Racial Discrimination and Symptoms of OCD Among African Americans

Discrimination is conceptualized as unfair treatment based on characteristics like race, gender, or socioeconomic status. Both major discrimination (e.g., being unfairly fired) and everyday discrimination (e.g., microaggressions) negatively impact mental health (Williams & Mohammed, 2013).

Everyday racial discrimination predicts higher odds of disorders like depression, anxiety, and substance abuse (Chou et al., 2012; Hunte & Barry, 2012; Mouzon et al., 2017).

This study examined symptoms of obsessive–compulsive disorder (OCD) in a nationally representative sample of African American adults (n 3,570) and correlations between OCD symptom dimensions and experiences of discrimination.

Williams, M. T., Taylor, R. J., Mouzon, D. M., Oshin, L. A., Himle, J. A., & Chatters, L. M. (2017). Discrimination and symptoms of obsessive–compulsive disorder among African Americans. American Journal of Orthopsychiatry, 87(6), 636–645. https://doi.org/10.1037/ort0000285

Key Points

1. Everyday racial discrimination was positively associated with obsessions surrounding contamination and unacceptable thoughts, as well as washing/checking, arranging, counting, and repeating compulsions.
2. Everyday racial discrimination was also significantly related to having more obsessions and compulsions overall, as well as meeting the criteria for OCD.
3. In contrast, non-racial everyday discrimination was not significantly associated with any OCD symptoms.
4. The findings suggest racial discrimination may uniquely contribute to OCD severity in African Americans.
5. The cross-sectional design prevents claims of causality between discrimination and symptoms. Additionally, the discrimination measure did not capture intersectional discrimination.

Rationale

Previous research shows OCD prevalence in African Americans is similar to the general population, but they tend to have poorer outcomes and more difficulty accessing care (Himle et al., 2008; Turner et al., 2016).

Understanding factors affecting OCD severity is an important public health goal, but no prior study examined relationships between discrimination and OCD symptoms.

Method

This study analyzed data from the National Survey of American Life, consisting of face-to-face interviews with a national sample of 3,570 African Americans on various measures.

The two types of everyday discrimination were the main independent variables that were used to predict the various OCD symptoms and diagnosis variables, which were the dependent variables.

Independent Variables

• Everyday racial discrimination: self-reported experiences of routine unfair treatment attributed to race (Williams et al., 1997)
• Everyday non-racial discrimination: self-reported experiences of routine unfair treatment attributed to non-racial reasons like gender, age, or weight

Dependent Variables

To assess OCD, the CIDI short-form version OCD diagnostic module (CIDI-SF OCD; Kessler, Andrews, Mroczek, Ustun, & Wittchen, 1989) was administered:

• Contamination obsessions: obsessive fears about dirty hands or germs
• Unacceptable thoughts obsessions: obsessive thoughts about harming others or shameful thoughts
• Washing/checking compulsions: compulsive washing, checking doors, etc.
• Arranging compulsions: needing to arrange things in a certain order
• Counting compulsions: feeling driven to count things
• Repeating words compulsions: needing to repeat certain words
• Number of obsessions
• Number of compulsions
• Meeting criteria for OCD diagnosis

Sample

The sample was nationally representative of African Americans ages 18 and over. 55.97% were female, with 35.73% ages 18-34, 42.65% ages 35-54, and 21.62% over 55.

Statistical Measures

Logistic and negative binomial regression analyses were used to test associations between everyday discrimination variables and OCD symptoms, controlling for demographic factors.

Results

Everyday racial discrimination positively predicted having contamination obsessions, unacceptable thoughts obsessions, washing/checking compulsions, arranging compulsions, counting compulsions, repeating word compulsions, more compulsions overall, more obsessions overall, and meeting OCD criteria.

Everyday non-racial discrimination did not predict any OCD symptoms.

Insight

The findings suggest experiences of racial discrimination are uniquely related to OCD symptom expression in African Americans, regardless of symptom type.

This aligns with research indicating central identity characteristics are most affected by environmental threats. Frequent racial discrimination may deplete resources for managing obsessions and compulsions.

Alternatively, vigilance resulting from dealing with racism could directly exacerbate OCD symptoms. Further research should investigate these causal mechanisms.

Strengths

• The study benefited from a large nationally representative sample of African Americans
• Use of validated measures of OCD symptoms and discrimination

Limitations

• The cross-sectional design prevents causal claims between discrimination and OCD symptoms.
• Additionally, the everyday discrimination measure did not capture intersectional discrimination combining race and gender.

Implications

Clinicians have a responsibility to address racial discrimination when treating marginalized patients, given its detrimental impact on mental health. For African Americans with OCD, therapists should normalize discussing racist experiences without judgment and validate their effect.

This enables processing appraisals in a supportive environment.

Further, clinicians must encourage Black patients to persist in seeking help despite discrimination concerns, communicating that their well-being is the priority.

However, the onus should not fall solely on individuals. Dismantling systemic societal racism via policy reform is imperative to nurture wellness and reduce mental health disparities affecting communities of color.

References

Primary reference

Williams, M. T., Taylor, R. J., Mouzon, D. M., Oshin, L. A., Himle, J. A., & Chatters, L. M. (2017). Discrimination and symptoms of obsessive–compulsive disorder among African Americans. American Journal of Orthopsychiatry, 87(6), 636–645. https://doi.org/10.1037/ort0000285

Other references

Chou, T., Asnaani, A., & Hofmann, S. G. (2012). Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cultural Diversity & Ethnic Minority Psychology, 18, 74 – 81.
http://dx.doi.org/10.1037/a0025432

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.

Hunte, H. E. R., & Barry, A. E. (2012). Perceived discrimination and DSM–IV-based alcohol and illicit drug use disorders. American Journal of Public Health, 102, e111– e117. http://dx.doi.org/10.2105/AJPH.2012
.300780

Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H. (1989). The World Health Organization Composite International Diagnostic Interview Short-Form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171–185. http://dx.doi.org/10.1002/
mpr.47

Mouzon, D. M., Taylor, R. J., Woodward, A., & Chatters, L. M. (2017). Everyday Racial Discrimination, Everyday Non-racial Discrimination, and Physical Health Among African Americans. Journal of Ethnic &
Cultural Diversity in Social Work, 26, 68 – 80. http://dx.doi.org/10.1080/15313204.2016.1187103

Turner, E. A., Cheng, H., Llamas, J. D., Tran, A. G. T. T., Hill, K. X., Fretts, J. M., & Mercado, A. (2016). Factors impacting the current trends in the use of outpatient psychiatric treatment among diverse ethnic groups. Current Psychiatry Reviews, 12, 199-220.

Williams, D. R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57, 1152–1173. http://dx.doi.org/10.1177/0002764213487340

Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2, 335–351. http://
dx.doi.org/10.1177/135910539700200305

Keep Learning

1. How might experiences of racial discrimination during childhood specifically impact later development of OCD?
2. What responsibility does the field of psychology have in addressing systemic societal racism contributing to mental health issues in marginalized groups?
3. What culturally-informed modifications could improve assessment and treatment of OCD among African Americans?