Self-Stigma and Effectiveness of Treatment in Patients with Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a common mental disorder that affects the functionality of the individual, along with his quality of life.

Obsessions are repetitive thoughts, images, and urges that individuals perceive to be intrusive and undesirable.  Compulsions, which can be both behavioral and cognitive, are repetitive actions that are performed in response to obsessions.

Patients with OCD generally feel shame and guilt for having those.  Patients with a decent insight can feel shame or fear being stigmatized particularly when noticeable compulsions occur in public.

It generally has a chronic course, as individuals with OCD start the treatment in year 10 on average.  The most important reason behind this delay is the feeling of shame, and the fear of being judged and stigmatized, which accompany the symptoms.

While nearly 70% of the patients treated with pharmacotherapy experience a major relief in the symptoms, only 25% to 47% achieve remission.  Cognitive behavioral therapy (CBT) is the psychotherapeutic method of choice.  In particular, exposure and response prevention (ERP) lead to remission in 52% of the patients.

There are several major factors affecting the treatment results.  Clinical characteristics, such as a lower severity of onset in OCD, depressive symptoms, the disorder being short-term, or the absence of a personality disorder, stipulate that OCD patients would better respond to CBT.  A higher severity of anxiety, however, stipulates worse treatment outcomes.

Self-Stigma

Self-stigma is another factor that could play a significant part in the outcomes of the treatment.  Self-stigma represents a process in which a socially-stigmatized individual becomes aware of the social prejudices related to his condition, agrees with them, and applies those to himself.

As a reaction, they feel more and more demoralized, hopeless, and desperate.  Self-stigma is associated with a higher anxiety, and symptoms of depression in depressive patients who have anxiety disorder and severe OCD symptoms.

In a study carried out by Deres et al., in-patients with a high rate of self-stigma showed lower rates of participation and collaboration in psychotherapy.  Moreover, self-stigma stipulated worse outcomes of treatment in patients with anxiety disorder, and in patients with unipolar depression undergoing a combined treatment.  Self-stigma is defined as an indication of a decrease in the medication compliance in patients with OCD.

REFERENCES:
– Ociskova, M., Prasko, J., Vanek, J., Holubova, M., Hodny, F., Latalova, K., … & Nesnidal, V. (2021). Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder. Psychology Research and Behavior Management, 14, 85-97.