Exploring Professional Help Seeking in Practicing Muslim Women with Obsessive Compulsive Disorder Washing Subtype in Australia
- Demographic Questions. Participants were asked about their age, employment status, and country of birth, education, ethnicity, occupation, and income level.
- The Dimensional Obsessive-Compulsive Scale (DOCS; Abramowitz et al. 2010) is a 20-item self-report measure that assesses the severity of four OCD symptom dimensions (contamination, responsibility for harm and mistakes, symmetry/ordering, and unacceptable thoughts) on a scale of 0 to 4 (total scores ranges from 0 to 80) with the clinical cut-off score of 21 for OCD. The DOCS has been shown to be a valid and reliable assessment of OCD symptom dimension severity across clinical populations (Abramowitz et al. 2010). The DOCS has excellent internal consistency (Cronbach’s α = 0.90; Abramowitz et al. 2010).
2.4. Data Analysis
All interviewees found these symptoms to be very distressing, time-consuming, and physically exhausting. Consequently, their religious OCD symptoms were observed as causing the most interference with normal life activities and the leading reason for seeking treatment. Their OCD symptoms not only put pressure on their lives, but also their family members and loved ones. For example, EE expressed disturbances related to her purity-related symptoms as such:‘I repeated Wudu before prayer for several times; I always have doubt about the number of ‘rakat’ [part of prayer] and if I am performing prayer in a correct order or not. I also wash everything related to myself especially when I have a doubt about touching anything wet or probably impure’.
All participants experienced excessive washing rituals that were related to religious practices and religious washing rituals were reported as the most common compulsion among participants. One of the participants reported also having non-religious OCD washing symptoms resulting from the fear of getting contaminated or sick. As BB said:‘During the time of my period, I tried not to touch many things as I definitely believed that I will make them impure which subsequently make me more anxious. After my period, I used to wash all my clothing separately with hands for three times and sometimes more than that to make sure they are pure…I remember I hated myself during my period because of being impure. I was really scared of not performing religious rituals in a right way, especially five-time daily prayer…It took me about an hour every time I wanted to use bathroom and I used to ask my family members if they want to use the bathroom in the next hour or not to decrease the inconveniency of my symptoms…’
‘When my symptoms started, I washed my hands frequently, I did not drink water in any one’s cup, I used to wash my plate, knife, spoon before using them in other people’s house before eating things. I was very fussy in eating food in others’ homes as I have thought other people’s things were dirty. And if I ate something that is not clean, I might get sick, and I also felt disgusted with having something not clean…I did not use to shake hands with anyone, because I was not sure if their hands are clean. I felt really uncomfortable’.
In another case, CC said:‘I wash excessively because I thought I always needed to be pure for doing my religious rituals like prayer. I was told by my parents that if my prayers were not accepted by God, none of my other good things will be accepted and I will be sent in the hell. So I had this fear that if I am impure or not clean, my religious practices won’t be accepted after my death. After three-time washing of my clothing and belonging I feel much better and am ready to perform my rituals and also do my normal activities’.
DD mentioned that the most important adverse consequence of not performing religious OCD rituals would be losing God’s love and attention, she stated:‘I think at that time I tried to prove myself to my husband that I am doing everything right in my religion, and I am a good Muslim…I got really nervous and anxious…I also felt guilty because I thought if I do not correctly perform my rituals, God won’t accept them, and I won’t be a good Muslim…And consequently, I will get punished and being sent to hell’.
‘It is also really important to be clean in our religion; there is a quote that: ‘cleanness is a part of religiosity in Islam’. And I think if somebody is not clean enough to perform her rituals and do not take care of herself, God won’t love her; If one does not have the love and support of God what will happen to her? Left alone in this world…I didn’t want this happen to me…’
DD has been given the following advice by an Imam:‘The first time I asked for help, I talked to an Imam…, and he recommended that I read Quran more and he reassured me God will help me if I ask for his forgiveness’.
EE described her journey to seek help for her obsessional symptoms:‘he told me I should pray more, and ask God to help me in this situation, as God is the only one who can help me now’.
Other interviewees also reported that religious related methods and advice provided a temporary relief rather than a long-lasting improvement for obsessional symptoms. One participant, DD, did not want to seek help at all, until she realised that her symptoms were impacting on her family members, and generally, the last option that interviewees acted on was seeking the help of psychiatric services. Specifically, there were long delays of between 5 and 13 years between the time when OCD-W symptoms were first noticed and when the women sought psychiatric help. There were also delays between first seeking help from a religious source to diagnosis of OCD of between one to eight years. Moreover, patients visited the mental health professional (MHP) after accepting that the benefits of religious advice were limited in terms of treating their OCD symptoms. As DD stated:‘I guess my symptoms started when I was 13, at the time I got my first period and one year after that, my doubting obsessions and washing compulsions started. I repeated wudu before prayer for several times; I have asked my friends and family members to watch me during prayer and tell me if I am performing it in a right way. Performing these religious rituals took a lot of time and I tolerated them for almost seven years; then, I decided to talk to an Imam who prayed at our mosque, he recommended me to read Quran more, and he reassured me God will help me if I ask for god’s forgiveness. I did read Quran more, and it gave me a temporary relief, but the symptoms persisted. I have been visiting my doctor every few months and I feel much better now’.
In contrast, two participants were given advice from their Imams about not paying excessive attention to their doubts and to disengage from their rituals. For example, CC stated:‘I did not want to ask for help, I was fine to do things like that…But when I was 18, my mom passed away, my symptoms got worse afterwards, and my little sister and brother tried to convince me not to wash things and myself excessively…I remembered my little sister used to come to the bathroom with me, watching me and trying to stop me from washing more. After few months, I realised that my behaviours are extreme, and I have put too much pressure on my family members, so I did try to talk to a religious advisor (Imam) which was not helpful. Eventually, at the age of 23, I sought professional help and went to see a psychiatrist; he did diagnose me with OCD’.
