Journal of Social and Clinical Psychology 29(8): 930-944 Perceptions of psychological symptoms may be influenced by religiousness, particularly when symptom presentation is shaped by a socio-religious context. We therefore examined whether among Jews, Orthodox affiliation was related to recognition of scrupulosity as obsessive compulsive disorder (OCD). Seventy Orthodox and 23 non-Orthodox Jews were randomized to view one of two matched vignettes describing religious or non-religious OCD. Whereas Orthodox Jews were equally likely to recognize both vignettes as OCD, non-Orthodox Jews were less likely to recognize the religious than the non-religious presentation as OCD. Furthermore, Orthodox Jews were equally likely to recommend professional treatment for both scrupulosity and non-religious OCD, whereas non-Orthodox Jews were less likely to recommend professional treatment for scrupulosity compared to non-religious OCD. These findings may suggest that familiarity with Orthodox practices increases sensitivity to distinctions between scrupulosity and normative religion, thereby increasing recognition of the need for professional treatment.