Scrupulosity in Missionaries: When Faith and OCD Get Tangled Together

He has already done everything required to be worthy of his mission. The bishop's interview, the stake president's interview, the temple recommend, all of it, months before he ever boarded a plane. And yet three weeks into the field, he is still confessing things to his mission president that were never sins in the first place. He redoes his personal prayers because they didn't feel right the first time. He replays a lesson with an investigator that afternoon, certain he said something wrong, though he can't quite say what. His companion thinks he is one of the most obedient missionaries he has ever served with. What his companion can't see is that obedience doesn't feel like devotion to him, but instead has started feeling like a trap he can't get out of.

What I want to talk about in this article is scrupulosity, sometimes called religious OCD. It is one of the more clinically specific things I work with, and in my experience it is also one of the most misunderstood, both by the people living with it and by the well-intentioned people around them.

What Scrupulosity Actually Is

Scrupulosity is a recognized subtype of obsessive-compulsive disorder built around religious or moral content. It has two parts, the same two parts that define OCD generally. First, intrusive, unwanted thoughts that create real distress, a fear of having sinned, a fear of offending God, a fear that a prayer or a repentance was not sincere enough to count. Second, compulsions performed to relieve that distress, repeated confession, repeated prayer, mentally replaying a conversation or an action over and over again looking for the moment it went wrong.

This is not the same thing as having a sensitive conscience. A healthy conscience focuses on a behavior not being right, correcting it and then moving forward. Scrupulosity insists, I am fundamentally flawed and God is disappointed in me, and it does not let go, no matter how much correcting, confessing, or praying you do. One is corrective, the other is a loop with no off ramp.

This pattern has one of the longest documented histories of any psychological condition. Martin Luther described feeling that even an accidental omission during his first mass would be a sin. Ignatius of Loyola, founder of the Jesuits, wrote about being trapped in cycles of confession he could never feel settled by. This is not a new-age concern, and it is not unique to any one faith tradition. It shows up wherever sincere devotion meets an anxious mind.

This pattern showed up in history in a far more dramatic fashion than repeated confession or repeated prayer and I think it illustrates the problem in an unforgettable way. In the thirteenth century, groups known as the Flagellants emerged in Italy, and by the time of the Black Death in the mid-1300s, they had spread across much of Europe. Believing the plague was God's punishment for sin, they marched from town to town whipping themselves in public, sometimes until they bled, convinced that enough physical suffering could finally cleanse them and appease God's wrath. It is a vivid, extreme illustration of exactly what scrupulosity does quietly, on the inside, to a modern mind, the conviction that enough punishment, enough confession, enough repetition will finally be enough to feel forgiven. It never was enough for the Flagellants either. They kept marching until the Catholic Church itself had to condemn the movement as having gone too far.

Why Mission Culture Can Be Fertile Ground

I want to tread carefully here and point out that none of what follows is a criticism of mission rules, exact obedience, or the structure of missionary service. There are good reasons that structure exists and most missionaries thrive inside it.

However, structure that works well for most people can become the exact soil scrupulosity needs to take root in someone who is predisposed to it. Worthiness interviews, companion accountability, daily reporting on effort and obedience, a culture that (rightly) teaches that exact obedience brings blessings, all of this asks a missionary to hold themselves to a constant, high standard. For most missionaries, that produces discipline and growth. For a missionary wired toward anxiety and intrusive doubt, it can produce a machine that never stops checking.

The clinicians and clinics who specialize in treating this population describe the same pattern repeatedly: a missionary who is already fully worthy to serve, who continues seeking reassurance anyway, because the reassurance never actually reassures. It is answered, and then those answers are doubted, sometimes within hours or minutes, only for the question to be asked and answered again.

How This Shows Up, Depending on Where Someone Is

In the Field

This is often the hardest stage to catch from the outside, because it can look like devotion with exactness. Repeated confession of things that don't need to be confessed. Prayers repeated because they did not feel right the first time. Doubt about whether a testimony was borne with enough sincerity, or worry that an investigator may not have felt the Spirit due to the missionary's own unworthiness, instead of recognizing that this process happens despite their imperfections. The unfortunate twist in these scenarios is that this pattern may often be praised by others as exceptional obedience, which only acts to reinforce it further.

Early Returned Missionaries

For an early returned missionary, the return itself frequently becomes the new obsession. For this individual, the early return is not a singular event but rather becomes an endless internal trial over whether the decision was righteous, whether more could have been done to avoid it, or whether coming home means something is fundamentally wrong with them spiritually. This is where scrupulosity overlaps with the shame so many early returned missionaries already carry, but scrupulosity magnifies it by re-litigating the question forever rather than ever being able to actually answer it and move forward. It often shows up as repeatedly re-justifying the decision to a bishop, to parents, to friends, seeking a reassurance that never quite settles the individual.

