Coming Soon!
When Religion and Morals Become OCD
Understanding and Treating Scrupulosity
by Leslie J. Shapiro
July 2023, 233pp, 6 1/8x9 1/4
1 volume, Praeger

Hardcover: 978-1-4408-7254-9
$65, £50, 57€, A90
Available for purchase 30 days prior to publication.
eBook Available: 978-1-4408-7255-6
Please contact your preferred eBook vendor for pricing.

Scrupulosity has been referenced as far back as Babylonian times and has historically been considered a religious problem or problem of faith rather than a clinical disorder.

This essential resource brings recognition to scrupulosity and moral perfectionism, an often overlooked and misunderstood subtype of Obsessive Compulsive Disorder (OCD).

Two to three percent of the global population suffer from OCD. Of that number, approximately five percent of OCD sufferers report having religious or moral obsessions. Scrupulosity, an often under-recognized subtype of OCD, leads those affected to mistake clinical OCD symptoms for committing sins, offending God, or being morally corrupt. Many people with scrupulosity or moral perfectionism turn to clergy for help rather than a mental health professional.

This book, authored by a therapist among the most experienced in the world in dealing with this disorder, covers the symptoms, diagnosis, history, development, causes, and treatment of scrupulosity. Intended for students, mental health professionals, and clergy, this essential resource includes the latest theory, research, treatments, and case studies necessary to recognize and destigmatize scrupulosity as well as encourage optimal treatment outcomes and relapse prevention.


  • Includes a diverse collection of case studies that showcase how OCD does not discriminate by culture or religious faiths
  • Provides clear guidelines for assessment and treatment based on the latest research
  • Teaches clinicians how to stay clinically focused on the OCD symptoms rather than religious or moral implications
  • Discusses the social and cultural attitudes toward scrupulosity as well as the specific religious practices that become scrupulosity and moral perfectionism symptoms
Leslie J. Shapiro, LICSW, has been treating OCD and Related Disorders since 1989. She has been a behavior therapist at the OCD Institute at McLean Hospital since its inception in 1997, running a weekly scrupulosity support group. She has developed an expertise in studying, treating, teaching, and publishing material that specializes in addressing conscience-related OCD symptoms. She was the recipient of McLean Hospital's first professional development research grant at McLean Hospital that piloted an outcome of a guilt group intervention and the David Judah Fund, Massachusetts General Hospital for her clinical research on OCD, scrupulosity, and pathological guilt. She has written several online continuing education courses on OCD and served as an adjunctive professor at the Boston University School of Social Work.


Leslie Shapiro is a highly skilled mental health clinician and author who has treated hundreds of patients with OCD and related disorders. Her expertise in OCD, especially scrupulosity obsessions and compulsions, enables her to apply theoretical models and research findings to promote best practices for patients, family members, and community members. Her astute observations are evident in this important book. —Gail Steketee, Professor Emerita, Boston University

This book, written by an OCD expert with decades of experience, will be a valuable addition to any clinician’s library. Leslie Shapiro has worked with patients with severe OCD in a residential setting at the OCD Institute at McLean Hospital since its inception and her sharing her insights garnered during her career is an invaluable addition to the field. If one wishes to go beyond the standard treatment guidelines towards even more “real world” experience, this is the book for you!—Darin D. Dougherty, MD MMSc, Massachusetts General Hospital/Harvard Medical School
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