“I need to go to the Church 16 times a day, or else God will kill my child.”
This is the thought that brings 28-year-old Mrs. M to the hospital.
“Every day I have repetitive thoughts about going to the Church 16 different times. If I don’t go, I fear that my children will die a horrible and sudden death at the hands of God. These thoughts have completely stopped me from going about my day and doing my work. In fact, I haven’t been to work at all in the past 3 months. I understand how illogical I sound when I say this, but when I try to resist these thoughts, I start feeling very uneasy and restless. Sometimes I experience difficulty in breathing, and it takes me around 5 minutes to calm down. I really want these thoughts to leave my head. I feel stuck in life.”
Mrs. M is a mother of one child, aged 2 years, and has been married for the past four years. She has been brought up as a Protestant and regularly used to go to the Church every Sunday before her obsessive thoughts began to occur. She was working as a loan officer for three years before quitting her job three months ago.
This is a classic case of Religious Obsessive-Compulsive Disorder (OCD).
Obsessive-Compulsive Disorder is an anxiety disorder characterized by uncontrollable and irrational ideas, impulses, or images, usually followed by behaviour that an individual feels compelled to perform repeatedly. When people realize that these thoughts are excessive or irrational, they may try to resist them, but this can lead to increased anxiety.
In severe cases of distress, a person may experience a panic attack and may feel temporary relief after performing the compulsive behaviour.
Obsessive-Compulsive Disorder (OCD) can involve unwanted thoughts and repetitive behaviours that interfere with daily life.
Religious OCD or Scrupulosity is a subgroup of OCD in which the person becomes preoccupied with obsessive thoughts based on religion or religious beliefs. In some cases, the obsessions can also centre around moral beliefs.
People who experience blasphemous obsessions may have a strong fear of punishment from a divine being or deity. In the case of Mrs. M, she believes that if she does not go to the Church sixteen times every day, God will punish her and take her child’s life.
This thought results in her spending much of her time at the Church and neglecting her family and job. She is aware of the vicious cycle that she is caught in and its consequences. However, the anxiety caused when she does not go to the Church leaves little space for rational thinking and can lead to a very time-consuming lifestyle. Mrs. M is also prone to developing depression.
There are ways of treating Scrupulosity, one of which is Exposure and Response Prevention therapy. This therapy is based on gradually developing tolerance to the repetitive thoughts that disturb an individual. Mrs. M may be supported in confronting her obsessions and resisting the compulsive behaviour. The number of times that she visits the Church may be gradually decreased until she is able to resist the urge to go to the Church several times a day. NIMH describes Exposure and Response Prevention (ERP) as a form of CBT that can effectively reduce compulsive behaviours in OCD. (NIMH)
This therapy can be supported by mindfulness meditation, which is similar to Pranayama in Hatha Yoga. This is, simply put, the act of paying attention to whatever you are experiencing as you experience it.
The key is to find a quiet, comfortable place and focus on becoming aware of your breath. Every time Mrs. M encounters her obsessive thoughts, she can sit in a quiet, comfortable place and start focusing on the sensation of air moving in and out of the body during each breath. The breathing can be used as an anchor while dealing with the obsessions that one experiences.
The symptoms of OCD may gradually decrease with consistent therapy. Taking back control of one’s life may seem like a far-fetched dream, but it can be possible with treatment and support from family.