptoms of OCD, such as checking, repeating, and asking for reassurance. Like the unwanted.

Does having strong religious beliefs increaes the likelihood of having scrupulosity OCD? :

Does having strong religious beliefs increaes the likelihood of having scrupulosity OCD? OCD is a neurobiologic disorder there must be a biological predisposition to have OCD Strong religious believes are not the cause of OCD There are only the grist for the OCD mill in a person who is biologically predisposed to it If strong religious believes were not present, the OCD would surely take a different form, such as contamination fears, or checking compulsions

Hypermorality and hyperresposibilty:

Hypermorality and hyperresposibilty Hypermorality involves an excessive preoccupation with the fear of doing something morally wrong, reprehensible يستحق التوبيخ and/or condemnable. These individual set excessive, unrealistically rigid and narrow standards in the areas of their lives. Examples: مراجعة فواتير الشراء – السرقة مراجعة الكلام مع الناس – الكذب

Hypermorality and hyperresposibilty:

Hypermorality and hyperresposibilty hyperresposibilty People who are hyperresposible Have an overly unrealistic sense of accountability, Such people take on responsibilities that realistically belong to others, or take responsibility for things that are beyond anyone's control.

Hyperresposibilty:

Hyperresposibilty Examples: فحص الأرض للتأكد من عدم وجود أي شيء مثل الماء أو أي مادة قد تؤدي للتزحلق (قشرة موز) حتى لا يضر الآخرين (مسمار-زجاج....) فحص القمامة جيداً للتأكد من عدم وجود شيء يجرح حاملها أو فرزها وتصنيفها إلى زجاج-معادن-ورق-.... حتى يسهل الاستفاده منها لمن يجمعها جمع الحيوانات في الشوارع والسلالم (قطط- كلاب -..... لحمايتها ورعايتها

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For example, they are afraid of going to hell, angering God, or living with guilt for their failure to protect others from harm. They have little time or energy left to concern themselves with the well-being of others because of living in constant fear for their own fate.

The Self Directed Program:

The Self Directed Program Step 1 Find a spiritual/Religious advisor مرشد. Step 2 Keep a daily record of your obsessions Step3 Make a target Obsessions list Step 4 Make a target Compulsions list Step 5 Devise an Exposure and Ritual prevention Strategy

Step 1:Find a spiritual/Religious advisorمرشد..:

Step 1:Find a spiritual/Religious advisor مرشد.. 1-choose a trusted person to serve as your moral , ethical or spiritual advisor يا سلام لو كان طبيبك النفسى, وهى دى خطتنا القادمة وأن يكون كل طبيب نفسي هو مرشد كل مريض وسواس 2-This person should have religious beliefs similar to yours with a basic understanding of scrupulosity OCD

Step 2-Keep a daily record of your obsessions:

Step 2-Keep a daily record of your obsessions Date Situations that trigger discomfort Discomfort level (o-100) Obs.thoughts , images,impulses that increase anxiety Compulsions,. thoughts, images, or behaviors that reduce anxiety

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Date Sit. that trigger discomfort Discomfort level (o-100) Obs.thoughts , images,impulses that increase anxiety Compulsions,exc.thoughts , images,or behaviors that inc. anxiety 9/12/08 Thoughts about attractive person other than my spouse 95 Impure thought –God will punish me Prayed 75 min. till it felt right 9/12/08 Looked at infant’s genitals 85 May be I enjoy looking-I will go to hell Avoided touching baby or going to his room 9/12/08 Went for a walk 90 I must never step on a living thing, violating God’s orders Keep my eyes on the ground watching everything I walk on 9/12/08 Sitting in a mosque or church 75 I feel like shouting obscenities at God Attended confessions or ask for forgiveness 3 times a week

