Fergus & Rowatt noted a gap in the literature regarding a possible relationship between attachment to God and scrupulosity. They hypothesized that there is a positive correlation between scrupulosity and both attachment anxiety and attachment avoidance. They used the Amazon Mechanical Turk website to recruit a sample of 450 adults who were over 18 years old and living in the United States. Multiple measurement instruments were used, including the Penn Inventory of Scrupulosity and the Attachment to God Scale, which uses a 7-point Likert scale to assess attachment anxiety and attachment avoidance regarding one’s perceived relationship with God. Overall, the AGS demonstrated adequate internal consistency in this study, with the attachment avoidance scale demonstrating good internal consistency. Regarding one’s perceived relationship with God, the results demonstrated a positive correlation between scrupulosity and attachment anxiety, and a negative correlation between scrupulosity and attachment avoidance. The authors propose that while the prevailing treatment for OCD scrupulosity is Exposure and Response Prevention therapy (a behavioral approach), there is a need for future research focusing on whether cognitive therapy that targets attachment anxiety in relationship to God might in turn reduce measures of scrupulosity. This supports my proposal that future study is needed to determine the efficacy of cognitive therapy in treating scrupulosity. Study limitations include the use of self-report measures; the use of correlational measures, which do not indicate a causal relationship; and the relative homogeneity of the sample participants (predominantly Protestant Christian).

This research team identified a gap in the literature concerning possible correlations between scrupulosity and the common cognitive processes thought to maintain OCD in general. They hypothesized that scrupulosity would be positively correlated to an inflated sense of responsibility, intolerance of uncertainty, overestimating the importance of intrusive thoughts and the need to control those thoughts, and moral thought-action fusion, which is the belief that thinking about something immoral is the same as committing an immoral act. A sample of 71 participants was recruited through an outpatient treatment center for anxiety disorders. Participants completed multiple self-assessment measures of OCD symptoms and related cognitive distortions, including the Thought–Action Fusion Scale. Reliability and validity for the TAFS has been established by Shafran. Results showed a moderate correlation between scrupulosity and the underlying cognitive processes maintaining OCD, including moral TAF, overvaluing and attempting to control intrusive thoughts, and overestimations of responsibility. The authors note that overly-scrupulous OCD patients often fail to adhere to ERP treatments when the exposures are perceived to be sinful. The results of this study support my proposal that future research is needed to discover whether cognitive therapy techniques such as psychoeducation might increase treatment adherence and effectiveness.

Shapiro et al. noted that the Pennsylvania Inventory of Scrupulosity-Revised had never been tested in a sample of severe psychiatric patients. The PIOS-R is a 15-question self-report assessment containing subscales of “fear of sin” and “fear of God.” It has demonstrated good psychometric properties in previous studies with samples from college populations. Shapiro et al. set out to test how well the factor structure of the PIOS-R would be maintained in a naturalistic sample of severe psychiatric patients, and the sensitivity and specificity of the PIOS-R in detecting clinically significant scrupulosity in this population. Shapiro et al. recruited 417 patients from the partial hospitalization and residential treatment programs at the Obsessive-Compulsive Disorder Institute. Participants were divided into two groups: Scrupulous and non-scrupulous based on a semi-structured intake interview. The PIOS-R was administered to both groups at intake, along with other self-report assessments. The PIOS-R demonstrated strong internal consistency. While a one-factor solution analysis demonstrated a substandard fit, a two-factor solution analysis demonstrated an adequate fit. The PIOS-R was found to have good sensitivity and specificity in identifying clinically significant scrupulosity. Future studies are needed to increase understanding of the severity of scrupulosity and its impact on patients with OCD, to better inform treatment development. This article supports my proposal, because a valid and reliable measure of scrupulosity is needed to assess the efficacy of cognitive therapy.