Full-Term Completed Missionaries

This one gets talked about the least, but can also be an issue. It can look like an obsessive review of an entire mission, searching for the one failure that supposedly canceled out all the good. Doubt about whether baptisms or testimonies really counted, because of some private, minor imperfection nobody else ever knew about. Often it can manifest in a concern that the individual is not spiritual enough, reading their scriptures enough, or feeling the Spirit to the same magnitude or frequency that they did on their mission. Sometimes there is a temporary lull after returning home, since the rigid structure that fed the compulsions is suddenly gone. But the underlying pattern rarely resolves on its own. It waits and often resurfaces later, when dating and marriage-timing pressure arrives and old worthiness and purity obsessions return in a new form and with new vigor.

What the Research Actually Shows

Scrupulosity has been studied specifically among Latter-day Saints for over a decade now, and the research has continued to grow. An early foundational study found that scrupulosity partially explains the connection between maladaptive perfectionism and higher rates of depression and anxiety among LDS individuals (Allen & Wang, 2014). A more recent study found that religious commitment itself can act as a buffer, meaning the relationship between faith and this struggle is more complicated than simply more religious intensity equals more scrupulosity (Allen & Griffin, 2025).

Separately, researchers have found a three-step chain worth acknowledging: as belief in legalism (the idea that a person can earn God's favor and salvation through strict obedience to rules and effort) increases, a person's ability to feel and experience grace tends to decrease. This is important because as that experience of grace decreases, scrupulosity tends to increase. Believing that salvation rests entirely on one's own effort to eliminate every trace of sin can create exactly the kind of pressure that the beast of scrupulosity feeds on. This finding points toward something important. It is not doctrine that is at fault here, but a distorted grace-less version of that doctrine that creates the issue.

What Can Help

Part of why ACT works so well here is that it addresses the problem at the right level. It does not try to argue a person out of their doubts, since scrupulosity by its nature is resistant to reassurance. Instead, it teaches a different relationship to the thought itself, noticing an intrusive thought as a thought rather than as a fact or a revelation from God.

A related, very practical framework comes from psychiatrist Jeffrey Schwartz's work on OCD, often summarized in four steps: relabel, reattribute, refocus, revalue. Relabel the thought as an obsession rather than a spiritual prompting. Reattribute it to the brain's OCD circuitry rather than it being attributed to sin or to God Himself. Refocus attention onto a chosen, values-aligned action for a set period of time, even for just a short period of time. An example of this could be deciding that connection is a value the missionary identifies with and then spending a few minutes contemplating how in their next interaction they will bring this to bear. Revalue the thought over time as what it actually is, a false alarm, not a fact requiring further response.

One of the hardest and most important skills in this whole process is learning to tell the difference between an actual spiritual prompting and an intrusive, anxious thought. In my experience, genuine promptings tend to bring a settled peace, even when they call for hard action. Scrupulosity never settles. It asks the same question again five minutes later, dressed up slightly differently. If reassurance never lasts and the doubt always returns, that gives you clear information about where the thought is coming from.

God does not use worry and doubt to communicate His message.

The Doctrinal Reframe

Elder Jeffrey R. Holland has spoken directly about what researchers and clinicians now call toxic perfectionism, teaching that Church members should not demean or vilify themselves, believing that somehow beating up on ourselves is going to make us the person God wants us to become. Recent Church-sponsored research on this exact topic has found that Latter-day Saints report toxic perfectionism at similar rates to most other religious groups, and that leaving the faith altogether does little to resolve it. The problem was never the devotion itself, but rather the distorted, grace-less application of that devotion.

The Atonement is not a finish line reached only after flawless performance. It is available exactly as you are today, despite your imperfections and shortcomings. A useful thought to sit with is not "have I done enough to earn forgiveness from God," but rather "am I opening myself up to a gift that has already been freely offered."

When This Calls for More Than an Article

It is important to recognize here that this article is educational. It is meant to help you understand what scrupulosity is, recognize it, and know that it is a treatable pattern rather than a spiritual failing. My license and 25 years of clinical experience inform everything written here. But an article is not the treatment for OCD or scrupulosity itself.

Real treatment for scrupulosity typically involves a licensed clinician, a proper diagnosis, and a structured therapeutic approach. It may require an evaluation for medication. Consultation with a bishop or other ecclesiastical leader is often a valuable part of this process as well, but is not a replacement for clinical care.

If what you have read here sounds like you, or like someone you love, the most useful next step is a conversation with a licensed therapist, ideally one familiar with both OCD and religious/faith considerations. Depending on the severity of the situation, coaching can be a valuable part of the broader journey once appropriate treatment is in place, helping with identity, values, and moving forward.

You are not fundamentally bad. You are not failing God. You may be carrying a treatable pattern that has borrowed the language from your faith to make itself feel and sound authoritative and unquestionable. But it is neither, and despite what it might tell you, it is not the only or best way to display your devotion.