Moral scrupulosity OCD

The need to be good

I’ve been preoccupied with being a good person for as long as I can remember. For most of my life, I didn’t think there was anything wrong with that. People praised me for it. Therapists would ask, “Why do you need to be so good?” But I didn’t know how not to be.

I am a kind person, deeply attuned to others’ emotions. When someone is hurt, I feel it in my body. My empathy isn’t just cognitive—it’s visceral. I can’t bear to see someone in pain, especially if I had anything to do with it.

But even so, there was something more happening.

Not just empathy. Not just kindness.
Under the praise was panic.
Under the care was fear.

It wasn’t just a fear of doing something wrong—it was the belief that I might be something wrong. That I might be, at my core, bad.

So I followed every rule. I apologized when no one asked me to. I replayed conversations endlessly, scanning them for harm I might have caused. If I could just make sure I never hurt anyone, then everything would be okay.

I’ve done something wrong. I can never fix it. It doesn’t matter if I’m perfect from now on—I have caused harm.

Eva reflects:

That’s terrible. You were already worrying about being bad as a child—when you’d made the fewest mistakes. It only builds over time. So existing becomes suffering.

Natalie responds:

That’s true. There were times I quietly accepted that my job was to suffer gracefully—to be cheerful, kind, and good, even when I felt like I was drowning. Because if I let the pain show, someone else might feel hurt. And that would only make it worse.

I am someone who feels deeply, thinks intensely, and holds myself to a moral standard so high it sometimes becomes unbearable. My OCD doesn’t show up as a fear of germs or an obsession with symmetry, it shows up in my ethics. In how I write. In how I speak. In how I replay conversations in my mind to make sure I was kind enough, fair enough, precise enough. It shows up in my overwhelming drive to be good.

I am deeply committed to truth, justice, and clarity, not just in what I believe, but in how I express it and how others might receive it. I don’t just want to be right; I want to be ethical. I want to make sure that no one is harmed by my words, that I haven’t misrepresented myself or others, that I haven’t missed an opportunity to prevent suffering. I scrutinize every sentence, not out of perfectionism alone, but out of a desperate need to know I’ve done no harm.

I question myself constantly, my motives, my phrasing, my tone. Even when I know I’ve tried my best, it doesn’t feel like enough. There’s always that anxious whisper: What if you got it wrong? What if someone misunderstood? What if you caused harm without realizing it?

Moral scrupulosity OCD has shaped the way I move through the world. It’s made me exceptionally thoughtful, and also exhausted. It’s made me principled, and very afraid and avoidant. I hold myself to a punishing internal code because I’m terrified of being careless with other people’s hearts.

My internal moral code (as shaped by OCD)

1. I must never cause harm—emotionally, physically, or morally—to anyone, even unintentionally.
2. I must always tell the truth—even when it causes discomfort, confusion, or personal consequences.
3. I must not upset anyone—even slightly—or I’ve failed as a good person.
4. I must always be fair, impartial, and morally pure in my intentions.
5. I must always make the most ethically correct choice, even if it costs me everything.
6. If someone sees me as unkind, unethical, or selfish, it must be true—and I must fix it immediately.
7. I must never break rules—even if the rules don’t make sense, or no one else is following them.
8. I must be accountable for every mistake, misstep, or misunderstanding.
9. I must not allow myself to feel good if there is still more I could do to help, repair, or be better.
10. I must not trust my own goodness unless it’s been externally verified.

Moral scrupulosity OCD

What I was experiencing wasn’t just “being too hard on myself.” It has a name: moral scrupulosity OCD.

This subtype of OCD involves an obsessive concern with doing the “morally right” thing, paired with compulsions meant to relieve the anxiety of possibly doing something wrong. It’s not about germs or locks—it’s about guilt.

Diagnostic criteria (DSM-5-TR)

Moral scrupulosity is defined by the DSM criteria for OCD:^[1]Diagnostic and statistical manual of mental disorders (5th ed., text rev.) (APA, 2022)

Moral scrupulosity OCD is characterized by the following obsessions:^[2]Obsessive-compulsive disorder in adults (Abramowitz & Jacoby, 2015)^[3]Scrupulosity: A cognitive–behavioral analysis (Miller & Hedges, 2008)

• Involuntary moral surveillance (mental replaying of interactions to check for harm)
• Sense of hyper-responsibility (apologizing or confessing excessively)
• Fear of moral failure (avoiding situations that might involve moral ambiguity)
• Carrying excessive guilt and shame
• Self-judgement and moral identity doubt (intrusive thoughts about being harmful or immoral)

The compulsions are often invisible:

• Mentally reviewing conversations
• Excessive apologizing or confessing
• Checking one’s motives
• Seeking reassurance
• Researching moral frameworks to find the “right” answer.^[4]Obsessive-compulsive disorder in adults (Abramowitz & Jacoby, 2015)^[5]Scrupulosity: A cognitive–behavioral analysis (Miller & Hedges, 2008)

Symptoms must be:

• Time-consuming (>1 hour/day)
• Cause significant distress or impairment
• Not better explained by another condition

What sets it apart

If you feel haunted by the idea you did something wrong—and you apologize, review, or avoid others just to quiet that voice—it might not be oversensitivity.
It might be OCD.

