may be an additional way to readjust beliefs associated with the disorder, though it may also stimulate greater anxiety. Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made. Treatment of scrupulosity in children has not been investigated to the extent it has been studied in adults, and one of the factors that makes the treatment difficult is the fine line the therapist must walk between engaging and offending the client. Epidemiology The prevalence of scrupulosity is speculative. Available data do not permit reliable estimates, and available analyses mostly disregard associations with age or with gender, and have not reliably addressed associations with geography or ethnicity. Available data suggest that the prevalence of obsessive–compulsive disorder does not differ by culture, except where prevalence rates differ for all psychiatric disorders. No association between OCD and depth of religious beliefs has been demonstrated, although data are scarce. There are large regional differences in the percentage of OCD patients who have religious obsessions or compulsions, ranging from 0–7% in countries like the U.K. and Singapore, to 40–60% in traditional Muslim and orthodox Jewish populations. History Scrupulosity is a modern-day psychological problem that echoes a traditional use of the term scruples in a religious context, e.g. by Catholics, to mean obsessive concern with one's own sins and compulsive performance of religious devotion. This use of the term dates to the 12th century. Several historical and religious figures suffered from doubts of sin, and expressed their pains. Ignatius of Loyola, founder of the Jesuits, wrote "After I have trodden upon a cross formed by two straws ... there comes to me from without a thought that I have sinned ... this is probably a scruple and temptation suggested by the enemy." Alphonsus Liguori, the Redemptorists' founder, wrote of it as "groundless fear of sinning that arises from 'erroneous ideas'". Although the condition was lifelong for Loyola and Liguori, Thérèse of Lisieux stated that she recovered from her condition after 18 months, writing "One would have to pass through this martyrdom to understand it well, and for me to express what I experienced for a year and a half would be impossible." Martin Luther also suffered from obsessive doubts; in his mind, his omitting the