OCD in African Americans

Characteristics of OCD in African Americans

People with OCD often deal with a variety of obsessions. African Americans in particular typically deal with obsessions involving cleanliness or “unacceptable” violent and sexual thoughts. [1] You can see how these obsessions are associated with undesirable stereotypes sometimes aimed at people of color — African Americans have historically been labeled as less clean and “violent or sexually deviant.” [1]

Those who have obsessions related to cleanliness/contamination OCD usually have fears surrounding contracting a virus, being poisoned, or getting ill (via blood, sweat, or even in a magical way — bad numbers or clothing worn at a funeral, for example). Common compulsions in African Americans who suffer from OCD include things like repetitive cleaning, repetitive checking, avoiding certain people or places that they consider to be “contaminated,” and rituals (prayers, etc.) to neutralize perceived (sometimes described as “magical”) contamination. [2]

African Americans who suffer from violent/sexual OCD can have obsessions/fears that revolve around sexual orientation, pedophilia, or running someone over with a car.” [3] The compulsions include: driving around the block numerous times to ensure they have not hurt anyone, looking at a specific type of pornography to assess whether they are gay/straight/bi, or even avoiding children at all costs.

In addition to contamination OCD and violent/sexual OCD, there are some other types of OCD and OCD-related behaviors commonly experienced by African Americans:

  • Symmetry/perfectionism: fear of doing something wrong and the need to have things “just right,” fearing harm will come to loved ones if things aren't done perfectly, and wanting things to be correctly aligned. Compulsions can include arranging or rearranging things, seeking reassurance, procrastinating on assignments for fear of making a mistake, etc. [4]
  • Hoarding disorder: This is a mental health disorder where people have difficulty getting rid of possessions that are no longer useful. Hoarding symptoms also include experiencing great distress when having to let go of collected items, and excessive clutter that results in unlivable living spaces. Unfortunately, African Americans who struggled with both OCD and hoarding behaviors tended to earn less money, have lower levels of educational attainment, and are more likely to rely on a spouse/partner for financial support than those without hoarding symptoms. [5]
  • Animal contamination: Research among African Americans with OCD also shows a significant concern with animal contamination. This concern with animal contamination may be related to historical events (i.e., dogs being used to hunt slaves as well as attack civil rights protestors). [6]

These are some subtypes of OCD that may be more common in African Americans, but OCD does not discriminate: it can appear in many different forms. Click here to learn more about OCD and its subtypes.

What does the research say about African Americans with OCD?

African Americans experience OCD at the same rates as those in other racial and ethnic groups, but face significant and unique barriers to accessing treatment. Many African Americans with severe OCD symptoms do not seek or receive potentially life-changing treatment.

OCD Treament

  • African Americans are less likely to receive treatment for their OCD [7]
  • African Americans with OCD may be underrepresented in residential and intensive outpatient treatment programs. [8]
  • Forty percent of African Americans with severe OCD do not seek treatment8, compared to 7% of the overall US population with severe OCD. [9]
  • African Americans face unique barriers to treatment when compared to White Americans: they are less likely to know where to go for help, may be less comfortable discussing their symptoms with a clinician, and a significant percentage are concerned about racial discrimination. [10] [11]
  • Fears about involuntary hospitalization are also common. [12]
  • African Americans are more likely to be concerned about encountering discrimination in the healthcare system than white americans, and are more frequently uncomfortable with the idea of sharing their problems with a clinician [13]
  • African Americans tend to prefer receiving care from an African-American therapist. [14]
  • African Americans are underrepresented in key parts of the mental health workforce (e.g., only 5% of psychologists are African American, while 13% of the population of the US is African American). [15]
  • Low-income African Americans who rely upon the community health system may find that few clinicians in this system are trained to properly recognize or treat OCD. [10]

OCD Research Participation

African Americans are among the racial and ethnic groups that are broadly underrepresented in OCD research conducted in North America. [16] Beyond issues of basic equity, this disparity has real consequences for people who need OCD treatment. Underrepresentation of certain racial and ethnic groups in OCD research calls into question the “generalizability” of what research studies discover. If the studies do not include everyone, we can’t be sure if the results – and the treatments based on those results – truly apply to everyone.

