Religiosity and obsessive–compulsive phenomena in Turkey: associations with obsessive beliefs and symptom dimensions

Obsessive-compulsive disorder (OCD) is a psychiatric condition marked by intrusive, unwanted thoughts and repetitive behaviors performed to neutralize the distress they cause. A long-standing question in clinical psychology is whether religious life shapes this disorder, given that many OCD symptoms—fear of sin, scrupulosity, compulsive washing or checking—can take religious forms in devout communities. A new cross-sectional study conducted in Turkey, published in BMC Psychiatry, offers one of the most precise answers to date, and its conclusion is strikingly selective: religious motivation is elevated in people with primary OCD, but it connects to the disorder not through overall symptom severity, rather through one specific cognitive belief—the conviction that thoughts are important and must be controlled.

The research, led by Cihad Erim of the Department of Psychiatry at Şişli Etfal Training and Research Hospital in Istanbul, leveraged Turkey’s unique socio-cultural context, where religious practice is woven into daily routines and moral reasoning. The sample comprised 169 participants: a clinical group with primary OCD without current psychiatric comorbidities (n = 93), diagnosed via the Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV), and a healthy control (HC) group (n = 76). Participants completed the Motivational Religiosity Scale (MRS), the Obsessive Beliefs Questionnaire (OBQ-44), and the Padua Inventory (PI-WSUR), three validated instruments that respectively measure the motivational drive behind religious practice, dysfunctional cognitive beliefs central to OCD models, and obsessive-compulsive symptom dimensions.

Methodologically, the study went beyond simple group averages. Group comparisons were evaluated using unadjusted t-tests and Analysis of Covariance (ANCOVA) adjusting for sociodemographic confounders such as education, income, employment, marital status, and alcohol use. Correlation analyses were corrected for multiple comparisons using the Holm-Bonferroni procedure, a statistical safeguard that reduces the risk of false positives when many relationships are tested simultaneously. This rigor matters because religiosity, education, and income are entangled in any population; without such adjustments, an apparent link between faith and psychopathology could simply reflect social structure rather than mental processes.

The first headline finding is quantitative and unambiguous. Unadjusted comparisons showed significantly higher MRS total scores in the OCD group compared to controls (M = 110.85 ± 28.56 vs. 92.75 ± 31.56; t = -3.91, p < .001, Cohen’s d = 0.60). In plain terms, people with OCD reported a stronger motivational drive toward religious practice than healthy participants, a medium-sized difference. Crucially, this group difference remained statistically significant in ANCOVA models controlling for sociodemographic covariates (F(1,161) = 9.84, p = .002, partial η² = 0.058), meaning the elevation in religious motivation was not an artifact of the OCD group being poorer, less educated, or differently employed.

What does this elevation mean? The cognitive science of religion suggests that religious systems engage the same mental machinery that OCD distorts: moralized thought, ritualized action, and heightened sensitivity to taboo or blasphemous cognition. In a devout society, intrusive thoughts about sin or blasphemy may be especially distressing, and the behaviors used to neutralize them—prayer, washing, repeated checking of one’s intentions—can mirror compulsions. Yet the study’s correlational results complicate this simple narrative, showing that the relationship between faith and OCD is not a broad, undifferentiated association but a narrow, domain-specific one.

In bivariate correlation analyses, religiosity (MRS) correlated positively with overall obsessive beliefs and multiple symptom subscales in healthy controls. Within the clinical OCD group, however, the picture narrowed dramatically. Religiosity demonstrated a robust positive correlation strictly with the OBQ Importance/Control of Thoughts subscale (ρ = 0.381, praw = 0.0002, padj = 0.002), and this association was maintained in multivariable linear regression adjusting for sociodemographic confounders (β = 0.341, p = .001). After Holm-Bonferroni correction, no other obsessive belief domain and no symptom dimension survived as significantly correlated with religious motivation in the clinical sample.

The Importance/Control of Thoughts belief is one of the pillars of modern cognitive-behavioral models of OCD. It refers to the conviction that having a thought is morally equivalent to acting on it—a phenomenon closely related to thought-action fusion (TAF)—and that one must exert control over unwanted cognition to prevent harm. Clinical experience shows that the harder a person tries to suppress an intrusive thought, the more frequently it returns, a rebound effect documented in experimental psychology. In religious contexts, where thoughts about the sacred carry moral weight, this belief may be amplified: an unwanted blasphemous thought is not merely noise but a spiritual event demanding response.

Equally important is what the study did not find. Religiosity was not associated with overall OCD symptom severity (PI-WSUR Total) or with broad symptom dimensions in the clinical sample. This null result is the study’s most consequential contribution, because it rules out a popular but simplistic hypothesis: that being religious drives OCD symptoms upward in a global fashion. Instead, the data suggest that religious motivation interacts with OCD primarily at the cognitive appraisal level rather than acting as a global driver of overall symptom severity. Faith, in this model, does not manufacture obsessions; it shapes how obsessions are evaluated once they occur.

For treatment, the implications are concrete. Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) remains the first-line psychological treatment for OCD, and its effectiveness depends on targeting the specific beliefs that maintain symptoms. If a devout patient’s compulsions are fueled by the belief that thoughts must be controlled and that thinking is morally dangerous, then therapy must address that appraisal directly—helping the patient tolerate intrusive cognition without ritualized neutralization—rather than treating religiosity itself as the pathology. The study’s findings suggest that clinicians working in religious communities should assess the Importance/Control of Thoughts belief as a potential maintaining factor, while avoiding the assumption that religious motivation is a symptom to be reduced.

The study has limits that temper its conclusions. Its cross-sectional design cannot establish causality: elevated religious motivation in OCD could be a consequence of the disorder, a contributing factor, or both, and longitudinal work is needed to disentangle these possibilities. The clinical group excluded current psychiatric comorbidities, which strengthens diagnostic purity but may limit generalizability to the many patients whose OCD coexists with depression or anxiety. The sample, drawn from a single outpatient clinic in Istanbul, may not represent Turkey’s full religious and regional diversity. Still, by combining a culturally rich setting with rigorous statistical correction, the study delivers a technically precise message: religious motivation is elevated in primary OCD and displays a domain-specific, selective association with cognitive beliefs regarding the importance and control of thoughts, independent of sociodemographic confounders. The dialogue between faith and this disorder, it turns out, happens not in the symptoms themselves but in the mind’s verdict on its own thoughts.

Subject of Research: Religiosity and obsessive–compulsive phenomena in Turkey: associations with obsessive beliefs and symptom dimensions

Article Title: Religiosity and obsessive–compulsive phenomena in Turkey: associations with obsessive beliefs and symptom dimensions

Article References: Erim, C. (2026). Religiosity and obsessive–compulsive phenomena in Turkey: associations with obsessive beliefs and symptom dimensions. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08605-w

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08605-w

Keywords: Religiosity, obsessive, compulsive, phenomena, Turkey, associations, beliefs, symptom, dimensions, scientific research