How many times have you heard the phrase - “Oh, that’s because I have OCD” - being used by people around you? I have witnessed this and thus felt that a lot of people misunderstand the gravity of having this mental health disorder and regard it as a condition that they have simply when they tend to be organised and neat. Obsessive-Compulsive Disorder (OCD) is a chronic mental health condition that mainly involves persistent, intrusive, unwanted thoughts that cause a person distress (obsessions) along with repetitive behaviours or mental acts (compulsions) that are performed to reduce being preoccupied with these obsessions temporarily. While OCD is a mental health disorder that is recognized universally, cultural contexts influence how the symptoms of OCD are manifested, perceived, and then treated or tended to. Many factors, such as the place where a person has been raised and the values or religious systems that have been followed, affect the kind of obsessions and compulsions that a person develops.
A study that explored the cultural manifestations of obsessive-compulsive disorder reported that there were differences in OCD symptomatology that come from religious as well as regional differences. Presented here as an example, the Christian samples in their study most often reported symptoms that pertained to obsessions with contamination and thought control. Moreover, Western studies provided results with symptom dimensions that grouped around a four or five-factor model, with prominence on contamination/ cleaning, hoarding, symmetry/ ordering, taboo thoughts/ mental compulsions, and doubt/ checking. Themes that catered to contamination and pathological doubt were emphasized in the Indian samples. Not only this, gender differences across the dimensions of symptoms were also found within the Indian samples. Male participants reported sexual and symmetry obsessions along with checking and bizarre compulsions. Conversely, female participants reported symptoms that were concerned with cleanliness (dirt, contamination, cleaning).With reference to the disorder’s universal recognition mentioned earlier, the study supported this aspect and found some cross-cultural similarities along with the mentioned differences. The fear of contamination, which was outwardly shown as a compulsion to wash hands, was prevalent in many cultures. Taken together, it can be derived that although the disorder that a patient is diagnosed with can be the same (OCD in this case), the kind of obsessions and resulting compulsions can come largely from the culture that they have lived in and embodied.
For understanding what is required to ensure a successful treatment of OCD, cultural competency has been studied. The study carried out for the same pointed out that standardized measures for the diagnosis of OCD do not cater to people of diverse populations. As a result, there isoften over- or under-diagnosis ofOCD symptoms. It is needless to say how such a misdiagnosis will further hamper the prognosis that is to be employed for the person with this mental health disorder. Furthermore, the study outlined that due to preconceived notions - that possibly stem from the cultural beliefs one has - clients with OCD tend to make use of alternate treatment systems that keep therapists at bay. Two of the examples of such systems involve turning to religious and spiritual sources of support and engaging through primary health care. That being said, it was also recognized and acknowledged that due to a paucity of mental health professionals trained to treat OCD, many people (especially from the communities of colour) may not be able to receive help from them in the first place . A possible solution that might prove to be beneficial in alleviating the adversities of a lack of appropriate treatment for OCD would involve understanding culturally relevant factors for the incoming clients by consulting with religious leaders and clinicians who may be coming from multicultural backgrounds.
A more specific study that examined the help-seeking intention in OCD and understood the predictors and barriers in South Africa, brought forward results about the most frequent help-seeking barriers being (1) wanting to handle the problem independently, (2) treatment concerns, (3) lack of finances, and (4) embarrassment and shame factors. Inadvertently, as it was seen in other places, this caused delays in accessing a lucrative method of treatment on the part of the clients. The results indicated that the barriers came from the individual or psychological domain. Thus, what can be inferred from this finding is that the factors that act as barriers for help-seeking come from inner, thought-related apprehensions that clients have rather than practical difficulties that can be found in the environment outside. Mitigation effects that target the aforementioned kind of barriers, by improving literacy for mental health, are therefore essential to push more clients towards treatment that can help them manage the symptoms of OCD.
With all the information presented above, it is safe to say that even mental health disorders that have global recognition are to be viewed with a cultural lens that pertains well to the individual clients. The phrase and the idea of ‘one-size-fits-all’ is to be rejected completely when understanding the symptoms of OCD. Not only this, but other predispositions of a client towards the disorder, and the subsequent method of treatment that is to be used for it, need to be understood thoroughly and tailored carefully, respectively. They need to meet the needs of the individual client after the gathering of substantial and relevant information about their holistic cultural background.
Prisha Agrawal