  • A review of clinical trials — the types of research studies used to determine whether new treatments for OCD are safe and effective — found that less than 2% of participants in these studies were African American. [11] By comparison, 13% of the population of the United States is African American [17]
  • We know that these disparities aren’t because African Americans experience OCD at lower rates. Research has confirmed that African Americans experience OCD at the same rate as others.
  • Prominent historic examples of abuses by research scientists against African-American research participants contribute to contemporary fear and mistrust. [18]
  • It is possible to recruit a representative number of African American participants for OCD research studies, but researchers must prioritize their recruitment efforts and carefully choose the most effective means of outreach. [19]

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Sources:

  • [1] Williams, M. T., Taylor, R. J., Himle J. A., & Chatters, L. M. (2017). Demographic and health-related correlates of obsessive-compulsive symptoms among African Americans. Journal of Obsessive-Compulsive and Related Disorders, 14, 119-126.
  • [2] Penzel (2018). Obsessive Compulsive Disorder Contamination Fears. Retrieved from: https://iocdf.org/wp-content/uploads/2018/06/Contamination-Fact-Sheet.pdf.
  • [3] Penzel (2010). Violent and Sexual Obsessions. Retrieved from: https://iocdf.org/wp-content/uploads/2014/10/Violent-Obsessions-Fact-Sheet.pdf
  • [4] Williams, M. Debreaux, M. (n.d). Retrieved from: https://iocdf.org/expert-opinions/african-americans-with-obsessive-compulsive-disorder-black-lives-matter/
  • [5] Williams, M. T., Brown, T., & Sawyer, B. (in press). Psychiatric comorbidity and hoarding symptoms in African Americans with obsessive-compulsive disorder. Journal of Black Psychology.
  • [6] Hatch, M. L., Friedman, S., Paradis, C. M. (1996). Behavioral treatment of obsessive- compulsive disorder in African Americans. Cognitive and Behavioral Practice, 3(2), 303-315.
  • [7] Himle, J. A., Muroff, J. R., Taylor, R. J., Baser, R. E., Abelson, J. M., Hanna, G. L., Jackson, J.S. (2008). Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: Results from the national survey of American life. Depression and Anxiety, 25, 993- 1005.
  • [8] Williams, M. T., Sawyer, B., Leonard, R. C., Ellsworth, M., Simms, J. V. & Riemann, B. C. (2015). Minority Participation in a Major Residential and Intensive Outpatient Program for Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive & Related Disorders, 5, 67-75. doi: 10.1016/j.jocrd.2015.02.004
  • [9] Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63.
  • [10] Williams, M. T., Domanico, J., Marques, L., Leblanc, N. J., & Turkheimer, E. (2012). Barriers to treatment among African Americans with obsessive-compulsive disorder. Journal of anxiety disorders, 26(4), 555–563. https://doi.org/10.1016/j.janxdis.2012.02.009
  • [11] Williams, M. T., Debreaux, M. (2016). African Americans with Obsessive-Compulsive Disorder: Black Lives Matter. OCD Newsletter, 30(1), 24-27.
  • [12] Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color.Journal of the National Medical Association, 99(8), 879–885.
  • [13] Williams, M.T., Elstein, J., Buckner, E., Abelson, J., & Himle, J. (2012). Symptom Dimensions in Two Samples of African Americans with Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive & Related Disorders, 1(3), 145-152. Doi: 10.1016/j.jocrd.2012.03.004
  • [14] Malat, J., Purcell, D., & van Ryn, M. (2010). Factors affecting Whites’ and Blacks’ attitudes toward race concordance with doctors.Journal of the National Medical Association, 102(9), 787-793.
  • [15] Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color.Journal of the National Medical Association, 99(8), 879–885.
  • [16] Williams, M., Powers, M., Yun, Y. G., & Foa, E. (2010). Minority participation in randomized controlled trials for obsessive-compulsive disorder.Journal of anxiety disorders, 24(2), 171–177. https://doi.org/10.1016/j.janxdis.2009.11.004
  • [17] US Census, 2019 .https://www.census.gov/quickfacts/fact/table/US#
  • [18] Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color.Journal of the National Medical Association, 99(8), 879–885.
  • [19] Williams, M. T., Proetto, D., Casiano, D., & Franklin, M. E. (2012). Recruitment of a hidden population: African Americans with obsessive–compulsive disorder.Contemporary Clinical Trials, 33(1), 67-75.