Talk:Scrupulosity/GA1

GA review

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Nominator: ThaesOfereode (talk · contribs) 01:56, 24 April 2026 (UTC)

Reviewer: ShillAwayAsSeenOnTV (talk · contribs) 16:49, 28 June 2026 (UTC)

I have experience editing and advising edits on psych pages, so I am a good fit to review this article. ShillAwayAsSeenOnTV (talk)

@ShillAwayAsSeenOnTV: Wonderful! I look forward to reading your comments soon. ThaesOfereode (talk) 19:07, 28 June 2026 (UTC)

@ThaesOfereode I am interested in how the literature covers the distinction between Scrupulosity and OCD. I personally could not find any factor analyses placing Scrupulosity into a family of disorders, like how Roysamb or Keyes have done this.

Particularly, what about the neuropsychology of Scrupulosity and OCD? Perhaps this would aid comparison and contrast between the disorders. Here are a few abstracts to consider:

Neural Correlates of Moral Sensitivity in Obsessive-Compulsive Disorder: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1211981

Subtle Threats to Moral Self-Perceptions Trigger Obsessive–Compulsive Related Cognitions: https://link.springer.com/article/10.1007/s10608-013-9568-6

Symptom Dimensions in Obsessive-Compulsive Disorder as Predictors of Neurobiology and Treatment Response: https://link.springer.com/article/10.1007/s40501-018-0142-4 ShillAwayAsSeenOnTV (talk) 23:32, 3 July 2026 (UTC)

Scrupulosity is widely considered a subtype of OCD. There were some concerns in the 90s and 00s that some substantive differences between scrupulosity and other forms of OCD (helpfully adumbrated in Abramowitz & Jacoby [2014], § 2.8) may have warranted a differentiated diagnosis. More recent literature overwhelmingly rejects these differences as substantive enough. The only factor analysis I found useful for scrupulosity is the one cited by Miller & Hodges (2008). Happy to integrate those articles for neuropsychological discussion though; standby as I work on doing so. ThaesOfereode (talk) 20:28, 4 July 2026 (UTC)

@ShillAwayAsSeenOnTV: I've integrated parts of the Thorsen et al. (2018) source. In general, I think the Harrison et al. (2012) and Abramovitch et al. (2013) are more reporting experimental results, which, while important, are dispreferred over clinical practice guidelines, systematic reviews, and meta-analyses for medicine-related articles. Still, I've added them to the "Further reading" section because I think they are of high quality and will be useful to the more invested reader. I look forward to the rest of the review. ThaesOfereode (talk) 23:47, 4 July 2026 (UTC)

@ThaesOfereode yeah you're right to cite WP:MEDASSESS, sometimes I forget to switch gears from writing manuscripts. I appreciate your effort to nonetheless find a way to incorporate the sources.

More feedback to come. ShillAwayAsSeenOnTV (talk) 17:00, 5 July 2026 (UTC)

Hi Thaes,

I'm sorry this is taking so long. A lot is going on right now:

- I had a review re-open for a math article.

- Someone was disruptively editing the Mania page.

I need a week to get sorted over here for these and other reasons. Anyway, technically, we are still waiting for an assistant reviewer on this article.

Thank you for your patience, ShillAwayAsSeenOnTV (talk) 19:27, 12 July 2026 (UTC)

Not a problem at all; take your time. I don't know if you saw, but I left a note at the Good Article talk page in the hopes of finding you an assistant reviewer, since your request was probably lost in the ether after the GAN drive ended. ThaesOfereode (talk) 19:44, 12 July 2026 (UTC)

@ShillAwayAsSeenOnTV: Hello! Pinging just to see if you might be willing to provide a review without an assistant since, after three weeks since my last comment, it seems unlikely one will come in future. ThaesOfereode (talk) 00:48, 2 August 2026 (UTC)

@ThaesOfereode Hi, yes, I will proceed without an assistant. ShillAwayAsSeenOnTV (talk) 15:32, 2 August 2026 (UTC)

Wonderful. Please let me know if you have any questions about the GA process as we go through; I'm happy to be of assistance whenever possible! ThaesOfereode (talk) 23:17, 2 August 2026 (UTC)

Evidence of SSRI efficacy?