People with moral scrupulosity aren’t just afraid of mistakes. They fear that being bad is embedded in them. Small infractions feel catastrophic. There’s no room for grace.

These symptoms aren’t just personality quirks—they reflect obsessions and compulsions, where even the most generous behaviors can become rituals to manage moral anxiety. The mental acts (like reviewing, apologizing, or over-giving) are done not out of peace, but to relieve unbearable self-doubt and fear of moral failure.^[6]Scrupulosity and obsessive-compulsive symptoms in a non-clinical sample: The unique contributions of morality and fear of God (Olatunji et al., (2007)

Natalie reflects:

Whenever someone says they like something in my home, I give it to them. I can’t keep it—it makes me feel guilty that I have it and they don’t. I’ve emptied my fridge, given away things I love, avoided people just to stop myself from giving everything away.

When my son moved out, I gave him everything he needed. He once asked if I had black garbage bags. I didn’t. But I bought some. Later, I realized I needed them—but I also knew: if he comes over, he’ll leave with them. And honestly? It’s easier to buy more than sit with the guilt of him not having what he needs.

Typical age of onset

• Childhood (ages 8–12): Gradual emergence
• Adolescence to early adulthood: Most common onset
• After 40: Less common, often triggered by major stress or loss

Scrupulosity often intensifies during life transitions, loss, burnout, or moral upheaval^[7]Scrupulosity: A Comprehensive Review of the Research (Painley, 2025)

Subtypes

Moral scrupulosity can present in different subtypes, and harm avoidance is one of the most common—particularly among autistic individuals.

Here’s a breakdown of the primary subtypes that clinicians and researchers have identified within moral scrupulosity OCD:^[8]Obsessive-compulsive disorder in adults (Abramowitz & Jacoby, 2015)^[9]Scrupulosity in patients with obsessive-compulsive disorder: Relationship to clinical and cognitive phenomena (Nelson et al., 2006)^[10]Scrupulosity and obsessive-compulsive symptoms in a non-clinical sample: The unique contributions of morality and fear of God (Olatunji et al., (2007)

1. Harm-Avoidance Scrupulosity

• Core fear: That you might cause physical, emotional, or moral harm to others, intentionally or unintentionally.
• Obsessions: “What if I hurt someone’s feelings?” “What if I influenced someone in the wrong direction?”
• Compulsions: Excessive apologizing, avoiding social situations, replaying conversations, seeking reassurance, confession.

2. Justice and Fairness Scrupulosity

• Core fear: Being unjust, unfair, or complicit in systems of harm or inequality.
• Obsessions: “Was I fair to everyone in that group?” “Am I benefiting from privilege in a way that’s wrong?”
• Compulsions: Over-correcting perceived injustices, moral self-policing, intense self-monitoring for bias or inequality.

3. Truth and Authenticity Scrupulosity

• Core fear: Being dishonest, misleading, or inauthentic, even unintentionally.
• Obsessions: “Was that technically a lie?” “Did I present myself accurately?”
• Compulsions: Overexplaining, disclaimers, correcting yourself repeatedly, withdrawing from communication.

4. Purity or Contamination (Moral Contamination)

• Core fear: Being morally contaminated by certain people, environments, or ideologies.
• Obsessions: “What if reading this makes me a bad person?” “Am I morally tainted by association?”
• Compulsions: Avoiding people or content, mental rituals to ‘cleanse’ thoughts, extreme guilt or shame over exposure.

5. Perfectionism & Moral Self-Image

• Core fear: Not being a good enough person; failure to live up to one’s moral ideals.
• Obsessions: “Did I do enough?” “Am I the kind of person I want to be?”
• Compulsions: Overworking, moral self-comparison, harsh self-judgment, compulsive self-improvement efforts.

6. Responsibility OCD / Hyper-Responsibility (Overlap)

• Core fear: Being responsible for preventing all possible harm or wrongdoing, even indirectly.
• Obsessions: “If I don’t act, is it my fault?” “Could I have prevented that?”
• Compulsions: Monitoring, overpreparing, fixing other people’s emotional states, avoidance of leadership or choices.