Another Imam gave this advice to BB:‘An Imam told me that everything impure needed to be washed three times for the next time I want to use it, in order to make it pure and clean. He also mentioned that when I am not sure about purity or impurity of something, I should consider that object as a clean and pure one’.
‘He told me, I don’t need to do the extra washing rituals continuously, and should stop having doubt about the rightness of my rituals and do whatever I have been asked to do in Islamic practices and not more, if I have excessive doubt about correctly performing my rituals, I should stop repeating, once is enough; however, that advice didn’t help me. I couldn’t accept it when I compared it with whatever I have learnt before; I continued to do what I was doing before’.
However, in two cases, participants mentioned that the medications they had taken were not helpful in decreasing their OCD symptoms, and they still suffered from religious OCD symptoms. DD stated:‘I decided to see a psychiatrist in advice of one of my friends. I was diagnosed with OCD at that time. My psychiatrist prescribed clomipramine and then changed it to Fluoxetine which I have taken since then and my washing symptoms got less severe afterward…It was like I felt less urge and anxiety to wash things…I am more relaxed now’.
Two participants had received psychotherapy; one had received Cognitive Behavioural Therapy (CBT) and one Exposure Response Prevention Therapy (ERP). Both participants who had received psychotherapy still had OCD. BB did not tolerate ERP well and discontinued treatment. She explained:‘I have tried taking Fluoxetine which could not help me at all. My symptoms are not under control according to my psychiatrist opinion…Life still seems so difficult to me, I have all my symptoms…I still spend at least two hours a day performing my washing rituals’.
‘In the second session my psychologist asked me to touch anything in the bathroom, like the floor and hand basin, and do not wash my hands or take a shower after that as a take home task. I could not tolerate that way of doing things or stop washing my hands and body…It made me sick and I did not continue seeing him as it was too much for me’.
Similarly, AA, stated:‘I am sure the way of upbringing at home and in school gave shape to my symptoms, praying to God did not help in decreasing my symptoms, if my mom was not sensitive to impurity and cleaning rituals in our religious rituals, I might never experience those symptoms, my religion made my symptoms worse, At the time I was trying to do things that might be accepted by God’.
However, CC indicated that religion both exacerbated her symptoms and provided a support for her in dealing with challenges:‘Since my childhood, I just tried to make everything in a perfect way in relation to my religion like being clean and pure before prayer…One of my teachers at school made me feel more sensitive to cleaning things, because she said God will not accept our rituals if we do not perform religious rituals in a right way, then I started checking many things in my rituals which increased the amount of symptoms that I had. That made me more uncomfortable with what I was doing…I tried so hard to get accepted by other important persons of my life like my teachers, parents and friends and I was not happy…’
Moreover, EE said:‘The way my husband treated me at that time, the intimidation he applied towards me and the fear he wanted me to have from sinning, have influenced the initiation and also maintenance of my symptoms…I still do have those sorts of fears…Although I believe having God in my world always helps me tolerate many difficult situations, however, I guess religious concerns increased my level of anxiety and OC symptoms’.
‘I am not sure if my religion did make an impact on my OCD symptoms, I guess God loves purity, cleanness is also recommended in our religion; at the same time, doing excessive rituals is not recommended...therefore, I am not sure if I am doing the right thing regarding my religion or not…it is confusing…’
Another participant, CC, stated:‘At the time when my symptoms were severe, sometimes I read Quran and prayed which helped me in relation to decreasing the anxiety I encountered and also increasing the hope regarding acceptance of my rituals by God, and to be loved by God which made me tolerate my symptoms more and to be more satisfied and happier’.
However, two participants considered their religiosity to add negative effects to their life, as EE stated:‘I am sure God loves me and his love, mercy and forgiveness will help me to overcome my symptoms in the end, I am praying and fasting more and hoping he will forgive me for what I have done wrong and also incorrect, regarding performing of religious rituals…I have felt much better after praying…at least for a while…’
‘I think God helped me in many challenging situations in my life, but I guess I cannot say my religion did help me to specifically reduce my OCD symptoms, on the other hand, it made me feel more guilty most of the times…I did control my symptoms with the help of my psychiatrist and medication I am taking now…’
Conflicts of Interest
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|Participant||Age (Years)||Born in Australia *||Employment Status||Endorsed Item 4 on the DRI||Age at OCD-W Symptom Onset||Age First Discussed OCD-W Symptoms with Imam||Age at Diagnosis by Psychiatrist||Y-BOCS Currently in Clinical Range|
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Mahintorabi, S.; Jones, M.K.; Harris, L.M. Exploring Professional Help Seeking in Practicing Muslim Women with Obsessive Compulsive Disorder Washing Subtype in Australia. Religions 2017, 8, 137. https://doi.org/10.3390/rel8080137
Mahintorabi S, Jones MK, Harris LM. Exploring Professional Help Seeking in Practicing Muslim Women with Obsessive Compulsive Disorder Washing Subtype in Australia. Religions. 2017; 8(8):137. https://doi.org/10.3390/rel8080137Chicago/Turabian Style
Mahintorabi, Somayeh, Mairwen K. Jones, and Lynne M. Harris. 2017. "Exploring Professional Help Seeking in Practicing Muslim Women with Obsessive Compulsive Disorder Washing Subtype in Australia" Religions 8, no. 8: 137. https://doi.org/10.3390/rel8080137