Obsessive-Compulsive Disorder in three understudied populations: A review of Latino, Black, and Sexual & Gender Minority Individuals

Abstract

Purpose of Review

This review overviews the research base for obsessive-compulsive disorder (OCD) among three historically understudied populations; Latino/Latin Americans, Black/African Americans, and Sexual and Gender Minority individuals.

Recent Findings

Findings suggest that while core OCD symptoms are broadly similar across groups, sociocultural factors such as discrimination, minority stress, stigma, family context, spirituality, and access to care significantly influence symptom presentation, severity, and treatment utilization. Recent studies have evaluated assessment tools and provided evidence supporting exposure and response prevention, while emphasizing the importance of culturally responsive assessment and treatment. Large-scale initiatives are also improving representation in OCD research and addressing longstanding disparities in knowledge and care.

Summary

OCD presents similarly across diverse populations, but cultural and contextual factors shape symptom expression and treatment experiences. Future research should prioritize representative samples, culturally informed assessment, and greater access to evidence-based care.

Introduction

Obsessive-compulsive disorder (OCD) is a psychiatric disorder with a well-established core phenotype of frequent, intrusive, uncontrollable thoughts and repetitive behaviors. Although its impacts are considerable [1] and is experienced by individuals worldwide [2], effective psychotherapies exist, namely exposure and response prevention (ERP), which has a strong evidence base across numerous studies [1, 3]. Despite its severity, burden, and established treatments, OCD remains understudied and undertreated among minoritized populations [4–6]. Much of existing OCD research has been conducted primarily with heterosexual, cisgender White samples, potentially limiting generalizability of many findings.

Accordingly, this review provides an overview of the current literature on OCD among three historically understudied populations: Latino Americans, Black/African American individuals, and sexual and gender minority (SGM) individuals. Although many other historically marginalized populations also remain substantially understudied in OCD research, we focus on these three groups because each has developed a sufficient body of literature to support a focused review, in addition to the authors’ involvement in these works. The goal of this review is to synthesize the existing and emerging literature on OCD in these three populations, highlight clinically relevant considerations for assessment and treatment, and identify important directions for future research.

Latino Americans

Prevalence

One-year and lifetime prevalence of OCD among Latinos1 and within Latin American countries are between 1 and 3% [2, 7], though one meta-analysis of anxiety disorders in Latin America estimated OCD prevalence rates below 1%, with higher rates in urban compared to rural or mixed settings [8]. Despite these findings, Latinos remain significantly underrepresented in OCD research [4, 5, 9], however recent initiatives have sought to address this gap [10].

Clinical Presentation

As seen within the broader literature, symptom heterogeneity of OCD is also common among Latinos, with data from a large, predominately Brazilian sample providing evidence for eight broad symptom dimensions [11]. Symmetry symptoms may be especially common, with lifetime prevalence rates of 86% in a sample of over a thousand Brazilians with OCD; these symptoms were associated with earlier onset, depressive symptoms, and sensory phenomena [12]. Consistent with other populations examined, insight has also shown to be variable in Latino samples, with worse insight linked with more severe OCD [13]. Further, varied symptom dimensions appear to have varied comorbidity patterns [11, 14, 15]. In general major depressive disorder, social anxiety disorder, generalized anxiety disorder, and specific phobias have emerged as common comorbidities among Latino individuals with OCD [13–15].

Additional findings suggest variation in presentations across demographic groups. Latinos with OCD with a family history of the condition appear to demonstrate earlier onset, greater psychiatric comorbidity, and elevated sexual/religious and hoarding symptoms relative to those without a family history [16]. Gender differences have also been reported, with one study finding that men experienced greater sexual/religious symptoms, tic disorders, and alcohol use disorders, whereas women more commonly endorsed contamination/cleaning, aggressive, and hoarding symptoms alongside several body-focused-repetitive and eating-related comorbidities [14]. Cross country comparisons have also suggested both similarities and differences. For instance, Brazilian and U.S. samples generally demonstrated comparable symptom profiles in one investigation [17], although Brazilian individuals have reported higher rates of generalized anxiety disorder, post-traumatic stress disorder (PTSD), and tic disorders than those in non-Latin American countries [17, 18]. A smaller comparison between Costa Rican and U.S. adults found broadly similar symptom presentations despite somewhat greater severity and psychiatric comorbidity in the U.S. sample [19]. In an analogue study, young adults in Mexico endorsed higher obsessive-compulsive symptom scores across dimensions than U.S. participants, with spirituality appearing to function as a protective factor among Mexican individuals [20].

