Waswasah: A Guide to Islamic Perspectives and Clinical Treatment of OCD
Religious OCD (Scrupulosity), or Waswasah, can feel like a relentless battle of faith—a constant back-and-forth in your mind. This internal conflict often leaves sufferers feeling mentally exhausted and, at times, on the brink of giving up. This article explores how Islamic scholarly instruction and modern Exposure and Response Prevention (ERP) therapy work together to provide a clinical path to recovery and relief.
What is OCD?
General OCD
According to the NHS (National Health Service UK), "obsessive compulsive disorder (OCD) is a mental health condition defined by a cycle of obsessive thoughts and compulsive behaviours. OCD can affect men, women and children. While it can affect anyone at any age it often begins around puberty and early adulthood. It is a distressing condition that can significantly interfere with daily life, but it is treatable."[1]
The NHS states that OCD consists of two main components:
An Obsession: An unwanted, unpleasant thought, image, or urge that repeatedly enters your mind, causing anxiety, disgust, or unease.
A Compulsion: A repetitive behaviour or mental act that you feel you must do to temporarily relieve the unpleasant feelings brought on by the obsession.
The Fear Factor
It is important to note that OCD is fear driven. Sufferers usually display:
Inflated Responsibility: The belief that they are personally responsible for preventing harm to themselves or others.
Overestimation of Threat: The belief that a negative outcome (like illness or sin) is much more likely or dangerous than it actually is.[2]
Putting the above together, as an example, a sufferer of contamination OCD will fear that if they do not clean something, they or someone else will become ill due to the presence of bacteria.
The religious OCD version of this would be an inflated fear of Najasah (impurity that renders prayer invalid if a certain amount is present on one’s body, clothing, or place of prayer). A person suffering with intellectual OCD of a religious kind may overestimate the threat of rendering their Islam void; they will ruminate over this and perhaps develop mental rituals that grant them a sense of temporary safety.
The 5 Common Types of OCD
While OCD varies from person to person and there is a difference of opinion regarding categorisation, experts (such as Joseph W. Ciarrocchi in The Doubting Disease) generally categorise OCD into five types:
1. Obsessional Checking The person worries that a task wasn't completed properly and feels compelled to check it repeatedly. The defining feature is the urge to check again mere minutes after the previous check.
2. Obsessional Cleaning This involves excessive cleaning of one’s body or environment due to contamination fears.
Religious Context: This is very common among Muslims, often manifesting as an inflated fear of Najasah (impurity). It can make performing Wudu (ablution) or Ghusl (ritual bathing) extremely difficult and time-consuming.
3. Obsessional Slowness This involves extraordinary precision, where the person takes an excessive amount of time to perform routine acts to make them "perfect."
Religious Context: A sufferer may spend 20 minutes washing a single limb during Wudu or repeat verses of Salah (prayer) endlessly until they "feel" right.
4. Obsessional Doubting-Conscientiousness This refers to a constant doubt that an action was done correctly. In religious OCD (scrupulosity), these doubts often concern committing a sin.
5. Obsessional Ruminating The process of turning an idea or image over and over in the mind. In scrupulosity, these thoughts are often blasphemous or immoral, causing immense distress because they contradict the sufferer's values.
Religious OCD or Scrupulosity
In addition to the above, we can add the category of Religious OCD or Scrupulosity, about which Joseph W. Ciarrocchi says, "Spiritual guides have long recognised how an overly sensitive moral conscience interferes with living a life based on faith." He notes that scrupulosity is a specific form of OCD where intrusive thoughts focus on violating religious, moral, or ethical beliefs. Historically, it has been called "the doubting disease" or a "phobia concerning sin."[3]
Individuals with scrupulosity will experience intrusive, unwanted thoughts, images, or urges about violating their religious, moral, or ethical beliefs. This could manifest as a fear of offending God, praying incorrectly, or misinterpreting teachings. They judge their own behaviour as immoral even when their faith community would see it as blameless.[4, 3]
Historical Context
Early European Accounts & Recognition
Medical accounts of OCD can be found as far back as the 14th century. Symptoms were described as scrupulosity and revolved around religious or moral purity, involving obsessive fears of sinning or committing wrong which would result in repetitive confessions or religious devotions. Such behaviours weren’t seen as medical conditions, however, but rather deemed spiritual afflictions or moral shortcomings.[5]
The formal recognition of OCD as a medical condition began in the 19th century, with French psychiatrist Jean-Étienne Esquirol being amongst the first to describe OCD symptoms in 1838. The German psychiatrist Karl Westphal further advanced the understanding of these symptoms in 1877. Using the term Zwangsvorstellung (compulsive idea) to describe obsessive thoughts, he distinguished them from delusions and noted that individuals suffering with such symptoms recognised their irrationality.[3, 6]
Early Muslim Accounts in The Quran and Prophetic Traditions
Religious OCD, often Islamically termed as waswasah (intrusive whispers or thoughts), has been recognised since the formative years of the Islamic framework itself.
