Obsessions include irresistible, persistent and irrational ideas accompanied by feelings of tension and fear. These ideas which plague the individual are “discordant,” that is, out of harmony with his habitual attitude, and “impulsive,” tending to reduce themselves spontaneously to action. The scrupulous person is frightened and flustered by the thought of doing a thing for which he has a positive abhorrence and by his inability to get the thought out of his mind. Phobias refer to habitual, irrational fears of a definite entity associated with a high degree of anxiety and unwarranted by objective reality. They are very intense fears, completely out of proportion to their causes or objects. Finally, compulsions strictly so called may be defined as irresistible, unreasonable urges to perform actions to free the individual from an obsessing idea. Tension and anxiety are associated if the act or external ritual is not performed. For the confessor, the recognition of a scrupulous person is not too difficult. The penitent’s own difficulties present the first and most obvious sign, e.g., irrational doubts about consent to temptation, as to the gravity of a sin, etc., and undue concern about circumstances. Concomitant signs confirming the judgment that a person is scrupulous include: (a) Obstinacy of judgment; Although the scrupulous person seeks advice, frequently from many confessors, he tends to follow his own judgment. He is inclined to think that the confessor has not understood him, that he has not given a complete picture of his state of soul, etc. (b) Inconstancy in acting owing to inability to judge rightly and the consequent frequent changes of judgment for light reasons. (c) Irrelevant accusations of multiple circumstances that tend to lose the sin in the maze of circumstances. (d) External motions by which the individual tries to do away with the fear, sin, or other difficulty. 617. Causes of a scrupulous Conscience.--Although the signs of scrupulosity are easily recognizable, the causes are not clearly defined, and authors are not entirely agreed in this matter. A listing of probable causes would include internal causes: (a) physical--the physical causes are virtually unknown. Most authors admit a constitutional disposition to scrupulosity, just as there is one to its quasi-genus, psychasthenia. Reductively this might involve disorders in the vago-sympathetic nervous system and the neuro-endocrine system. (b) psychical--the cause is attributed to too low a psychic tension. The inability to cope with obsessions and the attacks of phobias serve to exhaust the individual; (c) moral--perhaps a suspicious and melancholy character, a disposition that is overly impressionable and changeable, or a self-opinionated nature, overconfident of its own ability.