The Saint, the Sinner, and The Scrupulous: an examination of obsessive or compulsive symptoms relating to religion and morality
Authors: Simmons Claire N 
Published: June 2021

Part I examined three cases. One of extreme immorality, one of altruism, and one of Scrupulosity. The presentation of all three cases served to put the disorder of Scrupulosity in higher relief. In Part II we build on some of the aspects of Scrupulosity highlighted in Part I by examining the statistics. In other words, we ran a number of studies to better understand Scrupulosity. Additionally, we considered how Scrupulosity may influence an individual’s perception of self and others’ moral transgressions. As summarized in Part I, Scrupulosity is a form of OCD that focuses on morality. The objectives of previous research on Scrupulosity were to address the core features of the mental illness, i.e. obsessions and compulsions that are religious or moral in nature. Jonathan S. Abramowitz et al developed a questionnaire to measure Scrupulosity. Abramowitz et al, compiled an initial pool of 77 questionnaire items based on verbal reports, and “face validity of the constructs we were attempting to measure” (Abramowitz 2002). Subsequently, they shortened the scale to a 19-item measure including both secular and religious questions using a statistical method referred to as exploratory factor analysis (EFA). The scale was termed the PIOS (Penn Inventory of Scrupulosity) (Abramowitz et al 2002). A few years later, researcher Olantunji at Vanderbilt, published a revised 15-item scale, termed the PIOS-R (Penn Inventory of Scrupulosity-Revised)(Olatunji et al. 2007). The PIOS and PIOS-R are useful tools, however, one of the problems in studying Scrupulosity is that the current measure of the disorder is religiously themed. Both the PIOS and PIOS-R include items that seem inappropriate for secular persons because the items refer to god, hell, or other specifically religious beliefs (Abramowitz et al. 2002) (Olatunji et al. 2007). For a comparison between the PIOS and PIOS-R items see table 2 in methods. Having a religiously themed inventory is problematic because Scrupulosity does not only manifest in religious obsession, but also pathological morality. Both the atheist and the religiously devout may be stricken with Scrupulosity. That being said, the symptoms of Scrupulosity may present differently in religious versus non-religious populations. Thus, there is a need to develop a secularized form of the PIOS scale. Walter Sinnott-Armstrong, Jesse Summers, and I are interested in developing a novel scale intended to test for Scrupulosity more broadly in secular patients as well as those who identify with a religious group. We want to examine how Scrupulosity differs and remains the same when presenting in atheistic and agnostic populations. Therefore, we’re looking to develop a derivation of the PIOS questionnaire that will be inclusive of secular persons with moral obsessions, so that we can use the questionnaire to address research questions about moral decision making. This is important when considering the attribution of responsibility, and the degree to which we credit or blame individual actors. For the purposes of this thesis no new data was collected. This is in part due to complications regarding COVID-19. However, when researching Scrupulosity previously, Walter Sinnott-Armstrong, Jesse Summers, and post-doc Christine Lillie, collected preliminary data for a secular Scrupulosity scale (J. S. Summers and W. Sinnott-Armstrong 2019). I have been generously offered the use of this data collected in 2013. The synthesis and analysis presented in the rest of this paper is from the 2013 data set.