@ThaesOfereode: The source cited for the use of Selective Serotonin Re-Uptake Inhibitors to treat Scrupulosity is not a Randomized Controlled Trial (RCT) or meta-analysis of RCTs per WP:MEDASSESS. I tried following the citations in the source and went to Google Scholar myself, to no avail. If you cannot find a proper source yourself, the writing about SSRIs in the intro and body must be removed for this to meet GA standards (2a, reliable sources).

Overall structure of the article is comprehensive ("Broad in its coverage"), by comparison to Attention deficit hyperactivity disorder which is another GA article covering a mental health condition.

More feedback to come this week. ShillAwayAsSeenOnTV (talk) 03:03, 6 August 2026 (UTC)

Hi Shill, the only source I used to discuss SSRIs is Siregar et al. (2025), which is a systematic review that meets MEDASSESS guidelines (systematic reviews are at the top of the second pyramid). If I misunderstood you, just ping me again. ThaesOfereode (talk) 11:01, 6 August 2026 (UTC)

@ThaesOfereode Yes, you misunderstand, but maybe I can be more precise. I did see that Siregar et al. (2025) is a systematic review which generally has the same weight of evidence as a meta-analysis in [[WP:MEDASSESS]].

However, Siregar et al. (2025) is not specifically a systematic review of RCTs testing SSRIs in patients with Scrupulosity. Within Siregar et al. (2025), I found the sources they cited to support the use of SSRIs for treatment of Scrupulosity. These sources were also not reliable enough to meet MEDASSESS standards, "The best evidence for efficacy of treatments and other health interventions comes mainly from meta-analyses of randomized controlled trials (RCTs).[9] Systematic reviews of literature that include non-randomized studies are less reliable." Siregar et al. (2025) is the latter: a systematic review of literature that generally covers literature about Scrupulosity that, in its own references, cites papers that are not RCTs [Mancini et al. (2023) and Senderecka et al. (2019)]. ShillAwayAsSeenOnTV (talk) 20:32, 6 August 2026 (UTC)

Fair enough. I think the two sources (and rephrasing) fix this adequately. ThaesOfereode (talk) 00:16, 7 August 2026 (UTC)

The source from an authoritative text about OCD is fine (Siev as cited in Ambramowitz).

The other source, Albinska (2022), is questionable in its placement on the hierarchy of medical evidence. I thought to classify it as a clinical guideline, but it was published by a single author from a teaching hospital. Not from a group of specialists or specialist organization systematically producing clinical practice guidelines.

Supposing I accept the single author source, then you must also mention that SSRIs are not as effective in treating Scrupulosity as other subtypes of OCD. From Albinska (2022), "Pharmacotherapy with SSRIs (selective serotonin reuptake inhibitors) is the first-line treatment in patients presenting with OCD spectrum disorders. However, studies show that scrupulous people show lower SSRI response rates than patients with other OCD subtypes." Otherwise, WP:CHERRYPICKING violates NPOV. Neutrality is Good Article criterion number 4. ShillAwayAsSeenOnTV (talk) 01:00, 7 August 2026 (UTC)

Fair enough. This is addressed a little later on, but I've added a little extra there since it bears repeating. ThaesOfereode (talk) 12:08, 7 August 2026 (UTC)

To quote myself: "Supposing I accept the single author source [...]"

I did not say that I accept Albinska as a source. I told you why I don't, then I posed a hypothetical for possibility's sake that you could have convinced me to accept Albinska.

And I see the other articles about treatment and SSRIs in the citations and Prognosis section. The use of SSRIs for the treatment of OCD "traditionally" is not recognized justification in Wikipedia:Identifying reliable sources (medicine).

I am putting this on GAH. This article could be GA, but treatment recommendations must be robustly supported in accordance with WP:MEDRS. It is essential in any article about a medical condition.

