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Scrupulosity—a form of OCD with distinctively moral or religious obsessions or compulsions–raises problems for ordinary views of moral responsibility. We first characterize scrupulosity as a form of OCD, in particular by looking at three characteristic aspects of moral judgments made by the scrupulous: perfectionism, intolerance of uncertainty, and moral thought- action fusion. We then consider whether mesh and reasons-responsiveness accounts of responsibility can explain whether those with scrupulosity are morally responsible, and conclude that both face difficulty in making sense of their responsibility. We conclude with a discussion of how scrupulosity challenges the transfer principle—the claim that we are responsible for uncontrollable actions that derive from previous, controllable choices—by showing that scrupulosity, like other forms of OCD, may develop from previous, controllable choices. This shows that people with scrupulosity are more responsible than we may have thought initially, or that others, like alcoholics, may be less responsible than we thought.

Patients with Scrupulosity, a form of Obsessive-Compulsive Disorder with moral or religious obsessions and/or compulsions, appear to make moral judgments that are stricter or more stringent than others' moral judgments. This may suggest that Scrupulosity is a condition characterized by higher moral standards. This chapter explains why those with Scrupulosity are, instead, making systematically distorted moral judgments. First, it describes Scrupulosity as a distinctive form of OCD that characteristically exhibits three features: perfectionism, moral thought-action fusion, and chronic doubt. These features, which individually are compatible with genuine moral judgments, are the expression of underlying anxiety and thus lead to judgments that are distorted in at least three ways: (1) Anxiety narrows one's attention to a small, self-focused range of factors that will best soothe one's anxiety, at the expense of other factors that may be morally more important. (2) Anxiety leads one to focus on some factors that are not morally relevant. (3) Anxiety makes one's judgments inflexible.

Scrupulosity is a form of OCD in which a person’s obsessions or compulsions are focused on morality or religion. As such, the disorder superficially resembles a heightened focus on morality, which in itself we might find praiseworthy. Therefore, scrupulosity raises difficult issues for treatment, since treatment would seem to require making a person less concerned with moral issues, feel less morally responsible, ignore moral thoughts, and otherwise downplay moral responses that we normally encourage. In addition, the most effective treatment today requires patients to perform acts that get progressively more immoral in their view. This treatment raises a host of doubts about which treatments are morally and professionally defensible as well as about whether psychiatry can be value-free or scientific. We consider why treatment of scrupulosity may nevertheless be justified.

We sometimes want to understand irrational action, or actions a person undertakes
given that their acting that way conflicts with their beliefs, their (other) desires, or their (other) goals. What is puzzling about all explanations of such irrational actions is this: if we explain the action by offering the agent’s reasons for the action, the action no longer seems irrational, but only (at most) a bad decision. If we explain the action mechanistically, without offering the agent’s reasons for it, then the explanation fails to explain the behavior as an action at all. I focus on cases that result from compulsion or irresistible desire, especially addiction, and show that this problem of explaining irrational actions may be insurmountable because, given the constraints on action explanations, we cannot explain irrational actions both as irrational and as actions.