The link between higher OCD severity and greater impairment in quality of life (QoL) and functioning has also been replicated in samples of Latino adults and children [21, 22]. A study of Brazilians with OCD observed poorer QoL was linked with lower educational attainment, lower socioeconomic status, chronic illness course, and psychiatric comorbidity, with sexual/religious symptoms showing weaker associations in some analyses [22]. In a multinational Latino sample, OCD severity was found to be associated with reduced responsiveness to social interactions, while comorbid depressive symptoms were linked with diminished engagement in hobbies and goal-directed activities [23].

Suicidality also represents an important clinical concern within Latino OCD samples. Across Brazilian studies, approximately 10% of individuals with OCD reported either current suicidal ideation or prior suicide attempts, and over a third reporting lifetime active suicidal ideation [18, 24, 25]; these estimates appear similar to estimates meta-analytic estimates of suicidality in OCD as a whole [26]. Similar with non-Latino samples, greater comorbidity burden appears to be linked with higher suicidality [25], with comorbidities including mood disorders, PTSD, and substance use disorders associated with higher odds of past suicidality [24, 27, 28]. Further, suicidality is also greater among those with greater depression severity, lower quality of life and taboo symptoms, even when controlling for other factors [25, 29].

Several studies highlight broader contextual experiences among Latinos with OCD as well. Recent findings suggest that a meaningful proportion (e.g., greater than 25%) of both youth and adult samples reporting stigma- and discrimination-related concerns because of their OCD, with greater stigma associated with increased symptom severity and poorer functioning [21, 30]. Family accommodation also appears common and is associated with a broad range of more severe obsessive and compulsive symptoms among Brazilian individuals with OCD [31, 32]. Further, significant life events (e.g., emotional problems in the family, family financial problems) were reported by over 60% of individuals in one large Brazilian OCD sample and were associated with non-White racial identity, PTSD, sensory phenomena, and greater severity of sexual/religious and hoarding symptoms [33]. Relatedly, OCD-PTSD comorbidity was identified in 13.8% of a large multinational Latino sample and was associated with greater OCD symptom severity and poorer quality of life [34].

Considerations for Assessment and Psychological Treatment

Although commonly used OCD assessment measures have been translated into Spanish and Portuguese, only a handful have been validated for use specifically with Latinos. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was previously validated in Spanish for children and adults using smaller samples [35, 36], and one study supported general measurement invariance between Latino and White participants using the English-language Y-BOCS [37]. More recently, the Spanish Y-BOCS-II demonstrated strong validity and reliability in a multinational Latin American sample [38], with a follow-up study identifying a score of 22 as the cutoff for moderate OCD [39]. Spanish versions of the Obsessive Compulsive Inventory-4 and Florida Obsessive Compulsive Inventory-II have shown acceptable discriminative validity among Latinos with elevated obsessive-compulsive symptomatology [40]. The Dimensional Yale-Brown Obsessive-Compulsive Scale was developed in part using a Brazilian sample [41] and has demonstrated adequate psychometric properties in Brazilian populations [42]. Additionally, the Dimensional Obsessive-Compulsive Scale (DOCS) and the Obsessive-Compulsive Inventory–Child Version (OCI-CV) been validated among Mexican adults and Chilean youth, respectively [43, 44].

Treatment utilization among Latinos with OCD appears limited by systemic barriers and challenges in accurate symptom recognition. Barriers to care include language differences (within the U.S.), stigma, spiritual attributions of symptoms, concerns about treatment effectiveness, financial limitations, lack of availability, and preferences to manage symptoms independently [45, 46]. In a study of Latin American providers, overall rates of misidentification of varied OCD presentations ranged from 6.9 to 52.7% with presentations involving taboo thoughts more likely misdiagnosed [47]. Additionally, ERP was infrequently specifically recommended as a first line treatment (< 10% of the time), though accurate identification was associated with a greater likelihood of recommending first-line treatments [47]. Notably, these rates of misdiagnosis are largely consistent with what has been observed in U.S. clinician samples [48, 49].

In a large multinational sample of Latinos, 32.2% of individuals with OCD reported prior ERP [50], although recruitment through specialized clinics likely inflated these estimates. Indeed, while even in the U.S. there is a considerable lack of trained providers in ERP [49], this discrepancy is likely far greater in Central and South America [51, 52], though has yet to be formally estimated. Available data also suggest variability in psychiatric treatment access across the region, with serotonin reuptake inhibitor use for those being treated for OCD ranging from 40 to 88% across sampled Latin American sites [51]. However, more conservative estimates from the World Mental Health Survey found that only 7% of individuals with OCD in low- and middle-income countries – which include many Latin American nations – report receiving any form of treatment, in comparisons to rates of 40.5% in high income countries [2]. Within the U.S., Latinos with OCD may also be less likely to pursue higher levels of care (e.g., residential treatment); for instance, only 2.4% of 892 individuals receiving higher levels of care in one U.S. study identified as Latino [53], despite Latinos comprising 20% of the U.S. population [54]. Collectively, the existing literature suggests a considerable treatment gap for Latinos with OCD.

