Cross-Cultural Differences in the Presentation and Expression of OCD in Black Individuals: A Systematic Review

Previous research has examined the manifestation and symptomatology of obsessive-compulsive disorder (OCD) and indicates the severity and expression of OCD symptoms are influenced by cross-cultural differences. Existing literature documents that OCD prevalence rates are similar across racial and ethnic groups, yet the presentation of obsessive-compulsive symptoms among Black Americans remains understudied. When compared to White counterparts, prior research demonstrates that African Americans with OCD have greater contamination anxiety and concerns about animals. However, extant literature lacks clarity on whether these concerns are core features of obsessive-compulsive symptoms among African Americans with OCD, or if they are biological mechanisms in individuals with OCD. As a result, Black Americans are continually underrepresented in clinical research and treatment, experience higher discrimination levels, and have severe contamination/washing obsessive-compulsive symptoms. The underrepresentation of Black patients with OCD negatively impacts the ability to identify unique aspects of their clinical presentations and the development of culturally-specific treatments. Thus, this paper reviews culturally-specific expressions of OCD and examines sociocultural factors that impact the severity of this disorder in Black Americans. This paper also identifies how cultural differences in the presentation of OCD may increase misdiagnoses and barriers to treatment. Finally, it discusses clinical implications in diagnosis and treatment among Black Americans with OCD.