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Obsessive-compulsive disorder misdiagnosis among mental healthcare providers in Latin America

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ELSEVIER
DOI: 10.1016/j.jocrd.2021.100693

Keywords

Obsessive-compulsive disorder; Diagnosis; Exposure and response prevention; Assessment; Latin America

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Funding

  1. National Institute of Mental Health [U01MH125062]
  2. Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health [P50HD103555]

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Mental healthcare providers in Latin American regions show high rates of misdiagnosing OCD symptoms, especially regarding taboo thoughts like sexual obsessions. Education and training on OCD symptom recognition are necessary to improve accuracy in diagnosis and treatment recommendations.
Mental healthcare professionals often have limited awareness of different obsessive-compulsive disorder (OCD) symptom presentations, which may contribute to years between OCD symptom onset and treatment initiation. While research has identified high rates of OCD misdiagnosis among clinicians from the United States and Canada, research on OCD symptom awareness among healthcare providers in Latin American (LATAM) regions is limited. In this study, LATAM mental healthcare providers (N = 83) provided diagnostic impressions based on five OCD vignettes: three with symptoms centered on taboo thoughts (sexual, harming others, and religion/ scrupulosity) and two about contamination or symmetry obsessions. Rates of incorrect (non-OCD) diagnoses were significantly higher for the taboo thoughts vignettes (sexual, 52.7%; harm/aggression, 42.0%; and religious, 34.7%) vs. contamination obsessions (11.0%) and symmetry obsessions (6.9%). The OCD vignette depicting sexual obsessions was often attributed to a paraphilic disorder (36.5%). Bachelor's level clinicians had significantly lower odds of accurately identifying all three vignettes related to taboo thoughts compared to respondents with a graduate degree. Accurate identification of the three taboo vignettes was also associated with first-line psychological treatment recommendations (i.e., cognitive-behavioral therapy) even when controlling for respondents' theoretical orientation. Exposure was rarely mentioned when clinicians were prompted to provide treatment recommendations for each vignette (8-9% of the time for symmetry and contamination vignettes, 5-7% for taboo though vignettes). Like clinicians in the United States and Canada, mental health professionals in LATAM may misidentify OCD symptom presentations, particularly sexual obsessions, highlighting a need for education and training.

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