Cultural competence is the ability to understand, appreciate, and interact with people from backgrounds or belief systems different from your own. While cultural competence is necessary to deliver equitable, high-quality care across all facets of health care, it is imperative when treating mental health conditions. Mental health professionals must recognize a person’s culture, beliefs, and values to deliver more effective, personalized treatment plans.

‍

Obsessive-compulsive disorder (OCD) is a complex mental health condition that is often misdiagnosed due to a lack of understanding of the ways that symptoms present. Cultural competency is a necessity in OCD treatment, as symptoms and responses to therapeutic approaches are influenced by a person’s cultural beliefs and values. Incorporating a person’s lived experiences into therapy can increase their willingness to engage in treatment, and ultimately improve outcomes. 

‍

To discuss the impact of cultural competence on obsessive-compulsive disorder, we spoke with NOCD, the world’s leading provider in OCD treatment. 

‍

How does culture impact OCD?

‍

Saraa Lee, MSW, LSCW, a therapist at NOCD, says a person’s culture often defines the way that their OCD symptoms show up. “If I’m a Catholic and believe that the Virgin Mary should be approving of what I do, then that’s more likely to show up in my OCD,” she explains.

‍

Religious (scrupulosity) OCD is a common theme of OCD that is influenced by cultural experiences. People with this subtype may have intrusive thoughts, images, urges, feelings, or sensations (known as obsessions) that go against their religion and morals, leading to feelings of guilt and anxiety. These obsessions can lead to compulsions such as excessive praying, confessing, or engaging in rituals that attempt to relieve distress or neutralize the thoughts.

‍

Cultural influences on OCD beyond religion, such as race, ethnicity, and beliefs, can also shape how symptoms appear. For example, a study conducted in India found that more than 50% of patients with OCD believed supernatural causes led to their condition. 

‍

Another study found that Black Americans are more likely to experience contamination OCD. While the exact reason is unknown, it’s suggested that it could be tied to cultural norms and expectations surrounding cleanliness and hygiene, as well as the impact of discrimination and environmental injustices.

Why building trust is key to reducing stigma

‍

OCD can be difficult for some clinicians to identify. And because of ongoing discrimination within the health care system, a person’s experiences may be overlooked or even dismissed. “Based on my experiences and the conversations I’ve had, OCD is being ignored and seen as paranoia or anxiety,” Lee says. She adds that instead of recognizing persistent, intrusive thoughts as signs of OCD, some clinicians may dismiss them as a simple worry about one specific thing, ultimately missing the bigger picture of what’s going on.

‍

Misunderstandings like these can keep people from seeking exposure and response prevention (ERP) therapy, the most effective treatment for OCD, making trust and cultural competence essential.  

‍

“Culturally competent care takes into account a person’s identities across a variety of axes, incorporating their lived experiences, the hardships they face, and the different biases and systematic exclusion that they’d had within the health care system itself,” explains Kay Nikiforova, MA, Head of Clinical and Research at Violet.

‍

When people feel seen and understood by their clinicians, they’re more willing to engage in treatment and stick to it. This is especially important for ERP, as it requires vulnerability, patience, and consistency.

‍

“There is an element of getting comfortable with acknowledging that a clinician’s identities and privilege may not be the same as the patient’s,” Nikiforova says. “Being able to talk about race, bias, and discrimination without stigma is important because patients can notice when a therapist is nervous to talk about it.”

Addressing challenges to cultural competence

‍

A clinician’s biases, their exposure to different cultures, and their training in recognizing OCD symptoms across cultural perspectives all play a role in people being misdiagnosed, underdiagnosed, or overdiagnosed, Lee explains.

‍

One of the biggest challenges to incorporating cultural competence into ERP therapy is implicit bias. Some clinicians may unconsciously hold stereotypes about certain groups, affecting their ability to screen, diagnose, and treat patients with OCD. For example, a therapist might assume a Black patient’s fears around contamination are rooted in cultural norms around cleanliness, rather than recognizing them as signs of OCD.

‍

Many clinicians don’t receive in-depth training on how culture intertwines with OCD. “We still struggle to have a healthy grasp of what culture means to mental health and in the room when we’re treating people,” Lee explains. 

How to increase cultural competency in OCD treatment

‍

Below are steps OCD therapists can take to improve cultural competency in their therapeutic approaches:

Seek ongoing education

‍

Increasing cultural competency in OCD starts with education. Even if clinicians haven’t received professional training, they can still make an effort to educate themselves. “Pursuing education from clinicians or patient advocates with lived experiences can help them better understand how to serve those communities,” Nikiforova says. 

‍

As part of their in-depth training in treating OCD, NOCD clinicians undergo cultural competence education so they can form strong therapeutic alliances with Members of culturally diverse backgrounds. This includes strategies to identify their own biases, how to use supportive language, and prioritizing strength-based care.

‍

However, cultural competence education is an ongoing process. Lee recommends reading books from different cultural backgrounds to better understand their perspectives. Learning about other people’s lived experiences through conversations, stories, film, or other media offers insights that help clinicians be more empathetic and nuanced in their work.

Practice cultural humility

‍

Humility is another key component of building and sustaining trust in the therapist-patient relationship. Mistakes happen, and if therapists can recognize and acknowledge their wrongdoings, they can avoid breaking a patient’s trust. “If a therapist can maintain cultural humility and be able to say, ‘I said the wrong thing’ or ‘I didn’t know this,’ you can move past it, but it’s on the therapist to be self-aware when they’ve made a misstep,” Nikiforova says.

Let patients lead on their lived experiences

‍

It’s also crucial for an OCD clinician to allow their patient to guide them through their lived experiences and cultural beliefs rather than trying to take the lead. “The patient is the expert on their own experience,” Lee says. “They're not the ERP expert, but they are the expert on what they've been experiencing and what they need.”

‍

No clinician will get it right every time, but a willingness to learn and build trust can make a difference.

Reframing OCD treatment through a cultural lens

‍

Culturally competent care isn’t just about getting an accurate OCD diagnosis, but understanding what recovery looks like for each individual. There’s no single path to treating OCD.

‍

“Mental wellness and thriving look different depending on the person, their lived experience, and culture,” Nikiforova explains. “Therapists going into treatment with particular goals need to be aware that those may or may not align with what the patient believes is right for them.”

‍

Being able to reduce stigma, build and sustain trust, and deliver personalized, effective care requires clinicians to have humility and a willingness to listen. When clinicians can meet patients where they are, they’re more willing to engage in treatment and work towards recovery from OCD.

‍

About Violet

‍

Violet is the first platform in the health care industry to benchmark provider cultural competence. We equip care delivery organizations and health plan networks with the data they need to evaluate how effectively they're meeting the needs of diverse patient populations. Violet Benchmarks go beyond individual skill assessments—they inform strategies that elevate person-centered care across entire systems. By uncovering both strengths and areas for improvement, Violet empowers organizations to advance more inclusive, effective mental health care. 

‍

Book a demo today to learn how Violet’s benchmarking insights can enhance your quality strategy.

‍