Access to evidence-based treatment among Muslim females with obsessive-compulsive disorder washing subtype: influence of religious affiliation and scrupulosity

Abstract

This thesis presents the findings from three studies conducted to investigate the relationship between religiosity and Obsessive Compulsive Disorder symptom presentation in Muslim females, their help seeking pathways regarding religious OCD symptoms, and the beliefs, attitudes, experiences and behaviour of Imams regarding scrupulosity. Study 1 examined religiosity and OCD symptom manifestation in a sample of 139 high and low religious Muslim women with or without OCD washing subtype (OCD-W) in Iran. High religious Muslims with OCD-W reported being diagnosed with OCD at a later age, reported more severe OCD symptom severity at the time of diagnosis, and scored higher on self-report measures of OCD symptomatology compared to low religious Muslims with OCD-W. Study 2 employed qualitative interviews to investigate the impact of religion on OCD symptoms and the treatment-seeking experience in five Muslim women with OCD-W living in Australia. Excessive religious washing and repeating rituals before prayer were the most common compulsions reported by participants. Participants performed these rituals to prevent being punished by God and firstly sought help for OCD from Imams, not mental health professionals. There was an average of eight years between the age at which OCD onset and diagnosis of OCD by a mental health professional. Using an online survey completed by 64 Sunni and Shia Imams from Australia and Iran, Study 3 examined their attitudes, beliefs and experiences particularly concerning scrupulosity and OCD treatment. Findings revealed that the majority of Imams were unfamiliar with scrupulosity as a mental problem. Additionally, Sunni Imams were more likely to recommend suggestions inconsistent with the Exposure and Response Prevention treatment approach when asked for advice by congregation members about dealing with religious obsessions or compulsions. Research implications and limitations are discussed.