Talk:Scrupulosity

Surprised to see that so much discussion resulted in such a non-informative article

I visited this page after reading that several historical figures (St. Therese of Lisieux, husband of famous "Anne of Green Gables" author Lucy Maud Montgomery) suffered from religious scruples to a debilitating degree.

There are three uses of the word - first, the out-of-common-usage meaning that is typically conveyed as "suffering from scruples", which has a specifically religious context; second, the current common usage of the word, which more or less means "strict regard for what is right; scrupulous care; e.g., “Albert, with characteristic scrupulosity attempted to thread his way through the complicated labyrinth of European diplomacy.” [Note the absence from the definition of the elements of psychological disorder, obsession, religion, morality, pathology, guilt, distress and compulsion]" (copied from below). The third represents the transference of elements of religious scruples that resemble psychological disorders to definitions of clearly psychological conditions today, like OCD.

A reader coming here to find what could be meant by the former usage, which is the one that commonly requires research to comprehend, goes away sadly uninformed, which misses the point of referring to an encyclopedia to find something out.

The closest hint one has is the reference to Ignatius of Loyola, describing his temptation to religious scruples after treading upon two straws that accidentally form a cross. The explanation "obsessive concern with one's own sins and compulsive performance of religious devotion" is both vague and inaccurate - the concern is not with what are actually defined as sins by the church, but what are perceived as sins by the sufferer and which are not, in fact, sins; also, religious devotions and practices may be involved, but not necessarily.

The subsequent comparison with Obsessive-Compulsive Disorder is only useful for those who already understand that term well, and have some idea how that comparison applies.

It would be very useful to fill out this article with more concrete examples, as well as a better definition and explanation of the church's response to the disorder. In religious terms, "religious scruples" are a temptation - the sufferer focuses with horror and guilt on small or even involuntary failures to demonstrate perfect love for God, to the degree that God's love and mercy towards them fade far into the background, and the sufferer believes themselves to deserve condemnation or even to actually be condemned on account of things as minor as Ignatius's treading on the two straws.

This thinking ultimately rejects God's love and mercy and leads to despair or rejection of God, both of which are actual mortal sins, while treading accidentally upon cross-shaped straws (for example) is not a sin at all.

So for the example of the straws, Ignatius might have been led by the temptation (had he not recognized it as one), to think that though he saw the shape of the cross in the straws as he was about to tread on them, by treading upon them and not moving his foot aside to avoid it, he had demonstrated a lack of perfect love for the cross, for Jesus, and for God; that his own condemnation of himself based on this small action and coincidental occurrence of the shape was shared by God; that God recognized in him a lack of perfect love, which must also be hypocrisy, since he claimed to love the cross, Jesus and God; that indeed he was a hypocrite and deserved to be recognized as one; that he did not want to be but could not help it; that it is impossible to demonstrate perfect love for the cross unless one takes very great care at all times to avoid stepping on cross-shaped straws (and indeed by failing to treat with at least some movement of interior respect every shape that may coincidentally resemble a cross); that this is impossible; yet that thinking it is impossible is also a great sin since all things are possible with God; that he must be a very great sinner indeed since now it begins to become very stressful to try to figure out how to demonstrate love for God when straws are everywhere to trip you up; that a perfect devotion must be made in atonement for all of this... yet in the performance of the perfect devotion that will make up for the actual treading upon the straws, the implied sinful lack of love in having failed to avoid the appearance of disrespect, the apparent hypocrisy of claiming to love God while treading on straw-shaped crosses though they were spotted in time to avoid them, and the dismay at the obvious impossibility of always avoiding stepping on cross-shaped anything contrasted with the hope and belief that with God nothing is impossible... in the performance of the perfect devotion that will make up for all of this, another error is made.

The exhausted soul quickly becomes paralyzed - it fears to move lest it make even more errors, it fears to approach God, it fears God has abandoned it, it fears God has condemned it, and it is no longer able to think of God's love or mercy at all. The soul then despairs, or abandons God - either outcome is the result of a successful temptation.

More concrete examples and some better explanation along these lines would help convey why people "suffered" from religious scruples, what exactly they were, and why it was considered both debilitating and bad. I understand that there may not be too many sources one could quote from to illustrate good examples, but some effort ought to be made.

The article is lacking these to a sadly un-informative degree. Modern medical comparisons and terminology are not useful to the reader who has little idea what was meant by "religious scruples" to begin with. If that could be better illustrated, additional concrete illustrations of similarities in OCD scrupulosity would also make sense in filling out this article so that the debilitative aspects are clearly understood, and be useful in tying the concepts together.

