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Be sure to differentiate between OCD, cultural differences.

MIAMI -- African Americans significantly outscore whites on several popular obsessive-compulsive disorder measures because of cultural differences in beliefs about hygiene and contamination from animals, according to a poster presentation at the annual conference of the Anxiety Disorders Association of America.

Given those findings, African American patients should be carefully interviewed to differentiate between true obsessive-compulsive disorder (OCD) and cultural differences, said Monnica Williams, who is a researcher in the department of psychology at the University of Virginia, Charlottesville.

Ms. Williams and her colleagues administered four common OCD instruments to 1,010 nonclinical university students and members of the Charlottesville community.

There were 789 whites and 221 African Americans, after excluding people with an OCD diagnosis, those uncertain of their OCD status, other minorities, and respondents who left more than 15% of items blank.

The measures used were the Maudsley Obsessional-Compulsive Inventory (MOCI), the Padua Inventory (PI), the Obsessive-Compulsive Inventory (OCI) short instrument, and the Multiethnic Identity Measure (MEIM).

The investigators questioned participants about attitudes regarding health, hygiene, pets, and cultural mistrust.

They correlated those items with anxiety scores and ethnicity.

Previous research identified some differences by ethnic group, but those findings did not correlate the findings to cultural or ethnic attitudes.

In one study, African Americans were more likely than white Americans to endorse cleaning and washing items on the MOCI, PI, and OCI scales. In another trial, the MOCI was not predictive of OCD in African Americans.

"When we first stumbled across this, we did sophisticated statistics," Ms. Williams said.

"When African Americans were brought in for structural interviews, they had no more symptoms."

Therefore, Ms. Williams and her colleagues wanted to see whether a potential bias existed in these instruments.

"With MOCI, we could be getting a reading of cultural attitudes, not OCD. Some of the questions regarding cleanliness or animals might be more related to social behaviors."

For example, African Americans are less likely to own animals, according to Kimberly Decker, who is also a researcher in the psychology department at the University of Virginia.

"We found big differences in these scores," Ms. Williams said.

Specifically, there were significant black-white differences on the contamination/washing subscales of the MOCI, PI, and OCI measures.

The mean score on the MOCI subscale was 10.47 for blacks and 8.83 for whites.

On the PI, the means score was 12.49 for blacks and 7.83 for whites.

And on the OCI, the means score was 3.02 for blacks and 1.64 for whites.

"We would encourage clinicians to be aware of this," Ms. Decker said. "Some of the questions on the OCD tools may be more a result of cultural attitudes than OCD."

Pathologic worry and pathologic contamination anxiety did not have an ethnic bias, which suggests that those factors might be more indicative of actual OCD, Ms. Decker said.

Ms. Williams said she hopes the study findings lead to the development of instruments that are more culturally sensitive for diagnosing OCD.

"We would like to come up with a measure that is free of these ethnic biases, and make sure it works for whites, African Americans, Asian Americans, and Hispanics," Ms. Williams said.


Miami Bureau
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Title Annotation:The Psychiatrist's Toolbox; obsessive-compulsive disorder
Author:McNamara, Damian
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Aug 1, 2004
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