Help-seeking behavior, treatment barriers and facilitators, attitudes and access to first-line treatment in German adults with obsessive-compulsive disorder.

Background: Individuals with obsessive-compulsive disorder (OCD) face both personal and system-based barriers in receiving first-line treatment, i.e. cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). The present study comprehensively investigated help-seeking behavior, treatment barriers and facilitators, attitudes and access to gold-standard treatment in adults with OCD in Germany. We aimed to characterize the care situation and examine the influence of clinical and sociodemographic variables on help-seeking behavior and receiving treatment.

Methods: An anonymous online survey was performed in individuals with OCD who were recruited in- and outside the psychiatric healthcare system. The survey included a wide range of questions regarding help-seeking behavior, treatment barriers and facilitators, attitudes towards different treatment options and access to treatment. Sociodemographic and clinical characteristics were also collected. The final sample comprised 276 individuals with OCD.

Results: The mean delay to seeking psychotherapeutic treatment was M = 5.15 years (SD = 6.88) and the mean delay to recognition of OCD was M = 5.58 years (SD = 7.16). Of those 211 who had ever received CBT, 49.5% reported that therapist-guided ERP had been performed at some point during treatment. Indicators of poor healthcare, such as longer delay to recognition or a larger number of treatments before receiving ERP were significantly associated with increased symptom severity. Moreover, a younger age was associated with a shorter delay to recognition of OCD. Taboo thoughts (60.9%) and checking (52.9%) were the most commonly reported symptom dimensions, and individuals with current taboo thoughts were significantly more likely to be treated with CBT. Educational websites were identified as the most important facilitators in recognizing OCD and providing information on effective treatment options. Lack of knowledge about treatment options was reported as the most common barrier to seeking/receiving ERP-based treatment.

Conclusions: Delays to the recognition of OCD and to seeking help still exceed 5 years on average, but were reduced in younger individuals, potentially reflecting increased mental health literacy. Although our sample may not be fully representative, our results fill the gap between epidemiological surveys and previous studies in outpatients. Options for improving the care situation are discussed.