Note

After reading through the comments, I disagree with the perspective that this article ought to be primarily medical. It is appropriate to clarify where today's medical diagnoses differ from the historical perspective, but not everyone visiting here is primarily or only interested, or even interested at all in today's medical definition.

I would suggest a structure along the following lines:

History

Historical definition and concrete examples

Concrete, descriptive illustration of spiritual suffering

Spiritual consequences of the suffering in the context of religious belief

Famous historical figures who suffered from religious scruples

The Church's recommendations on overcoming religious scruples

Today's Medical Understanding

Today's definition and concrete examples

Similarities (and differences) of OCD/OCDP with historical religious scruples

Famous people who suffer from what is called "scrupulosity" today

Treatment

[After a second read through the comments I see that a real effort has been made to fairly represent the condition historically. While acknowledging that good, fair and even strenuous effort, it is still apparent that someone who wants to understand why the condition caused suffering and was debilitating, and has even been described as "torture" and "martyrdom", will not understand it by reading this article in its current form.]

172.10.237.153 (talk) 10:26, 15 August 2016 (UTC)

A talk-page-only example of how religious scruples caused anguish to the sufferers

I visited this page after reading how several historical figures (St. Therese of Lisieux, husband of famous "Anne of Green Gables" author Lucy Maud Montgomery) suffered from religious scruples to a debilitating degree.

A reader coming here to find out what religious scruples were and why they were debilitating goes away sadly uninformed, which misses the point of referring to an encyclopedia to find something out.

The explanation "obsessive concern with one's own sins and compulsive performance of religious devotion" is both vague and inaccurate - the concern is not with what are actually defined as sins by the church, but what are perceived as sins by the sufferer and which are not, in fact, sins; also, religious devotions and practices may be involved, but not necessarily.

In religious terms, "religious scruples" are a temptation - the sufferer focuses with horror and guilt on small or even involuntary failures to demonstrate perfect love for God, to the degree that God's love and mercy towards them fade far into the background, and the sufferer believes themselves to deserve condemnation or even to actually be condemned on account of things as minor as Ignatius's treading on the two straws.

This thinking ultimately rejects God's love and mercy and leads to despair or rejection of God, both of which are actual mortal sins, while treading accidentally upon cross-shaped straws (for example) is not a sin at all.

So for the example of the straws, Ignatius might have been led by the temptation (had he not recognized it as one), to think that though he saw the shape of the cross in the straws as he was about to tread on them, by treading upon them and not moving his foot aside to avoid it, he had demonstrated a lack of perfect love for the cross, for Jesus, and for God; that his own condemnation of himself based on this small action and coincidental occurrence of the shape was shared by God; that God recognized in him a lack of perfect love, which must also be hypocrisy, since he claimed to love the cross, Jesus and God; that indeed he was a hypocrite and deserved to be recognized as one; that he did not want to be but could not help it; that it is impossible to demonstrate perfect love for the cross unless one takes very great care at all times to avoid stepping on cross-shaped straws (and indeed by failing to treat with at least some movement of interior respect every shape that may coincidentally resemble a cross); that this is impossible; yet that thinking it is impossible is also a great sin since all things are possible with God; that he must be a very great sinner indeed since now it begins to become very stressful to try to figure out how to demonstrate love for God when straws are everywhere to trip you up; that a perfect devotion must be made in atonement for all of this... yet in the performance of the perfect devotion that will make up for the actual treading upon the straws, the implied sinful lack of love in having failed to avoid the appearance of disrespect, the apparent hypocrisy of claiming to love God while treading on straw-shaped crosses though they were spotted in time to avoid them, and the dismay at the obvious impossibility of always avoiding stepping on cross-shaped anything contrasted with the hope and belief that with God nothing is impossible... in the performance of the perfect devotion that will make up for all of this, another error is made.

The exhausted soul quickly becomes paralyzed - it fears to move lest it make even more errors, it fears to approach God, it fears God has abandoned it, it fears God has condemned it, and it is no longer able to think of God's love or mercy at all. The soul then despairs, or abandons God - either outcome is the result of a successful temptation.

