IB Docs (2) Team
Sociocultural approach to OCD
The sociocultural approach assumes that the ways in which people think, feel, and behave are products of sociocultural conditioning by family, friends, community, and the wider society. Although many Westerners believe OCD has a neurobiological basis, this does not explain the range of obsessions and compulsions that characterize different populations. This chapter will explore the role of environmental and cultural factors in the disorder.
In the USA, the prevalence of OCD is 1.6% across all ethnicity groups with no one cultural group being at greater risk. This suggests OCD may be biological in origin. This said, there is some international variation with rates as low as 0.3% in Brazil, but rising to 2.7% in Hungary, (Williams and Steever 2015), suggesting a role for environmental factors after all.
In the West, OCD is associated with checking, cleaning, and ordering, but in societies where religion plays are more central role in daily life, sexual urges and symptoms rooted in religious/taboo topics are common. This may be particularly true in tight cultures where deviations from cultural norms are deeply opposed. Enculturation may affect how OCD manifests, for example, the content of common ruminations and the specific nature of the compulsive acts. Cultures that provide detailed narratives around the importance of thoughts may lead people to become overly concerned with controlling their thoughts, and this explains the correlation between religiosity and OCD symptoms that exists in many parts of the world.
Ghassenzadeh et al. (2002) found that Iranian females, the majority of whom were housewives, were more likely to experience obsessions relating to purity, contamination, and washing than males. Thus the typical distribution of labour within a culture can shape abnormal thinking, i.e. the women were responsible for cooking and cleaning, and hence these thoughts dominated.
OCD and the curse of the evil eye
Watch the following video clip to learn about the "Evil Eye."
The curse of the evil eye is an ancient superstition common throughout the Middle East and the Mediterranean, but also found in Polish and Irish folklore. The belief is that a person can curse another by glaring at them. Amulets known as nazars are used as protection and to ward off evil.
The link between the evil eye and OCD is apparent from a quote taken from an Ancient Greek novel, “When anyone looks at what is excellent with an envious eye he fills the surrounding atmosphere with a pernicious quality, and transmits his own envenomed exhalations into whatever is nearest to him.” (Heliodorus 2020). Thus, people believe that bad thoughts, such as envy, can cause harm to other people and be passed into objects, suggesting links with thought-event and thought-object fusion.
Al-Solaim and Loewenthal (2011) carried out a series of interviews with women living with OCD in Saudi Arabia. The women revealed that even though they believed in biological imbalances and drug treatment, ultimately they believed the evil eye curse had caused their OCD.
ATL: Critically thinking about mental health
Puppy pregnancy syndrome - Chowdhury et al. (2003)
In a tiny rural hamlet near Calcutta, 73% of villagers believe dog bites can result in pregnancy in both males and females. This plight is greatly feared as it is believed that unless the puppy fetuses come out of the body in urine, the condition can be fatal. When cases arise, they are widely discussed in the community.
Hundreds have been treated by indigenous healers, who use herbs and chanting to ‘dissolve the fetuses’. Chowdhury et al. (2003) investigated seven such cases and although they define this as a culture-bound disorder, it shares characteristics with OCD, e.g. a milkman who became obsessed that a dog had licked his milk cans, developed compulsive checking of the milk, and avoided anywhere he might encounter dogs.
Read the following article on puppy pregnancy syndrome.
Do you think puppy pregnancy is a culture-bound syndrome or is this just a different set of symptoms of OCD? Should people in this village be diagnosed with OCD instead if they fit the DSM 5 criteria?
Teacher only boxDo you think puppy pregnancy is a culture-bound syndrome or is this just a different set of symptoms of OCD? Should people in this village be diagnosed with OCD instead if they fit the DSM 5 criteria?
Most students - and psychologists - will argue that this is a culture bound syndrome, even though there are some characteristics of OCD that are similar, the disorder is rather distinct. Have students think about what is similar and what is not similar. This leads to the question of whether it would be appropriate to treat the disorder with the medications used for OCD.
Religiosity and scrupulosity
It has been estimated that between 10 to 30% of patients with OCD have obsessive ideas about religion. OCD symptoms can be extensions of typical religious beliefs and practices, and research has shown that the severity of symptoms correlates with religiosity in a variety of religions. Scrupulosity refers to an excessive preoccupation with ‘doing the right thing’ according to one’s religious beliefs, and this is linked with moral perfectionism, a dysfunctional belief highlighted as a trigger for OCD by cognitive psychologists, such as Rachman (1997).
Scrupulosity
According to Miller and Hedges (2008), scrupulosity is a manifestation of OCD “characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive."
Watch the following video and then answer the questions below.
1. What are some of the obsessive thoughts that the narrator says people with scrupulosity may experience?
Worrying if they are praying enough or in the right way, whether they have committed a sin, or whether God is disappointed in them, concerns about purity, and going to Hell.
2. Why might a person with scrupulosity not go to church? How might this affect their symptoms?
A person my not go to church out of fear of having obsessive thoughts while in their place of worship. The person avoids situations that might trigger intrusive thoughts, but the relief provided is only temporary, and they are likely to feel even more guilty for not going.
3. According to the narrator, how can scrupulosity be treated?
Through a therapy called exposure and response prevention where the person is exposed to situations where they might think they are a bad person and that they are going to Hell for example. They are helped to realize that they can live with uncertainty and doubt and that they do not have to enact their compulsive behaviours in order for their anxiety to diminish.
4. Freud argued that religiosity is just a socially acceptable form of obsessive-compulsive behaviour. Do you agree?
An important point here is that in OCD there is often a disconnect between the content of the obsession and the compulsion. The sufferers themselves may see their behaviour as irrational and distressing. In religiosity, individuals see their behaviours as highly meaningful and consistent with their self-concept. This is different from scrupulosity where the individual does feel that their behaviour is out of control and their obsessional thoughts are distressing.
