Lesson 6 of 6 · When it is an illness
How to tell it has outgrown reading
Nobody draws a line and tells you when you have crossed it. There are markers though, and they are about your days rather than about your faith.
Time. Rituals that now take real time, or hours a day going on checking, reviewing and asking.
Function. Prayer avoided or taking hours. Work, study or sleep gone. Relationships being damaged by confession that keeps escalating.
Duration. Not a difficult fortnight. Months, in the same form, and not lifting.
And the ones that go faster. Any thought of ending your life, especially alongside a settled belief that you are damned and it is already decided. A belief that a thought has made you unforgivable. Doubt that arrived suddenly and out of character, or alongside hearing voices or fixed unusual beliefs, which needs a medical assessment first.
None of these says anything about your faith. They are the markers any clinician would use.
What the research says
What makes this a clinical problem is time and cost: more than about an hour a day, or marked distress, or interference with your life. There is no doctrinal criterion anywhere in it.
The diagnostic criterion is time and cost: obsessions or compulsions that are time consuming, conventionally more than an hour a day, or that cause marked distress or interfere with daily life. There is no doctrinal criterion anywhere in it.
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing doi
The other main international classification uses the same two markers, distress and interference. Two independent systems, and neither one asks about your faith.
The other main classification turns on the same two things, distress and interference with daily life. Two independent systems, neither of which asks about a person's faith.
World Health Organization (2025). ICD-11 for Mortality and Morbidity Statistics, 6B20 obsessive-compulsive disorder. World Health Organization
You get stepped up from self help on how much of your life is affected and whether the lower step helped. These markers are reasons to go and ask. They are not a score and they do not tell you what you have.
Guidance steps care up on how much daily life is affected and on whether a lower step has helped. These markers are reasons to go and ask. They are not a score and they do not tell you what you have.
National Institute for Health and Care Excellence (2024). Obsessive-compulsive disorder and body dysmorphic disorder: treatment, NICE clinical guideline CG31, last reviewed July 2024. National Institute for Health and Care Excellence