OCD in South Asian communities: when rituals stop being comforting

OCD is often missed in South Asian contexts because its rituals can be mistaken for religious devotion or cultural practice. Here's how to tell the difference.

Obsessive-compulsive disorder (OCD) involves intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts performed to reduce anxiety (compulsions). It affects approximately 1–3% of the population globally — South Asian communities included.

In South Asian cultural and religious contexts, OCD is particularly easy to miss, because its rituals can look like religious devotion.

Where OCD and religious practice overlap

Hand-washing, prayer, checking, cleanliness rituals — these are all features of OCD and features of normal religious practice. In Hindu, Muslim, and Sikh contexts particularly, ritual purification has religious meaning. When OCD manifests through these same forms, families often interpret it as piety rather than pathology.

The distinction matters clinically:

• Religious rituals are freely chosen and provide genuine comfort
• OCD rituals feel compelled — not performing them causes intense anxiety
• Religious rituals have a clear endpoint
• OCD rituals tend to escalate — more repetitions are needed to achieve the same relief
• OCD rituals significantly impair daily functioning

Scrupulosity OCD

A specific form of OCD — scrupulosity — involves obsessions around sin, impurity, blasphemy, or religious failure. It's particularly common in highly religious contexts. A person with scrupulosity OCD may pray for hours, seek repeated reassurance from religious leaders, or confess the same "sins" repeatedly — not from genuine devotion but from an OCD-driven compulsion they can't stop.

This is genuinely difficult territory because the content of the OCD is religious, but the problem is clinical.

Getting the right help

OCD responds well to ERP (Exposure and Response Prevention) therapy — a specific form of CBT developed for OCD. It is more effective than general therapy for this condition. A therapist who understands OCD and who also respects your religious context — not assuming that the religious content is the problem — is the right fit.

Medication (typically SSRIs at higher doses than used for depression) is also effective and often used alongside ERP for moderate-to-severe OCD.

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