172.10.237.153 (talk) 10:55, 16 August 2016 (UTC)

Surprised to see that so much discussion resulted in such a non-informative article

The article is lacking historical examples illustrating how someone suffered from religious scruples to a sadly un-informative degree. Modern medical comparisons and terminology are not useful to the reader who has little idea what was meant by "religious scruples" to begin with. If that could be better illustrated, additional concrete illustrations of similarities in OCD scrupulosity would also make sense in filling out this article so that the debilitative aspects are clearly understood, and be useful in tying the concepts together.

I disagree with the perspective that this article ought to be primarily medical. It is appropriate to clarify where today's medical diagnoses differ from the historical perspective, but not everyone visiting here is primarily or only interested, or even interested at all in today's medical definition.

[After a read through the comments I see that a real effort has been made to fairly represent the condition historically. While acknowledging that good, fair and even strenuous effort, it is still apparent that someone who wants to understand why the condition caused suffering and was debilitating, and has even been described as "torture" and "martyrdom", will not understand it by reading this article in its current form.]

172.10.237.153 (talk) 10:26, 15 August 2016 (UTC)

Welcome IP

Welcome, 172; thank you for your interest in this page. Editor Eubulides no longer edits Wikipedia, and I edit only sporadically. I do not plan to engage in a rewrite or update of this article, but stopped by to try to help you learn some editing techniques. This article has not been touched for six years, so it certainly has issues. However, your suggestions might be noticed by others if you first take note of the following:

1. New talk page entries go at the bottom of the talk page. I have added a header to the top of this page that provides helpful information about how to edit Wikipedia talk pages. If you could read that, your communication here would be more effective. Before attempting to change an article, it is helpful to learn to communicate on talk pages with other editors about your proposed changes.

2. You should always sign your talk page entries; you can do that by entering four tildes ( ~~~~ ) after your message.

3. I have archived the older talk page entries here; it is good to keep length in mind when editing talk pages. You might first propose sources for any content you want to change or add. All text on Wikipedia must be supported by reliable sources, and discussion is facilitated by making sure your content changes can be supported.

4. You will notice at the top of this talk page that this article is supported by three WikiProjects: the Medicine Project is one of them. I have included a link to what kind of sources must be used to support statements about health. Yes, there will be content in this article that is not strictly Med Project related, but any text relating to individual's health (including mental), must be supported by a reliable medical source.

5. Please have a look at WP:MEDMOS on how we organize and talk about health issues; for example, we do not refer to individuals who have a given condition as "sufferers".

6. You might also be interested in looking at Scruple (disambiguation), linked at the top of this article, which points to another article on scruples, conscience, about non-pathological scruples. The scope of this article is the psychopathological condition.

I hope this will give you a starting place for learning how to communicate on talk, so that you can then propose reliable sources and content additions. Regards, SandyGeorgia (Talk) 17:33, 16 August 2016 (UTC)

GA review

This review is transcluded from Talk:Scrupulosity/GA1. The edit link for this section can be used to add comments to the review.

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)

SSRIs in scrupulosity

I was reading the article this morning (fantastic article — great work on this, ThaesOfereode) and I saw concerns about how we describe the use of SSRI, so I thought I should give my 2c. As ShillAwayAsSeenOnTV mentioned, MEDRS requires us to meet a higher standard for referencing. Because the burden of proof required to make a treatment claim is higher, the way the article currently describes SSRIs (at least to me) implies that the claim is backed by RCTs, prospective study or appropriate meta-analyses/systematic reviews — which it is not.

• "Selective serotonin reuptake inhibitors (SSRIs) are generally used as pharmacological treatment if symptoms are severe enough, though response in patients with scrupulosity is lower than other OCD patients." — this gives me the impression that SSRIs are "generally used" to treat scrupulosity based on evidence from RCTs and appropriate meta-analyses/systematic reviews, which is not the case. SSRIs are used in scrupulosity because it is closely related to obsessive–compulsive disorder, for which we do use SSRIs based on evidence from RCTs and appropriate meta-analyses/systematic reviews. In my understanding, this is an important distinction to make so that we do not overstate the evidence. Something along the lines of "Selective serotonin reuptake inhibitors (SSRIs) are generally used to manage OCD and are/have been tried for scrupulosity, though they are less effective" might be more reflective of the evidence we have.

— Strange Orange | 17:20, 23 August 2026 (UTC)

Thanks for the kind words, Strange. I've read your comments and I think that's fair enough. I've reworded the relevant sections (adapted from your wording), but of course let me know if they're still off the mark. I will keep an eye out for scrupulosity-specific MEDRS for medication in the meantime. ThaesOfereode (talk) 21:47, 29 August 2026 (UTC)