Consider reading a few of the first four abstracts here: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C7&q=ssri+ocd+treatment+review+meta+analysis&btnG= ShillAwayAsSeenOnTV (talk) 13:38, 7 August 2026 (UTC)

I suppose I should ask before going further, but are sources that identify the use of SSRIs to treat OCD overall acceptable to you under these metrics or do you need me to find specifically that scrupulosity specifically is treated thus? If the former, the clinical guidances I've already cited should be acceptable, correct? ThaesOfereode (talk) 22:20, 9 August 2026 (UTC)

Sources should not just "identify" SSRIs as a treatment for OCD or Scrupulosity. They should contain appropriate supporting evidence. Here is why:

Suppose a publication of "Clinical Practice Guidelines" was written based on animal studies and case series alone. Then I would reject the studies if cited directly on Wikipedia. But if WP:MEDRS is taken literally, then we must believe books that appeal to inferior studies. Effectively, the book would act as a trojan horse for shaky science. So I am interpreting MEDRS in a way that enforces internal consistency of policy.

The clinical guidances you have already cited are not convincing on their face, due to an appeal to "tradition". It would help me to be convinced of their reliability if you look at those sources again for some documentation of their literature review process, or supplementary material containing the same.

If you disagree with my interpretation of MEDRS, we can discuss a policy change or clarification on the talk page for MEDRS (WP:PGCHANGE). ShillAwayAsSeenOnTV (talk) 01:18, 11 August 2026 (UTC)

And per my link to google scholar, if you find RCTs or reviews/meta-analyses of RCTs supporting SSRI use in OCD, I would accept these as sources given that you have reliable sources justifying that Scrupulosity is a subtype of OCD. ShillAwayAsSeenOnTV (talk) 01:27, 11 August 2026 (UTC)

I've reached out to some editors and one of them suggested that, unless the source directly approaches scrupulosity, it is likely WP:SYNTH to assume that treatment of OCD necessarily treats scrupulosity in the meta-analyses, even if scrupulosity is established as a subtype of OCD. In earnest, then, I would like to use our one line on SSRIs from the Albinska source and leave it there without any further discussion of SSRIs. I believe Albinska, as a source, meets the required standard for MEDRS. The journal is peer reviewed and its editorship includes several institutions with strong reputations (e.g., University of Maryland, Leipzig University, McGill University). I would characterize her work as a secondary source reviewing current literature. The sources she cites for the claim I'm citing are similarly two review type papers from peer-reviewed journals published by reputable institutions (American Academy of Neurology and Polish Psychiatric Association). I think this well qualifies it as a reliable source for the purposes it has been employed for in this article. ThaesOfereode (talk) 00:50, 12 August 2026 (UTC)

Okay, maybe that was WP:SYNTH of me to suggest. I would be interested in reading what the other editors had to say.

I stand by my point: in my interpretation of MEDRS, intended to preserve its spirit, there needs to be some kind of RCT data at the bottom of this chain of citations. All that your investigation shows is that one expert is citing another who is citing another. It's turtles as far down as we can see (so to speak).

Per WP:GANI#N4, your options were to ask me to ask someone for a second opinion or I fail this review and you "[...] renominate the article to get a different reviewer." Since I already suggested getting a second opinion and you did not respond to this, I choose to fail this review, "If you disagree with my interpretation of MEDRS, we can discuss a policy change or clarification on the talk page for MEDRS (WP:PGCHANGE)."

I genuinely wish you the best of luck in your subsequent review if you choose to seek it out. Mental health is an important topic to cover on Wikipedia and I appreciate your persistent efforts to do so as documented in the edit history of Scrupulosity. ShillAwayAsSeenOnTV (talk) 02:47, 12 August 2026 (UTC)

I am open to a second review (I apologize I missed it), but if you feel that fail and re-nominate is a better path, I won't stand in the way. I appreciate the time you've given this in any event. ThaesOfereode (talk) 12:08, 12 August 2026 (UTC)