In Christianity, Jesus states (Matthew 5:27-28) that the thought of committing a sinful act is equal to having already done it. This clearly shows how thought-action fusion is reinforced in some religions. Literal interpretations of such quotes may leave deeply religious people vulnerable to obsessive worries about sinful thoughts and neutralizing behaviours. It can be difficult to see where rigid adherence to religious teaching and OCD overlap. For example, in Islamic culture, the term napak or unclean is equated with being unholy. Al-wudūʼ refers to a specific way of washing the face, arms, head, and feet in preparation for prayer, and it is easy to see how people prone to OCD may develop uncertainty about whether they have washed sufficiently. Likewise, the term waswas (meaning ‘whispers from Satan’) refers to doubts and temptations that could fuel obsessive thinking. This is supported by Mahghoub and Abdel-Hafeiz (1991) who found the most common symptoms for Muslims with OCD related to prayers and washing (50%) and contamination (41%).
Research by Rosmarin et al. (2010) explored whether there was a difference between Orthodox and non-Orthodox Jewish participants in terms of their ability to identify scrupulosity versus non-religious type OCD. Although the researchers initially thought the Orthodox participants might not be able to differentiate between scrupulosity and strict religious observance, they were more able to do so than their non-Orthodox counterparts.
Much of the research adopts an etic approach - that is, a cross-cultural approach that compares non-Western cultures to Western cultures. Many of the supporting studies use the Y-BOCS framework to guide interviews and this can also mean cultural nuances are overlooked, as researchers seek symptoms that fit a more Western conception of the disorder.
Olson et al. (2019) demonstrated that even when researchers are very familiar with the ethnic groups being studied, problems can still arise. The researchers stress the importance of forging culturally-sensitive relationships, despite the risk of researcher bias.
One of the problems with research in this area, as previously noted, is that studies are often conducted with individuals who are already showing symptoms making it unclear whether deeply religious people, for example, are propelled into more fundamental adherence to religious values due to underlying uncertainty and doubt. Religious institutions with clear rules about how to structure one’s life may be appealing to people who are vulnerable to anxiety.
It can be difficult to recruit participants for cultural research on OCD, as help-seeking is often directed towards religious figures, indigenous healers, and elders in the community.
Qualitative studies are often conducted at single sites, meaning it is not possible to know how representative the issues might be.
Sociocultural theories may be more descriptive than explanatory. There is no clear explanation of how sociocultural factors actually lead to the onset of OCD symptoms, but it does provide a framework for understanding cultural differences in symptoms.
The prevalence rate for OCD in the United States is roughly the same across all ethnicity groups suggesting that...
Answer: Similar prevalence rates across ethnicity groups with differing child-rearing practices, levels of religiosity, and attitudes imply that environmental factors are not as important as biological factors shared by all humans.
Which of the following statements does not explain variations in prevalence rates between countries, e.g. Hungary (2.7%) and Brazil (0.3%)?
Answer: Differences in prevalence between nations suggest that cultural differences have some impact on the diagnosis of OCD, even if they only have a small role to play. This could also be linked to the extent to which people seek help from medical professionals and therapists as opposed to faith healers and religious leaders though, as caes may exist but not be diagnosed in some nations.
In Western cultures, OCD symptoms are more likely to involve…
Answer: Forbidden thoughts linked to sex and aggression may be more common is tight cultures where there are restrict rules for public behaviour and blasphemous thoughts may predominate in countries that are more religious. In more secular (less religious) cultures such as those found in the West, OCD symptoms are more likely to involve checking and ordering.
Which type of obsessions are more common in African-American people with OCD?
Answer: Some researchers have suggested that this is due to historic segregation of African-Amercians, and pernicious stereotypes which have led to enduring anxieties about cleanliness.
The word nazar refers to what?
Answer: Nazar is an Arabic word meaning sight and describes the eye-shaped amulets seen across the Middle East and Mediterranean. They are said to protect people from the curse of the evil eye.
In one study, Muslim women believed that their obsessive-compulsive symptoms were…
Answer: Al-Solaim and Loewenthal (2011) conducted a qualitative study using semi-structured interviews to explore OCD in women in Saudi Arabia. Despite accepting explanations of their symptoms and taking medication, they still believed the ultimate cause of their problems was having received the evil eye. They were positive about their condition though they knew it was not their fault, and families were generally supportive due to the lack of stigma around psychiatric symptoms.
Which of the following is not true about puppy pregnancy?
Answer: Although some animals are seen as sacred in India, dogs are not.
Waswas or ‘whispers from Satan’ is a phrase used to describe unwanted thoughts that elicit self-doubt in people of which religion?
Answer: Waswas is an Arabic word, used by Muslims to refer to doubts that serve to weaken a person’s faith. It can also refer to temptations that might lead people to engage in sinful behaviour.
Rosmarin et al (2010) found that Orthodox Jews….
Answer: Contrary to the initial hypothesis, Orthodox Jews were more likely to label scrupulosity as a type of OCD requiring treatment by a professional therapist. The researchers noted that this was likely because the Orthodox Jews were more knowledgeable regarding the community’s standards for Orthodix Jewish behaviour and thus found it easier to recognize when a person had crossed over into abnormal thoughts/behaviours.
Which of the following is not a weakness of research into sociocultural factors affecting OCD?
Answer: Al-Solaim and Loewenthal (2011) asked an independent researcher to verify the credibility of their analysis by matching 20 quotes to the six themes. All the other statements are, indeed, weaknesses of research in this area.
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