From an Islamic perspective, waswasah can come from either the nafs, which in English translates as the inner self or soul, or can come from external forces like Satan. In western psychology, there are different theories on the origins of intrusive thoughts, but most point to organic sources, indicating that these thoughts come from the brain or body (dysfunctional brain chemistry, imbalanced gut flora, etc.) of the sufferer. Waswasah consists of intrusive thoughts that cause cognitive dissonance (mental distress due to contradictory beliefs, values, or thoughts), and poses a risk to a person’s spiritual and psychological homeostasis. In this publication, I will define what the disease is, discuss clinical treatment options and make recommendations for treatment providers. The purpose of this publication is to contribute to the growing field of Islamic psychology by providing mental health clinicians and imams with the foundational knowledge and tools necessary to help clients with this condition, which, I will argue, needs to be treated differently from other forms of OCD. As a result, those who suffer from waswasah are unsure where to get help, and when they do seek assistance these individuals often do not receive the specialized treatment they need. General clinicians unfamiliar with waswasah also have difficulty providing treatment, or may cause the client more harm than good if they do not understand the religious nature of the obsessive thoughts and compulsive behaviors. For Muslims, Islamic community leaders have been the primary treatment providers for this condition, although they do not have the clinical training nor the time to effectively address the needs of these individuals. Waswasah is not a Muslim disease -it is a religious presentation of OCD in Muslims. Obsessive-compulsive disorders related to religiosity are known in clinical literature as scrupulosity, are found in all religions, 2 and are especially difficult to treat because of the religious appearance of the symptoms. Perpetuated by irrational fears and catastrophic thinking, these acts of worship become a source of anguish instead of spiritual nourishment. Obsessions are rooted in fear that their acts of worship are inadequate and that the acts must be repeated until perfect. Muslims who suffer from waswâs al-qahri unwillingly take everyday acts of worship, like washing for prayer ( wudu ), or prayer itself, to extreme lengths. Waswâs al-qahri is a presentation of obsessive-compulsive disorder (OCD) that is not included in the Diagnostic Statistical Manual (DSM) 1 or International Classification of Diseases (ICD) for several reasons including lack of research, diagnosis overlap and insufficient recognition of spiritually-based diseases by the American Psychiatric Association (APA). Waswâs al-qahri, which means ‘overwhelming whisperings’ in Arabic, is a complex mental health disorder found in Muslim populations.
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