Faye – I do remember you from last year’s Virtual Camping and it was nice to see it on Nightline — they did a decent job in showing what we did; although, more time and more explanation would have been nice (Click to see Nightline segment). In answer to your question, can scrupulosity be treated with exposure and response prevention? The short answer is yes. Like all OCD, the focus of treatment is learning to live with uncertainty. There are many kinds of scrupulosity, so depending upon the type there will be variations in treatment. In a sense, treatment will be taking a risk of offending God, but treatment will also be an act of faith. For everyone who believes in God, there is the question as to what is his nature – merciful and forgiving or angry and punishing? The religious texts can provide evidence for either. In the end, we are stuck guessing and if you think about it, either guess is possibly offending the other version. If He is forgiving, then isn’t it an insult to treat Him as cruel. And when you say a prayer over again, aren’t you offending both versions — after all, God always knows what is in your heart even if you don’t, so to repeat a prayer is to suggest he is stupid and can be fooled by words. So what is to be done? Like all questions, we have to guess and it doesn’t matter that we all would like to make the right guess, because we all don’t get to find out until we die, unless you get a personal communication and that would be a nice miracle. On the other hand, suppose God opens your ceiling, looks down and just says, “Hi Faye.” In the morning your hair is white, you’ve had this wonderful miracle; you know there is God. On the other hand, you are still uncertain. His appearance was a blessing, but was it a warning? What are you supposed to do? You are back to guessing.
So in treatment, we assume that you are guessing. As long as you are doing this, we suggest picking the God you would like to believe in. Because the one that leads you to ritualize isn’t comforting and really your prayers aren’t to him, but to the OCDemon. Your act of faith one that is scary – you commit yourself to the merciful forgiving God. And what if you are wrong. I would suggest that you love God so much, that you will accept punishment if you guessed wrong. I’m suggesting putting your faith on the line. Because you don’t really have a choice. Like all OCD treatment, this is hard, but not as hard as your life is when you devote it to the OCDemon. And the devil is the right analogy, because in listening to your OCD, your life loses meaning, you have trouble helping yourself or others. You lose everything listening to the false promises of the OCDemon. It is simple decision, but it is not an easy one. Obviously treatment and preparation are more complicated than I’ve written her, but I hope this gives you a good start. Just as you have begun to overcome contamination, you can overcome this.