Measurement and impacts of intersectionality on obsessive-compulsive disorder symptoms across intensive treatment.

Abstract

Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have been underrepresentative in terms of patient race and ethnicity. The present study piloted a novel technique to measure multiple marginalized identities and assess their impact on obsessive-compulsive disorder (OCD) symptoms and treatment response across intensive residential treatment (IRT). Participants included 715 residents receiving IRT for OCRD. Measures included the Yale-Brown Obsessive-Compulsive Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Obsessive Beliefs Questionnaire-44, and measures of depression and quality of life. In addition, we piloted a marginalized identity score, an additive measure of intersectionality. Most patients endorsed holding primarily privileged identities. Higher marginalized identity score was significantly correlated with higher depression symptom severity and lower quality of life throughout treatment. Both at baseline and discharge, higher marginalized identity score was significantly and positively correlated with greater OCD symptom severity. Higher marginalized identity score was significantly associated with greater severity of DOCS1, DOCS2, DOCS4, and obsessive beliefs across multiple domains. Consistent with previous literature, patients in our IRT setting were not demographically representative of the general population. Individuals with more marginalized identities endorsed higher symptoms of OCD, obsessive beliefs, OCD dimensions, and depression, as well as lower quality of life at admission and discharge. Results support increased consideration of the role marginalization plays in symptom severity, symptom presentation, and treatment response across treatment settings. Further investigation is warranted to better address the multiplicative effects of holding intersecting marginalized identities and how treatment may be adapted to ameliorate these inequities. Public Policy Relevance StatementIntensive residential treatment for obsessive-compulsive and related disorders (OCRD) has proven to be efficacious for non-Latino white individuals. However, less is known about the efficacy of interventions for individuals holding one or more marginalized identities and how this may impact the experience, presentation, and response to treatment. Further research is needed on the efficacy of OCRD treatment in individuals from historically and contemporarily disadvantaged groups to improve our understanding of the evaluation, adaptation, and development of more efficacious and acceptable treatments for these individuals.

Understanding the Psychological Impact of Oppression Using the Trauma Symptoms of Discrimination Scale

“…These identities alone were associated with comparable or greater discriminatory trauma than non-specific intersectional identities. Nonetheless, clinicians should be aware that greater intersectionality is more likely to signal cumulative trauma, and it also can be an impediment to treatment, as has been seen with other disorders as well (eg, 58 , 59 ).…”

Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines

“…Race, ethnicity, gender, sexual orientation and ableism constitute some examples of identities that may be societally privileged or marginalized according to group membership. Wadsworth et al (2020) demonstrated that holding more marginalized identities increased OCD symptom severity in the contamination, harm and symmetry dimensions at baseline and discharge for OCD patients. Furthermore, having more marginalized identities was related to increased obsessive beliefs about responsibility/threat over-estimation and perfectionism/certainty at both time points.…”

“…Having several marginalized identities can compound the effects of discrimination on OCD phenomenology. Intersectionality refers to belonging to two or more communities that have been historically marginalized (Wadsworth et al, 2020). Race, ethnicity, gender, sexual orientation and ableism constitute some examples of identities that may be societally privileged or marginalized according to group membership.…”

Anxiety-Related Disorders in the Context of Racism

“…Across numerous studies, experiences of racial discrimination have been found to predict and exacerbate OCD symptoms and access to care [e.g., 12 ]. For instance, Wadsworth and colleagues [ 13 ] examined having multiple marginalized identities with OCD symptoms and intensive residential treatment response and found that those with more marginalized identities had an increased severity of fear of contamination concerns. Further, possessing multiple marginalized identities was associated with heightened OCD symptoms at both admission and discharge from the treatment program.…”