The Quran: We find that the concept of intrusive thoughts is clearly addressed in the Quran. For example, Surah An-Nas is dedicated entirely to seeking refuge from "the whisperer" (Waswas), acknowledging that these intrusive thoughts are an external affliction, not a reflection of the person's heart.
Allah says, {Say, ˹O Prophet,˺ “I seek refuge in the Lord of humankind, the Master of humankind, the God of humankind, from the evil of the lurking whisperer—who whispers into the hearts of humankind—from among jinn and humankind.”}[7]
Prophetic Traditions: The Prophet ﷺ addressed this issue in various incidents recorded within prophetic traditions. Two examples include:
`Abbad ibn Tamim, my uncle, asked the messenger of Allah ﷺ about a person who imagined to have passed wind during the prayer. The prophet ﷺ replied: "He should not leave his prayers unless he hears sound or smells something."[8]
Abu Huraira narrated, “Some Companions of the Prophet ﷺ came to him and said, ‘We find thoughts in our minds that are too terrible to speak of.’ He ﷺ said, ‘Do you really experience this?’ They said, ‘Yes.’ He replied, ‘That is clear faith.’”[9]
This hadith is profound, as modern clinicians highlight that OCD intrusive thoughts are usually a result of deep-rooted beliefs. Therefore, a person having such ‘terrible thoughts’ experiences them precisely due to the strength of their faith. Since intrusive thoughts usually manifest as ideas that contradict one's strict moral framework or tenets of faith, the Prophet ﷺ stating that the presence of such thoughts is ‘clear faith’—over 1,400 years ago—is significantly profound.
Scholarly Discourse
Muslim scholars have discussed the issue of Religious OCD (waswasah) early on in Islamic scholarly discourse. This is found particularly in books of Tafsir (Quranic Interpretation) and Fiqh (Islamic Jurisprudence)—specifically within the chapters of Tahara (Purity) and Salah (Prayer). These texts often instruct that intrusive thoughts must be ignored, as scholars understood that once entertained, the issue would continue to grow and become debilitating.
The great scholar of Islam, Imam An-Nawawi (may Allah have mercy on him), commenting on one of the statements of the Prophet ﷺ, instructs a person suffering from intrusive thoughts:
"The person should stop thinking about it and realise that this thought is a whisper (intrusive thought) from Shaytan (a devil), who is attempting to corrupt and mislead this person. They should, therefore, stop paying attention to these whispers and focus on something else."[10]
This is very much in line with modern CBT-based approaches to intrusive thoughts and OCD. In this context, "ignoring" the thought means sitting with the thought and becoming comfortable with its existence until it eventually subsides on its own. Crucially, the compulsion must be left off; the challenge then becomes managing the ensuing guilt.
As an example of this modern approach, Joseph W. Ciarrocchi states:
"We cannot emphasise enough that, in most cases, reducing scruples is a two-part process which the person carries out simultaneously. No change in rituals will occur if one exposes oneself to the obsessional scruple but continues to perform the ritual. People must experience the fear, and, at the same time, block or prevent the ritual/compulsion."[11]
He highlights the necessity of ignoring the thoughts while simultaneously resisting the compulsion. This aligns perfectly with the modern clinical standard of Exposure and Response Prevention (ERP).
How to Treat Religious OCD
1. Understanding the Cycle
Treating OCD requires breaking the loop between the thought and the action.
The Trigger: You have a distressing thought (e.g., "I broke my Wudu").