Many people with moral scrupulosity experience a blend of these subtypes. My main subtype is harm-avoidance, but I also have the truth, perfectionism and responsibility subtypes.

A note on expectations toward others

People with moral scrupulosity often care deeply about fairness, honesty, and justice, not just in themselves, but in others. Yet they rarely hold others to the same harsh standard.

Instead, they internalize responsibility:

“Maybe I didn’t explain it clearly.”
“Maybe I should’ve prevented it.”

This internalized hyper-responsibility has been widely documented in OCD^[11]A cognitive theory of compulsive checking (Rachman, 2002) and particularly in scrupulosity.^[12]Scrupulosity in patients with obsessive-compulsive disorder: Relationship to clinical and cognitive phenomena (Nelson et al., 2006)

What causes moral scrupulosity?

Scrupulosity emerges from a complex mix of biology, psychology, development, and environment.

1. Neurobiological vulnerability

• Overactivation in the cortico-striato-thalamo-cortical (CSTC) circuit^[13]Neurosurgical targets for compulsivity: What can we learn from acquired brain lesions? (Figee, 2013)^[14]Obsessive-compulsive disorder: Beyond segregated cortico-striatal pathways (Milad & Rauch, 2012)
• Hyperactive anterior cingulate cortex (ACC), associated with guilt and conflict monitoring^[15]A meta-analysis of functional neuroimaging in obsessive-compulsive disorder (Whiteside, 2004)
• Serotonin dysregulation, which is why SSRIs may help^[16]Escitalopram in obsessive-compulsive disorder (Stein, 2007)

2. Cognitive & psychological traits

• Inflated responsibility: “If something went wrong, it must be my fault.”
• Thought–action fusion: “Thinking something bad is as wrong as doing it.”
• Moral perfectionism: “I must never be unfair, unkind, or selfish.”
• Intolerance of uncertainty: “If I don’t know what’s going to happen, I can’t cope—and something bad is sure to follow.”

These distortions are common in OCD and often present in autistic individuals as well.^[17]Cognitive behaviour therapy for anxiety in children and young people with autism spectrum disorders: A meta-analysis (Ozsivadjian et al., 2021)

3. Developmental & family influences

• Rigid, punitive, or guilt-based upbringing
• Conditional love based on behavior
• Childhood trauma, especially when paired with responsibility for others’ pain

Even without a biological predisposition, these dynamics can create enduring patterns of moral hypervigilance^[18]Genetic and environmental influences on obsessive-compulsive symptoms in adults: A population-based twin-family study (Grootheest et al., 2007)

4. Sociocultural & religious factors

• Religious teachings focused on sin, punishment, or purity
• Secular values that emphasize shame, self-sacrifice, or perfection
• High-pressure caregiving professions or collectivist cultures

Important: Many people with moral scrupulosity are not religious. The moral code may be secular—kindness, justice, non-harm—but the intensity of distress is the same.

5. Neurodevelopmental factors: autism & ADHD

Autistic and AuDHD individuals may be especially prone due to:^[19]Autism spectrum and obsessive-compulsive disorders: OC behaviors, phenotypes and genetics (Jacob et al., 2009)^[20]Adult attention-deficit hyperactivity disorder: key conceptual issues (Asherson et al., 2016)

• Black-and-white thinking
• Literal interpretation of rules
• Hyper-empathy without emotional filters
• Alexithymia and interoceptive confusion
• Rejection Sensitivity Dysphoria (RSD)

These traits make moral ambiguity intolerable and guilt difficult to resolve.

6. Reinforcement & the OCD loop

Compulsions briefly relieve anxiety—so the brain learns that rituals work. But they become self-reinforcing. What began as kindness becomes a job of trying not to be bad.

Environment alone?

Yes. Many people develop moral scrupulosity through guilt-based upbringing, cultural pressure, or trauma—even without a biological predisposition to OCD.

But when someone does have a neurobiological or neurodevelopmental vulnerability (like OCD, autism, or ADHD), they’re far more likely to experience persistent, intrusive moral distress that spirals into compulsive behaviour.

The environment lights the match—but biology may have laid the fuse.

