Dear Therapists, 

We have a wonderful daughter who is back from seminary, happily working and doing very well BH, but here is the concern…

While my daughter was in high school she started taking on more and more chumras and started becoming more and more frum and shtark. It affected her relationship with her friends, how she dressed, what she ate, (or didn’t eat), her sleep, her davening, her ability and confidence in herself when making decisions, what she did in her “spare time”, etc. She was also very emotional from the pressure she put on herself to do so much in such a perfect way. Some of her teachers expressed concern, while others praised her, wishing all their students would be like our daughter. At home, also I was confused, to me some things she was doing were of concern, but I kept thinking that I’d rather her be like she was, then going in the other direction, C”V.

When she went to seminary this past year, we were strongly advised that she see a therapist. Nothing major, nothing to be concerned about, probably a few visits to help her… These weekly visits lasted for the whole year, and there was even talk that it may be helpful for her to continue seeing someone back at home. In the end, it was mutually decided by the therapist and our daughter that she could manage back at home without therapy. 

Our daughter had an amazing year at seminary. She made a lot of friends and speaks to them regularly. Her eating is normal, she dresses nicely, she’s more relaxed and B’Simcha, and knows how to say “no” when asked to do a chessed, or babysitting job that she really can’t fit in, etc. She still davens very long and is makpid to learn and to do her mitzvos with the utmost Kavana, and to not waste any time, (like we all should be doing), but it’s not with the same pressure that it was before she went to seminary. 

My question is that if someone made a comment, “What’s wrong with… Is she OCD?” How do we know if our daughter should in fact still be seeing a therapist, or if she’s just a frum, shtark girl keeping themitzvos the way HaShem wants them to be done?

Thank you very much for your help and advice.

Dear reader:

As I read your letter, I found myself contemplating the thought of the Ramchal.  The Ramchal opens Mesillas Yesharim with a critical, catch-all of Yiddishkiet: “Yesod HaChassidus V’Shoresh HaAvodah HaTemimah” he begins, “The base of piety and the source of pure Avodas Hashem” exists when it becomes clear and true to a person what his or her purpose in this world is.  It is interesting that the Ramchal chooses the term Chassidus when describing how we should know what is expected of us from Hashem. Doesn’t “piety” mean going above and beyond?

                Or HaChaim HaKadosh (Vayikra 26:3) says no. Citing the famous idea that “Lo AmHaaretz Chassid” – that one who is not learned cannot be a Chassid, Or HaChaim explains that the reason an Am HaAretz cannot be a Chassid is that one who is not aware of what s/he is doing cannot make the same Chumros or Gedarim in the style of the pious. Doing so could take an intended act of care and turn it into an act of sin. Sometimes, what we think we are doing  “just to be careful”  is actually Halachically incorrect and perhaps sinful. If we throw out food just because we have a doubt about its Kashrus (instead of finding out the Halacha) then we violate Baal Tashchis.If we repeat the word Modim over and over until we feel we had the properKavanna – it might look like we are doing the right thing but in actuality, weare violating the Halacha. The Mishna clearly notes that one who does so needs to be silenced. How much more dangerous is it to repeat Berachos  or Tefillos over and over when we are somewhat doubtful if we said each word properly or with the right Kavana? What would Ramchal and Or HaChaim say then?

Here is where the catch-22 comes in for many people as they suffer trying to figure out if they (or their loved one) are behaving within the proper boundaries of Halacha with scruples and Chassidus or if they are suffering from a subtype of OCD called Scrupulosity. Whereas in other cases of OCD, those suffering are logically aware that their experienced threats are irrational and unlikely (as I’ve been told often “I mean how hard is it to see that the risk you might catch a germ”) , with Scrupulosity the religious or legal consequences (or threats) of the thought have made its irrational nature difficult to discern the scruples from scrupulosity (“I mean who wants to go to Gehenom?”). Still, Psychologists have noted five key features that distinguish scruples from scrupulosity:

  1.  When practices go further than the requirements of Halacha, one might be mistaking scruples for scrupulosity. When someone acts “more Frum than Hashem” it is likely that we are looking at behavior characteristic of Scrupulosity. For instance, if Halacha requires that when washing Netilas Yadim it is to be done twice on each hand, the person with Scrupulosity will repeatedly wash to be sure that he covered each hand twice until the wrist and can wash twenty times or more.
  • When the person becomes overly preoccupied with a focus on a seemingly trivial part of the Halacha instead of the whole picture, s/he is likely to be expressing behavior moreakin to Scrupulosity. When a religious patient is more focused in Tefila on“pronouncing it perfectly” instead of developing a sense of Kavanna and connecting to Hashem through Tefillah, the focus is more like scrupulosity than scrupulous. Usually the motivation described by those with this style  is a fear of not “doing it right” which will have all sorts of negative consequences and no real desire to do it right to bring Nachas Ruach to Hashem.
  • Healthy and scrupulous religious beliefs do not interfere with the normal practice of the religion.Scrupulosity frequently interferes with the proper practice of religion. For instance, when a person with Scrupulosity OCD does not attend Minyan because of the fear that s/he cannot contain intrusive thoughts, s/he is expressing scrupulosity.
  • The person with Scrupulosity spends excessive time and energy on minute, trivial aspects of  spiritual life (like being exceedingly Chosheish for a Chumra beyond the boundaries of Halacha) while ignoring more important aspects of spiritual life including Mitzvos Bein Adam L’chaveiro, Gemilas Chessed, Tzedaka and Ahavas Hashem.
  • The pre-occupation withdoing a Halachic ritual until it is  “perfect”, the repetitive praying, vigilant ritual preparation and unnecessary Kappara-seeking  found in Scrupulosity closely resemble the typical OCD symptoms of checking, repeating and asking for reassurance. The person with Scrupulosity often demonstrates behaviors that are persistent,unwanted and repetitive. S/he will regularly report feeling “too much pressure”and experience difficulties with choices and enslaved to doubts which cause alot of distress.

Remember:  Strong religious convictions do not cause or imply Scrupulosity. In fact two of the greatest Poskim of our times – The Steipler Zatzaland Yibadel L’Chaim Tovim, HaGaon HaRav Rav Chaim Kanievski Shlita have published letters with their awareness and guidelines as to how to approach Scrupulosity. HaGaon HaRav Asher Weiss Shlita too, has beautiful Teshuvos detailing how to approach Scrupulosity. None of these Gedolim can be accused of not having strong religious conviction. Rather, Scrupulosity is a type of OCD, which we see as a neurobehavioral disorder. A person’s religious convictions are merely one aspect of his or her being that OCD uses to cultivate doubt and create anxiety. If OCD didn’t attack a person’s religious beliefs, it would surely take on a different form, whether that be a contamination fear or a checking compulsion or another arena for OCD to unleash anxiety. Scrupulosity takes strong religious ideals and blows them out of proportion, making them distorted and corrupt.

                This is the difference between a diagnosis of OCD and one of piety. I cannot tell whether it applies to a particular person without meeting him or her but knowing the details of what to look for, certainly should prove to be helpful.

                Withall of that in mind, please let me make 2 observations about your letter. The first is in regard to your question and the other is about “what people say:”

                Your daughter is a lucky girl. She has parents who love her and believe in her tremendously. Both in her pre-seminary growth and her seminary years, you, her parents, have demonstrated that you want what is best for her and are willing to  do whatever it takes to get it for her. Therefore, as far as to when and whether to know if your daughter should see a therapist, I would encourage you to simply sit down and ask her. She is,after all, the best expert on herself. Is she feeling pressured in her Avodas Hashem or is she comfortable with her boundaries of Halacha so that she can wholesome grow within them? Would she want to discuss her pressures with a therapist and a Rav both of whom get her background and what she wants out of life (i.e. her Chova in the world)? If the answer is yes, there are some great licensed professionals and awesome Rabbonim and Poskim who would be great sources of guidance  for her– and for you – and the discussion can go from there. Be sure to offer encouragement to her!  If the answer is “no”, confirm your belief in her to her  and remind her that as parents you are there for her and believe in her and if she ever wanted to revisit this or any other issue, you are all ears. Your daughter will appreciate it either way.

                At the same time, I cannot walk away from this letter without making a general comment that might have nothing to do with your daughter. I refer to the point from the person who might say “What’s wrong with… Is she OCD?”.  The answer to the question is “no”. Your daughter is your daughter. She sounds like  a bright, energetic, beautiful, friendly dependable Baalas Middos V’Chessed. She (like everyone else is the world) is not OCD. OCD is a diagnosis of a treatable challenge that some people face – it is not a definition of that person. When we boil a person down to the label of that person’s challenge we ignore the person and the Maalos that s/he brings to the world. When we do that, we get to wear a label too – shallow and dismissive– shameful and wrong. That condition, is a bit more difficult to treat but we certainly can. For, as Frum Yidden, we are certainly better than that.

Taalu VTatzlichu,

Jonathan Schwartz PsyD

Clinical Director, Center for Anxiety Relief

Union, NJ