The Compulsion: You feel an urge to fix it (e.g., renewing Wudu).
The Trap: If you perform the compulsion, you get short-term relief, but the anxiety returns stronger next time.
The Solution: You must sit with the discomfort. Think of the intrusive thought like a passing car or background noise—you notice it is there, but you do not run after it or engage with it. By refusing to do the compulsion, the brain eventually learns that the "threat" wasn't real.
2. The Guilt vs. Taqwa (Righteousness) Trap
In standard OCD, resisting a compulsion feels risky. In religious OCD, it feels sinful.
The Confusion: You think, "If I don't renew my Wudu, I am praying without purity, which is a sin."
The Reframing: Resisting the urge to check is not negligence; it is the clinical treatment required. You are not responsible for the outcome (which is in Allah's hands); you are only responsible for the effort to resist the disorder.
3. Understand The Root Fear: Outcome vs. Effort
OCD attacks a person's deepest values. For Muslims, this fear generally orbits around the invalidity of worship or the nullification of Islam. To overcome this, the sufferer must reframe their understanding of responsibility:
You are not responsible for the outcome (Acceptance): Whether an act is accepted is entirely up to Allah.
You are only responsible for the effort: Your duty is to perform the action to the best of your ability without yielding to excessive doubt. The rest is with Allah.
4. Reassurance Seeking
Another component of OCD is the compulsive act of reassurance seeking. An OCD sufferer will often seek out reassurance, looking for comfort that their ritual act of worship has been accepted, or was performed without compromise, or that they have not nullified their own Islam with thoughts or actions. For example, sufferers often ask scholars or family members, "Is my prayer valid if...?"
It is essential that the OCD sufferer restrict themselves from diving into the online rabbit hole of reassurance seeking, as sufferers will know the frustration, anguish and pain that ensues.
"Reassurance-seeking is just another compulsion, and when people give reassurance, they are participating in the compulsion and inadvertently feeding the OCD. That’s because receiving reassurance once is never enough for a person with OCD. The requests will come again and again in an endless cycle that doesn’t address the root of a person’s anxiety and actually makes the anxiety stronger."[12]
The Rule: Reassurance is a compulsion. It feeds the OCD. Family members should support you by not answering these repetitive questions. You must stop "checking" online or asking for rulings on things you have already asked about.
Conclusion & Next Steps
Recovery involves three simultaneous steps: exposing yourself to the fear (e.g., praying with the doubt that you broke Wudu), preventing the response (refusing to redo it), and acclimatising yourself to "the guilt."
If you are struggling, remember that you do not have to choose between your faith and your mental health. At Tasfiyah Therapy, we offer CBT and Exposure and Response Prevention (ERP) whilst also utilising traditional knowledge of Islam—including Islamic Jurisprudence, Islamic Theology, and spiritual well-being. We both understand and respect your Islamic values whilst we utilise modern clinical tools.
Our services are not restricted only to those seeking a bridge between modern clinical CBT and Islamic traditions; we offer our services and help to all, regardless of their religious place.
References
[1] Obsessive compulsive disorder (OCD) - NHS [2] Beliefs, compulsive behaviour and reduced confidence in control - PMC [3] The Doubting Disease, Joseph W. Ciarrocchi [4] Religiosity, Spirituality, and OCD-Related Symptoms in Clinical and Nonclinical Samples [5] History | Obsessive-Compulsive and Related Disorders | Stanford Medicine [6] The history of OCD | OCD-UK [7] The Quran, Surah An-Nas, Trans. Dr. Mustafa Khattab, The Clear Quran [8] Sahih al-Bukhari [9] Sahih Muslim [10] Commentary of Sahih Muslim, Imam an-Nawawi [11] Reducing Compulsive Scruples, The Doubting Disease [12] Signs and Symptoms of Religious OCD
About the Author
Ashraf Dabous is a Psychotherapist and serving Imam at a major London Mosque. He holds a BA from the Faculty of Dawah and Usul al-Deen (Islamic University of Madinah) and an MSc in Cognitive Behavioural Therapy from Goldsmiths, University of London. His background includes formal studies in Theology, Jurisprudence, and spiritual wellbeing, alongside four years of clinical practice.