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Obsessive Thoughts ,images or impulses SUDS level (o-100) 1-Iam having an impure thought and God will punish me 70 2-May be I enjoy looking-I will go to hell 80 3-I must never step on a living thing, violating God’s orders 60 4-I feel like shouting obscenities at God,or image of jesus 90 5-May be I told a lie without knowing it, I’ m certainly a bad person 95 6-may be if I don’t understand this passage of the holly book I won’t go to heaven 100 Step 3: make a target obsessions list

Target obsessions list:

Target obsessions list SUDS level 0-100 Obsessive thoughts, images or impulses 1 2 3 4 5 6 7 8 9 10

Step 4: Make a target Compulsions list:

Step 4: Make a target Compulsions list Compulsive behaviors, including thoughts, actions that neutralize or reduce anxiety SUDS level if u don’t do the compulsion 0-100 Average amount of time per day or week if applicable 1- 2- 3- 4-

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Compulsive behaviors, including thoughts, actions that avoid, neutralize or contain anxiety SUDS level if u don’t do the compulsion Average amount of time per day or week if applicable 1-Praying for a long time. till it feels right 100 Most of the time 2-Avoided touching baby or going to his room 90 About 4 times a week 3-Keep my eyes on the ground watching everything I walk on ايات الله,قران,شيء يشبه الصليب،كائنات حية(نملة,ضفضع) 85 90 min/day 4-Attended confessions and ask for forgiveness for my blasphemous thoughts كفرية 95 All the time, when outside 5-repeating god forgive me 24 times سورة من القران او مقطع من الكتاب المقدس 100 4 hours per day

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Compulsive behaviors, including thoughts, actions that avoid, neutralize or contain anxiety SUDS level if u don’t do the compulsion Average amount of time per day or week if applicable 6-repetitively reading the same scriptures over and over until they are perfectly understood 95 2 hours per day 7-Holding my breath when walking by a non –kosher butcher so I won’t inhale the scent of non kusher meat جزار لا يذبح الذبح الشرعى (اليهود) 80 Avoided daily

Step 5-Devise an Exposure and Ritual prevention Strategy:

Step 5-Devise an Exposure and Ritual prevention Strategy This strategy is based on yr lists of target obsessions and compulsions, The first target is to lower the level of distress

The ritual prevention works best when::

The ritual prevention works best when: 1-Exposure must be prolonged and repeated 1.5-3 hours per day, for 4-7 days a week. U must remain in anxiety provoking situation long enough to promote habituation.

The ritual prevention works best when::

The ritual prevention works best when: 2-The exposure must be acceptable to u, and not oppose yr core religious beleifs محاضرة القسم,كلام الأطباء,ترك الصلاة لغاية ما تخف Remember that OCD behaviors are excessive, unwanted, persistent ,and not based on the true requirements of religious or spiritual practice

The ritual prevention works best when:

The ritual prevention works best when 3-As U expose yr self to anxiety provoking situations, work to reduce yr compulsive rituals gradually on a day to day , week to week basis. 4-If U r feeling Unsure or Unsafe when blocking a ritual , the general rule is “do the Opposite” of whatever scrupulous idea Yr OCD mind tells U to do.

The ritual prevention works best when::

The ritual prevention works best when: 5-Make copies of the scrupulosity Exposure and Ritual prevention planning form and use it to help U plan Yr EPR strategy on day to day or week to week basis.

Scrupulosity Exposure and Ritual prevention planning Form:

Scrupulosity Exposure and Ritual prevention planning Form Target Obsessive thoughts , images, or impulses Never step on any living thing or I’ll be punished Target Compulsions Check, recheck,and retrace steps while walking outside Exposure and Ritual prevention strategy Become more comfortable taking reasonable and prudent risks while walking ,gradually reduce checking behavior SUDS before starting ERP 95

Scrupulosity ERP planning Form (Cont..):

Scrupulosity ERP planning Form (Cont..) How long (min, hours) per exposure 30 minutes How often (days , weeks ) Three times per day Target SUDS level 20 Avoidances to be stopped Walking outside is not to be avoided Additional instructions Discuss exposures with advisor before proceeding

