Barriers Faced by People With OCD in Seeking Help: Dissecting a Qualitative Study
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Title: Seeking help for obsessive compulsive disorder (OCD): a qualitative study of the enablers and barriers conducted by a researcher with personal experience of OCDCitation: Robinson, Karen J., Diana Rose, and Paul M. Salkovskis. “Seeking help for obsessive compulsive disorder (OCD): a qualitative study of the enablers and barriers conducted by a researcher with personal experience of OCD.” Psychology and Psychotherapy: Theory, Research and Practice 90, no. 2 (2017): 193-211.
Obsessive Compulsive disorder affects people diagnosed with it to the point of delaying professional help. This article covers a qualitative study that provides the factors or rather the barriers that deterred people suffering from OCD from seeking professional help and positive enablers that made them eventually seek professional help. This content may inform OCD awareness campaigns conducted by HCPs or how HCPs can speak to patients in order to counter the barriers faced by people with OCD in seeking treatment, thus promoting help-seeking behaviour.
SynopsisAim: To identify the barriers in seeking treatment for OCD and the factors that push people to seek help for their OCD.Results section organized as:Factors that caused people to delay seeking help for their OCD “Internal / cognitive factors” that caused people to delay seeking professional help Concerns related to GP / treatment Positive enablers that led them to seek professional help eventually 
Prominent themes identified 
Theme 1: Factors that caused people to delay seeking help for their OCD
Participants feared stigma in relationships and in other contexts.
Hiding OCD from other people due to fear:“Nobody knows – nobody had ever known I had it . . . And you don’t want people to know.” 
Only opening up when participant got really sick:“But you know all through this time my family … didn’t really know anything that was going on. Then I did take sick leave. Obviously, I had to sort of let them know.  And then that was the first time in my life that I told them.”
Participant not knowing what OCD was.Feeling embarrassed about having OCD:“I felt embarrassed as well about it, cause I didn’t understand why I wasdoing it. That’s one of the main reasons why I delayed for so long because I was embarrassed.” Fear of criminalisation. Participants feared that their intrusive thoughts makes them a “criminal”.
“Oh … I really thought that if I told them what I was thinking that I’d be either sectioned or sent to prison … Really, that was like the scariest thing …I don’t think anyone wants to be sectioned or sent to prison, do they? … So that’s why.  I just thought …other people would think, ‘Oh my God’, you know, ‘What a monster’.  That’s why I never told anybody.”
Theme 2: “Internal / cognitive factors” that cause people to delay seeking professional help 
People’s internal appraisals and state of their OCD delayed treatment.Participants felt that their OCD was manageable: “It didn’t affect me enough” “I think for a long time I felt maybe I could deal with it myself.  I felt I wanted to deal with it myself.”
Participants felt that their OCD was not significant:“He immediately referred me and I was so surprised because I thought what I told him was not of much significance.”
Participants were reluctant to admit their OCD was a problem.“But I think maybe it was just kind of, if we don’t focus on it, it will go away. If wepretend it’s not happening, it’s not really there …”“Suppose you also don’t know how different things can be, if you do get the right advice and treatment …cause that’s what, that’s the only thing you’ve ever experienced.”  Participants were vulnerable to share their issues with the doctor. 
Theme 3: Factors related to GP / treatment that acted as barriers to seeking help
Participants were sceptical on whether the doctor knew what the problem was. Participant only went to the doctor after not knowing what the problem was.“I suppose, yeah, doubting whether the doctors would know what it was and be able to help, would have been one of those compounding factors.”  Participants were concerned about the GP’s reaction prior to consultation.“I didn’t know what it would be like and I suppose what they would think.” The participant was concerned about the treatment in treating their OCD.Participants were reluctant on trying medications as part of their treatment: “You don’t know whether they’re going to give you medicines, and you know, thatmight seem a bit of a sledgehammer to crack a nut.” Participant reluctant to undergo CBT as part of therapy“I think in a sense … not having to go through thehard process of CBT … not having this long process of getting better.”
Theme 4: Positive enablers that led them to seek professional help eventually 
Participants were supported by loved ones to seek treatment. Mother of participant encouraged treatment:“She had said you must have treatment. There’s treatment out there … she kept on, I mean it was over a period, for about a year she kept on at me … but you know every time she mentioned it, I wouldn’t talk about it … I’d brush it off. I’d be so, so horrendously embarrassed … but it was through her pushing me … to do something about the OCD. There could be something done about it. I wasn’t aware of treatment till she started telling me.” 
Four participants were supported by OCD website forum members:“I can remember writing on the forums on the websites, saying, you know, I’m going to the GP and … everyone thought, ‘Oh, well done’. You know. ‘You’ll be fine’. ‘Don’t be scared’. And getting loads of replies back.” Reaching crunch point, participants went for treatment. Participant contemplated ending life by overdosing. “I got to another stage where, um, the head wasn’t coping again, and I was getting extremely depressed. The only reason I went to the doctor in the first place was I left my [partner] a note … and I’d been drinking one night, and left [her/him] a note, ‘I want to die’. I couldn’t cope. And I thought I wanted to take an overdose. So my [partner] took me to see my doctor. Which was a good thing.” Participants related to the news by the media.The participant was relieved that she could relate to the lady on the television that also had OCD.“I seen that lady on the tele … I watched her tell her story and I thought, ‘Oh my God!’ It was just like a revelation! … relief poured down … I wasn’t relieved to find out that I’d got OCD, but I was relieved to find out, you know, I wasn’t going to get sectioned or sent to prison.” Participants had instilled confidence in mental health professionals for recovery. Participant confided in the psychiatrist and felt relief as she could help her:“I was nervous before I went, obviously, um, but I felt that I could do this… I got there and … at that point I sort of crouched, and I was like ‘I’ve got OCD’, and I just burst into tears basically. But she was really good … I was lucky, because she knew a lot about OCD, she knew about treatments … and she was very kind.” Participants sought treatment due to the nature of their thoughts. Participant thoughts involve harm to their children:“And at this stage … I thought my children were in immense danger.” Participant sought treatment to become a better parent: “Firstly for my children … I thought you’ve got to be a decent person.” 
What do these themes mean?Theme 1: Barriers which caused people to delay seeking help 
Stigma affects their relationships with others. 
Theme 2: “Internal / cognitive factors” that cause people to delay seeking professional help 
People not acknowledging the need for treatment for their OCD/ undermining their disease
Theme 3: Concerns related to GP / treatment that acted as barriers to seeking help
Participants thought the GP could not identify the problem. 
Theme 4: Positive enablers that led them to seek professional help eventually 
Being supported by loved ones.Relating to others’ similar struggles. Having confidence in GP and professional treatment. Seeking professional help due to abnormal thought nature. 
Key messages for HCPs relating to OCDIt is important to clarify patients’ misconceptions with their OCD and seeking treatment. Such as, informing how OCD affects a patient’s brain and behavior, as well as benfits of early interventions. The prevalence of OCD in the society can be communicated via OCD awareness campaigns, thereby reducing societal stigma, which is a constant barrier to seeking treatment among patients.Acknowledging the patients’ journey prior to the visit for consultation and being non judgemental is good to foster the trust between the doctor and the patient.


Content from: LAGOM’s Atiqah
Edited by: LAGOM’s Shehani



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