Culture & Diversity in OCD

Obsessive Compulsive Disorder (OCD) doesn’t discriminate. It can affect any person regardless of age, race, gender, culture, ethnicity, or socioeconomic status. Research indicates that it takes an average of 14-17 years from the onset of symptoms for an OCD sufferer to receive an appropriate diagnosis and access effective treatment. However, the odds are likely greater for ethnic and racial minorities given persistent societal stigma and existing cultural barriers to mental health treatment. In fact, according to findings by the Surgeon General, large-scale mental health research involving racial and ethnic minorities is staggeringly lacking, which has resulted in disparities between existence of effective treatments and access to quality mental health services in minority populations.

BARRIERS TO TREATMENT

Since effective, evidence-based OCD treatments exist, why is it such a challenge for minorities to get the healthcare needed to prevent unnecessary suffering?

Barriers to Obtaining OCD Treatment in the General Population:

Fear of social stigma.

Lack of accurate public awareness.

Insufficient OCD specialists in local communities.

Inadequate mental health training in healthcare professionals.

Treatment costs and lack of insurance coverage.

Added Barriers for Minorities with OCD

Cultural stigma of perceived weakness or being labeled as “crazy”.

Distrust of healthcare professionals.

Discrimination, racism, and bias in healthcare settings.

Reliance on alternative support (i.e., religion, traditional healers, cultural rituals, etc).

Language & communication barriers.

Transportation challenges.

Difficulty finding childcare.

Inability to take time off work for fear of losing job.

Insufficient culturally competent treatment providers.

A mental health system weighted heavily towards non-minority values and culture norms.

CULTURAL STIGMA

Stigma in general tends to be the most significant emotional barrier to mental health treatment. Though, various racial and ethnic cultures may hold different perceptions and meanings about mental illness. Some groups practice emotional restraint and prefer to not dwell on uncomfortable thoughts and be perceived as weak. Other groups associate mental illness with a lack of spirituality and rely on religion to reduce their suffering. Although different stigma exists for each individual culture, there are a few common ones within specific minority groups. Of course, this by no means include all of the cultural variations and infinite spectrum of subgroups that exist in the US and around the world.

African-Americans

Mental illness is a punishment from God.

Shame and personal weakness is associated with emotional distress.

Seeking help reflects spiritual or moral frailty.

Perseverance and resilience is prioritized through self-reliance.

Having strong religious faith heals a sufferer’s soul.

Mental health providers are to be distrusted.

Latin-Americans

Mental illness is caused by sin or a lack of faith that can be cured by prayer.

Machismo – Emotional distress is a sign of weakness and must not be displayed.

“Loco” or “Locura” – Being labeled as crazy by family and others.

“Nervios” – Being labeled as nervous or anxious by family and others.

Mental health topics are ostracized where family members tend to refuse to acknowledge it.

Mental illness is influenced by evil spirits or a parent’s wrongful actions.

Asians-Americans

Mental illness is caused by emotional disharmony or evil spirits.

Problems are related to wrongdoings committed in a past life.

The value of collectivism discourages open displays of emotions for the benefit of social and familial harmony.

Saving face – Individuals must not appear weak and maintain a proper public appearance.

Mental illness reflects poorly on family pedigree.

Individuals are expected to suffer in silence or bring shame to the family’s reputation.

Middle-Eastern-Americans

Mental illness is viewed as a punishment from God and results in being possessed by evil spirits.

“Evil Eye” – Evil in objects are transferred into the sufferer.

Family is central support system rather than relying on outside sources.

Privacy maintains honor and family reputation.

Emotional distress is permitted as physical symptoms.

Mental illness brings shame and disgrace to the family.

REDUCING CULTURAL ROADBLOCKS TO OCD TREATMENT

In order to reduce stigma overall, we need to empower those who are suffering to eliminate the negative perception and educate our communities about OCD and its evidence-based treatment. When there are at least 1 in 100 adults and 1 in 200 children diagnosed with OCD in the US alone, and many more undiagnosed or misdiagnosed, there are millions of sufferers and family members afflicted by this condition. Despite the lack of awareness and understanding of OCD, imagine if we all came together and spoke out about it without shame, embarrassment, or judgment, how that will affect our society to bring change.

To improve access to OCD treatment in minority populations, there are several factors to include:

Remove the language & communication barrier by increasing the number of OCD providers who speak the individual’s native language and can interpret cultural nuances and various jargon appropriately.

Increase the number of diverse OCD specialists with similar cultural, racial, or ethnic background to increase the trust and acceptance of treatment by the sufferer.

Provide cultural diversity training to OCD treatment providers to improve cultural humility, competency, sensitivity, and understanding when engaging with a patient from a different racial or ethnic population.

Raise awareness in various racial and ethnic groups about the physiological and biological roots of OCD and the value of evidence-based CBT/ERP treatment to reduce cultural stigma.

Inform and collaborate with religious leaders and places of worship to encourage sufferers to seek mental health treatment.

Educate and include family members into OCD treatment to increase their support, minimize shame, embarrassment, or guilt, and eliminate unhealthy family accommodations.

Involve racial and ethnic minorities in mental health organizations, education, and legislation to change cultural attitudes and mistaken beliefs about OCD and improve access to quality OCD treatment.