Exposure & Ritual prevention daily ( weekly)plan:

Exposure & Ritual prevention daily ( weekly)plan Day( week)1 Walk 30 paces (1/2-1 min) without looking down or checking ,repeat 5 times/day Day(week)2 Walk 60 paces( about 1-2 min) without looking down or checking ,repeat 5 times/day Day(week)3 Walk 120 paces(2-4 min)without looking down or checking ,repeat 5 times/day Day( week)4 Walk 160 paces(3-6min)without looking down or checking ,repeat 5 times/day

Imaginal Exposure Plan:

Imaginal Exposure Plan Day ( week)1 Do imaginal exposure with the image of accidently stepping on an ant ,hold image until SUDS level goes to less than 20 repeat daily Day(week)2 Do imaginal exposure with the image of accidently stepping on a frog, snake,hold image until SUDS level goes to less than 20 repeat daily Day(week)3 Do imaginal exposure with the image of accidently stepping on a frog, snake, killing it, being tried for cruelty to animals , found guilty and punished old image until SUDS level goes to less than 20 repeat daily

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Intrusive thoughts, impulses to shout obscenities at the image of jesus or God Target Obsessive thoughts , images, or impulses Attend confession repeatedly , repeat prayers four\times Target Compulsions Expose self to horrofic thoughts for increasing amounts of time until horrofic thought habituates .Reduce confessions and reassurance Exposure and Ritual prevention strategy 90 SUDS before starting ERP

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45-90 min per day How long (min, hours) per exposure Once a day How often (days , weeks ) 0-20 Target SUDS level Must attend church or mosque regularly Avoidances to be stopped Discuss exposures with advisor before proceeding , discuss guide lines for appropriate use of confession and prayer with advisor Additional instructions

Exposure and Ritual prevention Plan:

Exposure and Ritual prevention Plan Reduce confessions to two/week , reduce prayers only to the obliged ones Day( week)1 Reduce confessions to one/week , reduce prayers only to the obliged (maintain normal prayer schedule) Day(week)2 Stop all obsessional rituals Day(week)3 Stop all obsessional rituals Day( week)4

Imaginal Exposure Plan:

Imaginal Exposure Plan Hold thought of shouting obscenities at the image of jesus or God in mind for 1 min, repeat every 10 min for 1 hour Day( week)1 Hold thought of shouting obscenities at the image of jesus in mind for 2 min, repeat every 7 min for 1.5 hou Day(week)2 Hold thought of shouting obscenities at the image of jesus in mind for 1 min, repeat every 5 min for 1.5 hours Day(week)3 Hold thought of shouting obscenities at the image of jesus in mind for 8 min, repeat every 5 min for 1.5 hou Day( week)4

Key Points:

Key Points 1- U r not Planning to act on yr bad thoughts , only to think about them. Thoughts do Not Equal actions. 2-Daily place Yr self in situations that will trigger symptoms Avoid avoidance المسجد,الصلاة,القران,الأذكار، الكنيسة، الترانيم

Key Points:

Key Points 3-Tell Yr advisor to give U reassurance that U R doing the right thing only once . rephrasing a question or asking a second person to get another reassuring answer is not helpful Be honest with yr self , If U ALREADY KNOW THE ANSWER , Don’T ASK .

Key Points:

Key Points 4-When u want to avoid a situation or activity do it any way .If u feel an urge to do something to alleviate yr anxiety , DON”T DO IT. 5- Allow bad thoughts to pass into yr mind, as if seeing them through a distance

Key Points:

Key Points Ignoring obsessive thoughts weakens them while fighting against them strengthens them causing them to grow and multiply الوسواس سؤال لو جاوبته يبقى 100 لو جاوبتهم يبقوا 1000 The standards and beliefs of people with scrupulosity OCD often go beyond those of most devoted members of their own religion.

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