CMHD

Obsessive-Compulsive Disorder

Cultural Competency in the Treatment of OCD

In directing ourselves toward a multiculturalist and anti-racist orientation, it is important to appreciate that our research and clinical perspectives emanate primarily from a Western perspective. This means that the theoretical framework, explanatory models, and research procedures undertaken to gain the knowledge follow from this frame of reference. It should be noted that other cultures may have different explanatory models in regard to mental health, and specifically OCD, and as such, may not completely accept a cognitive-behavioural therapy (CBT) conceptualization of how OCD is maintained or how to alleviate it.

It is essential that clinicians recognize that clients may be members of communities that are marginalized and stigmatized due to race, ethnicity, culture, and/or religion. This means they experience discrimination, reduced opportunities, and limited access to a society’s resources, including medical care. This may pose additional difficulties that need to be addressed in treatment. Clinicians must acknowledge and counteract personal biases through introspection and consultation if they are to become culturally competent. It is also integral that clinicians recognize many clients’ experiences of compounded stigma from both having OCD and being part of a racialised community that experiences oppression and mistrust of the mental health system as oppression, stereotype threat, and stereotype compensation have the potential to contribute to obsessional content and associated compulsions.

Standardized OCD assessment measures do not examine these factors adequately and are often not validated on diverse populations. As such, they may be inadequate for assessing diverse populations and may have the propensity to either over- or under-diagnose OCD symptoms. Clinicians should therefore use culturally validated measures, and when this is not possible, should consider the accuracy of test results and communicate such findings with caution.

Diverse clients may utilise many different avenues to find help for their OCD. Common examples of alternate help-seeking behaviours among various cultural groups can be summarised as follows:

  • Alternative healing methods (e.g., herbal medicine, acupuncture)
  • Family and community advice and support
  • Religious and spiritual sources of support
  • Traditional or folk healers, clergy
  • Engagement through primary care
  • Use of emergency room services

Of course, we should not forget that many people racialized people do seek help from professional therapists and counsellors, and may still not find help for their OCD due to a shortage of mental health professions trained to treat OCD, which is likely to be even more so in communities of colour.

One way treatment providers can increase client comfort and engagement is through community consultations, accessible psychoeducation, transparent dialogue, and involvement of diverse and culturally competent staff. In recruitment notices and exchanges with diverse communities, mistrust and fear surrounding engagement in research and treatment should be acknowledged. Offering treatment at flexible times, situating treatment at accessible locations, and creating welcoming spaces for family and close others in-session and in treatment waiting rooms can also offset many barriers. The importance of family to a client should be respected and may be demonstrated through involving family in consultation and psychoeducation about OCD, as well as providing information about the harms of family accommodation. Family can also be an integral component of treatment when desired.

Clinicians should be open to adapting conventional therapeutic approaches and integrating treatment approaches, which are cognizant of the client’s values. Differentiating experiences of OCD from normative cultural and religious experiences may involve consultation with community leaders and religious/spiritual healers, education on cultural experiences, peer consultation with multicultural clinicians, and consideration of the distressing and impairing nature of the behaviour. Such collaboration ensures that exposures do not violate religious, spiritual, or cultural norms. We also advise clinicians to respect and integrate clients' models of attribution for their OCD symptoms and the importance of collaborative support with religious and traditional healers.

OCD

What Is Obsessive-Compulsive Disorder?

OCD is a severe, disabling disorder, characterized by the presence of obsessions and compulsions, where obsessions are unwanted and distressing thoughts, images, or impulses, and compulsions are repetitive behaviours intended to reduce distress associated with obsessions. A person with OCD may suffer from a variety of symptoms; however primary dimensions of OCD symptoms include contamination and cleaning, symmetry and ordering or arranging, doubts about harm and checking, and unacceptable thoughts and mental rituals.

People with OCD have heightened rates of other mental health disorders such as major depression, eating disorders, substance use disorders, and anxiety-related disorders, as well as poor physical health. As such, they experience a lower quality of life across important functional domains such as leisure, relationships, work, and educational activities. OCD is found across race, ethnic group, and nationality, and it is estimated to afflict approximately one in sixty individuals over their lifetimes.

Related Publications

Williams, M. T., Rouleau, T., La Torre, J., & Sharif, N. (2020). Cultural competency in the treatment of obsessive-compulsive disorder: Practitioner Guidelines. Cognitive Behaviour Therapist, 13, e48. doi: 10.1017/S1754470X20000501

Pinciotti, C. M., Smith, Z., Singh, S., Wetterneck, C. T., & Williams, M. T. (2022). Call to action: Recommendations for justice-based treatment of obsessive-compulsive disorder with sexual orientation and gender themes. Behavior Therapy, 53(2), 153-169. https://doi.org/10.1016/j.beth.2021.11.001

Sookman, D., Phillips, K. A., Anholt, G. E., Bhar, S., Bream, V., Challacombe, F. I., Coughtrey, F. L., Craske, M. G., Foa, E., Gagné, J. P., Huppert, J. D., Jacobi, D., Lovell, K., McLean, C. P., Neziroglu, F., Pedley, R., Perrin, S., Pinto, A., Pollard, C. A., Radomsky, A., Riemann, B., Shafran, R., Simos, G., Söchting, I., Summerfeldt, L. J., Szymanski, J., Treanor, M., Van Noppen, B., van Oppen, P., Whittal, M., Williams, M. T., Williams, T., Yadin, E., & Veale, D. (2021). Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Research, 303 (113752), 1-54. https://doi.org/10.1016/j.psychres.2021.113752

Leins, C., & Williams, M. T. (2018). Using the Bible to facilitate treatment of religious obsessions in obsessive-compulsive disorder. Journal of Psychology and Christianity, 37(2), 112-124.