When autism intersects with scrupulosity

Autistic traits that are usually strengths—fairness, conscientiousness, literal thinking—can become tormenting when distorted by OCD:

• Literal interpretation → fear of technical violations
• Black-and-white thinking → moral rigidity
• Hyper-empathy → guilt over imagined harm
• Alexithymia → confusion between authentic and intrusive guilt
• Detail focus → rumination and mental checking loops

The role of rejection sensitivity

Rejection Sensitive Dysphoria (RSD)—commonly linked with ADHD—can overlap with moral scrupulosity:

• Fear of disapproval or criticism
• Avoidance of moral conflict
• Shame spirals and emotional shutdowns

While RSD is most commonly associated with ADHD, many autistic people report similar experiences—especially when moral perfectionism is layered on top.

When moral scrupulosity leads to burnout

This cycle of being good, kind, and conscientious might sound admirable. But for autistic people—already filtering their tone, masking, scanning for nonverbal cues, and trying not to offend—it becomes unsustainable. Add moral scrupulosity, and you’re left with an inner critic that never stops.

Burnout for autistic people often includes:^[21]Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout (Raymaker et al., 2020)

• Emotional exhaustion
• Sensory overwhelm
• Loss of executive function
• Deep cognitive fatigue

And when we’re too depleted to meet our own moral standards? The guilt returns. The loop restarts.

When guilt turns dangerous

Suicidality

Moral scrupulosity doesn’t always look dramatic on the outside. It often looks like kindness. Conscientiousness. High moral standards. But inside, it can become a relentless and wear down a person’s ability to cope.

For some, the guilt becomes more than a mental loop. It becomes a crisis. If you believe you’re a danger to others, or that your very presence might cause harm, then existing itself begins to feel morally unsafe.

That’s where suicidal ideation can enter, not from a desire to die, but from a desperate wish to stop being harmful.

“If I didn’t exist, I couldn’t hurt anyone.”
“If I disappear, I can’t make any more mistakes.”
“People would be better off without me.”

This isn’t about failure or hopelessness. It’s about feeling morally defective, and fearing that no amount of goodness can ever undo the harm already done.

Natalie reflects:

I’ve had suicidal ideation since I was a teenager. It was not due to depression, it seemed very reasonable and moral choice at the time. If I had caused harm, the logical next step was to remove myself.

Once, my ex-husband got very upset with me for not rinsing the plates well enough before putting them in the dishwasher. I walked out of the house. When he called to ask where I was going, I calmly told him:

“I’m going to terminate myself so I can’t hurt anyone anymore.”

At the time, it didn’t even occur to me that his reaction might have been unreasonable. I just knew I had upset someone, and that meant I was dangerous.

Both of my suicide attempts in the past were triggered by this same logic: someone was hurt or upset, and I believed the only responsible thing to do was eliminate myself. At the time, that felt perfectly rational.
Only now, armed with the understanding that I have OCD, does it finally make sense.

Substance use disorder

Some people turn to substances as a way to numb the guilt, escape the anxiety, or temporarily silence the compulsive self-monitoring. The relief may be short-lived, but in the moment, it feels like the only way to stop the spinning.

And yet, those coping mechanisms often feed the cycle. Addiction brings more guilt. Suicidal ideation brings shame. The OCD loop strengthens. The self-trust erodes further.

This is why scrupulosity, especially when layered on top of autism, RSD, or trauma, can be so dangerous. The world may see someone who is highly ethical. But inside, that person may be suffering profoundly under the weight of impossible moral expectations.

Finding a way through

Looking back, I can see that people were concerned—not because I was misbehaving, but because I was too good.

My teachers actually called my parents in for a meeting. Not to report bad behavior, but because they were worried about the opposite. They said I was “too well-behaved.”

I never interrupted. I never forgot a task. I volunteered to clean up after everyone else. If another student got in trouble, I’d feel responsible. I tried to preempt problems by being perfect—by anticipating needs before they were spoken.

To outsiders, it looked like maturity. To my teachers, it looked like a child trying too hard to be safe. They weren’t wrong. At the time, I didn’t understand why they were concerned. Isn’t being good the goal? Isn’t that what everyone wants?

The turning point for me wasn’t a technique. It was learning that this had a name: Moral Scrupulosity OCD.

For years, therapists praised my goodness—or questioned it—without naming what was happening. That only made me try harder. But one day, my therapist said: “This sounds like moral scrupulosity.”

And for the first time, I could ask: Is this guilt coming from me—or from the OCD?

Since being diagnosed, everything makes more sense. I now understand why people were concerned—not because I was failing, but because I was suffering.

What helped me heal

While I still struggle with moral scrupulosity OCD, the following things helped me reduce it:

• Therapy with a compassionate, neuroaffirming therapist
• Learning to question guilt instead of obeying it
• Compassion—not for others (I’ve always had that), but finally for myself
• Medication

Healing doesn’t mean I never feel guilty; it means I no longer trust guilt to tell me who I am.