Do cultural factors effect clinical manifestations of OCD? Clinical features of a Turkish sample

Objective: In the present study we evaluated the clinical characteristics of OCD patients monitored in an outpatient program and compared them with other cultures.

Method: The study included 116 OCD patients who presented to the clinics at the Bakirköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, met the inclusion criteria, volunteered to participate in the study after being diagnosed and were referred by two psychiatrists. The diagnosis was confirmed using the Structured Clinical Interview Form for the DSM-IV Axis I Disorders (SCID-I). An inquiry form was developed for obsessive compulsive symptoms based on the obsessions and compulsions included in the Yale-Brown Obsession Compulsion Scale (Y-BOCS) according to their incidence and a sociodemographic form from the SCID-I clinical interview guide.

Results: Our sample consisted of 30 male (25.9%) and 86 female (74.1%) patients. The mean age was 34.96±10.23 years. The most common obsessions were impurity-contamination (49.1%), followed by doubt (20.7%) and religious (11.2%) obsessions. Secondary obsessions included doubt (53.4%), impurity-contamination (14.7%) and sexual obsessions (9.5%), respectively. In tertiary obsessions, 21 patients reported presence of symmetry-exactness (18.1%), 13 patients reported doubt (11.2%), 10 patients reported sexual (8.6%) obsessions, and 43 patients (37.1%) had no tertiary obsessions (Table 1). Ninety-six percent of patients had accompanying compulsions. The most common compulsions were cleaning and washing (53.4%), checking (26.7%) and repetitive ritual behavior (7.8%).DISCUSSION: The most common obsession in the present study was impurity/contamination with a rate of 49.1% in line with the literature, followed by doubt obsessions of 20.7%. The most common compulsion reported in literature is washing accompanied by obsession of contamination, and it is followed by checking. Similarly, in our study, the primary compulsion was cleaning and washing with a rate of 53.4%, followed by checking (26.7%) and repetitive ritual behaviors (7.8%). Although the first two obsessions and compulsions are in line with the literature, the tertiary obsessions reported as aggressive or sexual obsessions in the literature were replaced by religious obsessions (11.2%) in our sample. An intercultural study showed that religious obsessions were the most common obsessions with 60% in the Egyptian sample, and 50% in the Saudi sample. However, the rate of religious obsessions was 6% in the U.S., 5% in the United Kingdom, and 11% in India. Studies on Jewish populations showed similar results with the Muslim populations, with a religious obsession rate of 50%. We believe that the rate of religious obsession is associated with our country's position, being at the junction of Western and Eastern cultures. Relatively lower rate of sexual obsessions compared to the literature may result from the fact that obsessions related with sexuality may be more difficult to report than other obsessions in our population.