A Wayward Trajectory in Biblical Counseling: A Critical Review

Lucy Ann Moll is the author of "Overcoming Taboo P-OCD: A Faith-Filled Way to Respond to Horrific Intrusive Thoughts About Children," which had formerly been published at the Biblical Counseling Coalition (BCC) blog until it was removed "for further editorial review." This article was likely removed due to the response it generated, as it evidences a tremendous lack of discernment and features a litany of unsupported assertions and unbiblical conclusions. However, some of the more fundamental assertions of the removed article are present in Moll's 2018 article entitled "Biblical Counseling and OCD." This essay critically reviews Moll's available article on OCD and demonstrates that the same errors are present therein.

Moll uncritically adopts the taxonomy of obsessive-compulsive disorder and repeatedly uses the acronym "OCD" not as a description of a set of behaviors, but as a brain disease. For example, she notes, "a person with OCD typically feels compelled to ease their anxiety through performing a compulsion." OCD refers to recurrent thoughts that the individual has sought to cease and repetitive activity owing to these thoughts.[1] Subsequently, Moll's statement is tautological since OCD is not the identification of a pathology but a description of behaviors, namely, obsessive thoughts and related compulsions. My point here is that Moll has tipped her hand that she has accepted the secularist trope that OCD and similar behaviors are actually owed to a physiological problem. Indeed, Moll goes on to claim:

OCD has a strong physiological basis. Among the scientific evidence are twin and family studies that show people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. But the most important physical component is the brain itself. By using Positron Emission Tomography (PET), researchers have discovered intriguing differences between the brains of people with OCD and other people.

There are three problems with Moll's attempt to turn a set of behaviors into a brain disease. First, one must substantiate the claim that observable differences in the brain either cause or meaningfully contribute to the behaviors of OCD. There is a complete lack of supporting evidence to suggest that OCD is a brain disease: "There is no appropriately validated algorithm that can be used to diagnose OCD based on a brain scan."[2] There is no evidence that OCD is congenital [3], and there is no evidence that OCD is owed to defective brain chemistry (e.g., serotonin levels) [4]. Second, because Moll's assertions assume causality rather than mere correlation, she commits the post hoc ergo propter hoc fallacy. Third, although she never cites any biological pathogenesis, Moll has claimed that OCD "has a strong physiological basis," and has therefore implied that there is no human responsibility for the behaviors described as OCD. That is, if OCD has a pathological basis, the sufferer is no more responsible for the relevant behaviors than the childhood cancer patient is for his illness. However, Moll insists that OCD is "an anxiety problem." This assertion seems to imply that anxiety is similarly owed to pathology. Since anxiety is contrary to the command of Christ (Matt. 6:25-34), it is a sin, and subsequently, Moll has no meaningful basis to suggest that either anxiety or OCD are amoral physiological phenomenon.

The issue of responsibility is an especially pertinent subject since Moll's "P-OCD" article omits any reference to one's responsibility before God for pedophilic thoughts. The Bible explicitly commands God's people to sanctify their thoughts (e.g., Eph. 4:17-24). Sinful thoughts originate in the heart (Mark 7:21), and while those who engage in them may be horrified or conflicted, they are inherently responsible and must subsequently pursue repentance and renewed allegiance to Christ through the means of grace.

In another article entitled, "What Is Taboo OCD? When Intrusive Thoughts Attack What You Value Most," Moll argues that intrusive thoughts about engaging in sodomy, pedophilia, incest, or violence are not "spiritual failure[s]." Rather, she argues, "It is anxiety misfiring—tagging a random thought as a threat and demanding certainty where none exists." Anxiety, however, is a sinful behavior and not an autonomous phenomenon. Thoughts about engaging in sexual degeneracy are themselves sinful: "Everyone who looks at a woman with lustful intent has already committed adultery with her in his heart" (Matt. 5:28). Thoughts about engaging in violence are also sinful (Matt. 5:21-22). Rather than pass these thoughts off as autonomous and amoral anxiety, Scripture teaches that we ought to recognize the evil of such thoughts, repent, and overcome evil with good by thinking about what is true, right, holy, and good (Rom. 12:21; Phil. 4:8).

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1. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC and London, UK: American Psychiatric Pub., 2013), 237-42. Cf. Supplement to Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Text Revision (Washington, DC and London, UK: American Psychiatric Pub., 2024), 263-71.

2. Jon E. Grant, Samuel R. Chamberlain, "Exploring the neurobiology of OCD: clinical implications," Psychiatric Times, last modified March 2, 2020, https://www.psychiatrictimes.com/view/exploring-neurobiology-ocd-clinical-implications.

3. See Pauls' study in which he notes that while "numerous candidate gene studies have been reported for OCD," "none have been demonstrated to achieve genome-wide significance." David L. Pauls, "The Genetics of Obsessive Compulsive Disorder: A Review of the Evidence," American Journal of Medical Genetics 148c (2018): 137.

4. See the findings of Jalal et al.: "The role of serotonin, dopamine and glutamate systems...remains inconclusive." Baland Jalal, Samuel R Chamberlain, Barbara J Sahakian, "Obsessive‐compulsive disorder: Etiology, neuropathology, and cognitive dysfunction," Brain and Behavior 13, no. 6 (2023): 10.