To seek advice or not to seek advice about the problem: The help-seeking dilemma for obsessive-compulsive disorder

Dept. of Personality Psychology, University of Valencia, Valencia, Spain.
Social Psychiatry (Impact Factor: 2.54). 08/2008; 44(4):257-64. DOI: 10.1007/s00127-008-0423-0
Source: PubMed


Although obsessive-compulsive disorder (OCD) is associated with considerable distress, it has been reported that OCD patients delay considerably in seeking treatment for their problem. The present study aimed to explore some variables hypothetically involved in the help-seeking process among OCD patients.
Twenty-six OCD patients without comorbid conditions completed the Interview of Help-Seeking, specifically designed for this study, which assesses to what extent patients delay seeking treatment for their problem, and three group of variables: factors influencing the recognition of the problem, reasons for delaying the treatment-seeking, and reasons for finally seeking treatment. Participants also completed OCD measures, as well as a questionnaire on thought control strategies.
The mean length of delay in seeking treatment was 39.38 (SD = 50.95) months, and a great variety of reasons for delaying were observed. The OCD patients who delayed consultation longer, in comparison with patients who delayed less time, used fewer social control strategies, and they were less aware of the interference and behavioral changes associated with the problem.
To gain more insight about the problem and to experience greater interference from the symptoms were determinants in the active search for help. Conversely, the main barriers to the help-seeking were the fears of stigma and the meaning of the thought contents. Additionally, the fact that patients are willing to disclose their obsessions to other people may favor an adequate representation of the problem and the need to seek mental health treatment.

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Available from: Amparo Belloch, Oct 09, 2014
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    • "Stepped-care treatments are commonly recommended in the OCD literature (Lovell & Richards, 2000;Mataix-Cols & Marks, 2006b; National Institute for Health and ClinicalExcellence, 2005), have been demonstrated to be effective in the treatment of OCD (Gilliam et al., 2010;Tolin et al., 2005), and have been shown to result in significantly reduced costs (Tolin, Diefenbach, & Gilliam, 2011). However, a limitation of these traditional stepped-care models is that they do not take into account geographical and other barriers that impede an individual's ability to access traditional face-to-face treatments (Baer & Minichiello, 2008;Belloch et al., 2009;Goodwin et al., 2002;Marques et al., 2010). Thus, many individuals are not able to 'step up' to the more intensive levels of care (such as face-to-face outpatient or inpatient services) if they have not benefitted from a low intensity treatment. "
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    ABSTRACT: Obsessive-compulsive disorder (OCD) is a chronic mental health condition that results in a significant societal burden. Remote treatments do not require the patient to attend traditional face-to-face treatment services and can be used as a way to overcome barriers to accessing face-to-face treatment. The aim of the current study was to synthesize the current literature on remote treatment for OCD using a meta-analytic approach. Relevant articles were identified through an electronic database search and the references of previously completed reviews on the topic of remote treatment for OCD were also reviewed. Eighteen studies (n=823; mean age=31.20 (SD=10.36); 56.2% female) were included in the meta-analysis. Within-group findings indicate that remote treatment for OCD produces a decrease in symptoms of a large magnitude (g=1.17; 95% CI: 0.91-1.43). Between-group findings indicate that remote treatment for OCD is more effective than control (g=1.06; 95% CI: 0.68-1.45) and outcomes are not meaningfully different from face-to-face treatment (g=-0.21; 95% CI: -0.43-0.02). Those methodologies that are low intensity produce a decrease in symptoms of a large magnitude (g=1.36, 95% CI: 1.00-1.72), as do higher intensity treatments (g=1.64, 95% CI: 1.33-1.95). These findings have important implications for the development of stepped-care treatments, which may be able to be delivered in a purely remote fashion.
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    • "The perception of not needing treatment was previously reported as one of the greatest barriers to seeking OCD treatment [27]. Other studies have also reported that between 28.50% and 64.79% of patients with OCD believe that they can manage their symptoms on their own [12] [19] [27] [28]. Similarly, 55.2% of our patients reported believing that they could overcome symptoms, which was related to delayed treatment seeking. "
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    ABSTRACT: Background: Patients suffering from obsessive compulsive disorder (OCD), despite heightened levels of functional impairment and disability, often wait several years before starting pharmacological treatment. The interval between the onset of a specific psychiatric disorder and administration of the first pharmacological treatment has been conceptualized as the duration of untreated illness (DUI). The DUI has been increasingly investigated as a predictor of long-term outcomes for OCD and other anxiety disorders. The present study investigated DUI, and demographic-clinical factors associated with DUI, among a sample of patients with OCD. The relationships between DUI, insight, and treatment outcomes were also assessed. Methods: We evaluated 96 subjects with a DSM-IV diagnosis of OCD using the Structured Clinical Interview for DSM-IV Axis I disorders, a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and a questionnaire designed by our group to identify reasons for delaying psychiatric admission. Patients with OCD showed a mean DUI of 84 months. However, DUI was not predictive of remission defined by a Y-BOCS total score of 10. Using the median value, a categorical cut-off for DUI of 4 years was calculated. Results: For patients with a shorter DUI (≤4 years), the age of OCD onset was significantly older than patients with a longer DUI (>4 years) (p<.001). The following four items related to reasons for delaying treatment were significantly endorsed by patients: the fact that symptoms were spontaneously fluctuating over time (61.5%), believing that OCD symptoms were not associated with an illness (60.4%), believing that one can overcome symptoms by him/herself (55.2%), and not being significantly disturbed by OCD symptoms (33.3%). Delaying treatment because of perceived social stigma was only endorsed by 12.5% of patients. Believing that OCD symptoms were not associated with an illness was significantly associated with a longer DUI (p=.039). Conclusions: Results from the present study suggest that patients with OCD show a significant inclination toward delaying treatment admission. However, DUI was not predictive of remission in terms of symptomatology. Believing that OCD symptoms are not associated with an illness might indicate impairment in insight, a denial of the problem or could be associated with awareness of OCD as a mental illness. Factors related to the nature and course of OCD appear to be important determinants in delaying treatment among patients with OCD.
    Full-text · Article · Apr 2015 · Comprehensive Psychiatry
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