The influence of cultural factors on obsessive compulsive disorder: religious symptoms in a religious society.

Judaism is one of many religions that demand cleanliness and exactness, inculcate the performance of rituals from childhood and view their non-performance as wrong or sinful. Rituals concerning cleanliness and exactness are the commonest presentations of OCD. In a sample of 34 psychiatric out-patients with OCD in north Jerusalem, religious symptoms were found in 13 of the 19 ultra-orthodox patients, and in one of the 15 non-ultra-orthodox patients. Nine of the 15 OCD patients with religious symptoms also had non-religious symptoms. Four main topics of religious symptomatology were found: prayer, dietary practices, menstrual practices and cleanliness before prayer. The dictates of religious codes regarding these topics are presented and the law is rigorous in its demands, in many cases encouraging repeating rituals. Nevertheless, repetitive performance of religious rituals is recognized by OCD sufferers and their rabbis as expressing psychopathology rather than heightened spirituality. The forms of the religious obsessions and the associated rituals in this sample were similar to the presentation of OCD in non-religious patients. Religion appears not to be a distinctive topic of OCD, rather it is the setting for the condition in very religious patients.