Robinson Karen J, Rose Diana, Salkovskis Paul M
Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Department of Psychology, University of Bath, UK.
Psychol Psychother. 2017 Jun;90(2):193-211. doi: 10.1111/papt.12090. Epub 2017 Apr 10.
Obsessive compulsive disorder (OCD) can be hugely disabling. Although very effective psychological treatments exist, many people delay years before seeking help or never seek treatment. There have been clinical observation and short questionnaire studies on why people delay, but little qualitative research exists on this complex subject. The present qualitative study aimed to identify the barriers to seeking treatment and the factors that encourage or push people to seek help for their OCD (positive and negative enablers).
A qualitative, exploratory study using in-depth, individual, semi-structured interviews was conducted by a researcher with personal experience of OCD.
Seventeen people with OCD, contacted through the charity OCD-UK, were interviewed about the factors that impacted on their decision to seek help or not. The interviews were analysed using thematic analysis.
Barriers identified were stigma, 'internal / cognitive' factors, not knowing what their problem was, factors relating to their GP or treatment, and fear of criminalisation. Positive enablers identified were being supported to seek help, information and personal accounts of OCD in the media, and confidence in their GP. Negative enablers were reaching a crisis point and for some participants (whose intrusive thoughts were about harming children) feeling driven to seek treatment because of the nature of the thoughts, that is, seeking help to prevent the 'harm' they feared they were capable of doing.
Participants identified a range of barriers and enablers that impacted on their decision to seek help or not. These give important indicators about the likely causes for delayed help seeking in OCD and ways in which people might be encouraged to seek help earlier.
People with OCD may face a wide range of barriers to seeking help, including concern about the reaction of health professionals. The level of awareness, kindness, and understanding shown by first-line practitioners can be very important to those seeking help. Acknowledging a person's journey prior to seeking help is likely to foster trust between therapist and patient. Some barriers to seeking help, for example, fear of criminalisation, may continue to have an important effect afterwards unless sensitively explored and understood.
强迫症（OCD）会导致严重的功能障碍。尽管存在非常有效的心理治疗方法，但许多人会拖延数年才寻求帮助，或者根本不寻求治疗。关于人们拖延的原因已有临床观察和简短问卷调查研究，但针对这个复杂主题的定性研究很少。本定性研究旨在确定寻求治疗的障碍以及鼓励或促使人们为其强迫症寻求帮助的因素（积极和消极促成因素）。
由一位有强迫症亲身经历的研究人员进行了一项定性、探索性研究，采用深入的、个体的、半结构化访谈。
通过慈善机构“英国强迫症协会”联系了17名强迫症患者，就影响他们寻求帮助与否的因素进行了访谈。访谈采用主题分析法进行分析。
确定的障碍包括耻辱感、“内在/认知”因素、不知道自己的问题所在、与全科医生或治疗相关的因素以及对被定罪的恐惧。确定的积极促成因素包括得到寻求帮助的支持、媒体上关于强迫症的信息和个人经历，以及对全科医生的信任。消极促成因素是达到危机点，对于一些参与者（其强迫观念是伤害儿童），由于这些想法的性质而感到不得不寻求治疗，即寻求帮助以防止他们担心自己可能造成的“伤害”。
参与者确定了一系列影响他们寻求帮助与否的障碍和促成因素。这些为强迫症患者延迟寻求帮助的可能原因以及鼓励人们更早寻求帮助的方式提供了重要指标。
强迫症患者在寻求帮助时可能面临广泛的障碍，包括对医疗专业人员反应的担忧。一线从业者表现出的认知水平、友善程度和理解能力对寻求帮助的人可能非常重要。承认一个人在寻求帮助之前的经历可能会促进治疗师与患者之间的信任。一些寻求帮助的障碍，例如对被定罪的恐惧，除非得到敏感的探讨和理解，否则之后可能会继续产生重要影响。