Treatment outcomes research among Latinos is limited relative to White, non-Latinos. Some studies suggest ethnicity is unrelated to treatment outcome in OCD [55], whereas others indicate that ethnicity and acculturation may moderate which interventions are most effective among Latino youth [56, 57]. Still, several studies conducted in Latin America, primarily in Brazil, support the effectiveness of cognitive-behavioral therapy/ERP for OCD across individual, group, and internet-delivered formats [58–61]. Consistent with findings in non-Latino populations, poorer insight, greater psychiatric comorbidity, and higher baseline symptom severity have been associated with worse treatment response in these samples [58, 62, 63].

Clinical guidance for ERP with Latino individuals emphasizes the need to distinguish culturally normative or faith-consistent behaviors from OCD symptoms and tailor exposures in ways that align with the individual’s cultural values, religious beliefs, and family context [7]. Effective ERP therefore may benefit from collaboration with family members or clergy, and requires attention to stigma and avoidance of exposures that could inadvertently undermine cultural identity, increase shame, or damage therapeutic rapport [7].

Future Directions

Until recently, OCD research among Latinos was generally concentrated in only a few countries (e.g., U.S., Mexico, Brazil). This gap is increasingly being addressed through the Latin American Trans-ancestry INitiative for OCD genomics [10], a multinational effort to expand Latino representation in OCD genetics research. With more than 5,000 Latin American participants with OCD, ongoing genotypic and phenotypic studies from this initiative are expected to substantially advance understanding of OCD in Latinos. Future research should also directly examine how factors such as acculturation, environmental context, immigration-related stressors, and specific spiritual and cultural beliefs shape OCD presentation, assessment, and treatment, given their broader role in Latino mental health [64]. Additionally, efforts are needed to expand dissemination of evidence-based treatments, including ERP, across Latino communities and Latin America broadly.

Black and African Americans

Prevalence

Approximately 1.6–2% of African Americans and Caribbean Black Americans2 meet criteria for OCD over the lifespan [65, 66]. However, current epidemiological knowledge remains limited by underrepresentation of Black individuals in OCD research [4, 5], raising concerns about accuracy estimating burden and clinical characteristics of OCD within Black populations.

Clinical Presentation

Some evidence suggests that, relative to non-Hispanic White individuals, African Americans may more frequently endorse contamination/washing symptoms, animal-related fears, and hoarding tendencies [67–71]. Within varied Black populations, one large study found few overall symptom differences across African American and Black Caribbean groups, aside from Haitian American participants, who reported fewer symptoms overall [72]. Research also suggests possible cultural variation in OCD-related cognitive processes, with African American individuals in one study more likely to engage in thought suppression and control strategies, whereas maladaptive interpretations of intrusive thoughts appeared more strongly linked to symptoms among European Americans [67]. Similarly, prior research found that African American participants scored higher than European Americans and Latinos in ratings of importance and need to control thoughts [70].

Emerging evidence highlights the role of racism, discrimination, and broader sociocultural stressors in shaping OCD symptoms among Black individuals. Greater racial discrimination has been associated with increased obsessive-compulsive symptom severity, including intrusive thoughts, contamination, harm, and taboo obsessions, as well as washing and repeating compulsions [72, 73]. Relatedly, elevated obsessive-compulsive symptoms among Black individuals in Canada – particularly foreign-born participants – has previously been linked with discrimination, internalized racism, and microaggressions, whereas social support appeared protective [74]. Discrimination may also prospectively predict greater obsessive-compulsive symptom distress, especially among Black individuals with a strong identification with an emphasis on Black racial identity [75]. Some scholars suggest that heightened contamination fears among Black individuals may reflect historical and ongoing impacts of racist stereotypes surrounding cleanliness and segregation [69]; consistent with this, one experimental study found that African American participants exposed to Jim Crow-related imagery demonstrated greater contamination-related avoidance [76]. Broader stressors may similarly exacerbate symptoms, as COVID-19 anxiety was associated with increased obsessive-compulsive symptoms among young Black adults partially through heightened psychological inflexibility [77]. Further, lower socioeconomic status may be associated with increased OCD risk and symptomatology among Black individuals [65, 66, 72].

The Sociocultural Model of OCD provides a useful framework for understanding that OCD symptoms among Black individuals are shaped not only by cognitive-behavioral processes, but also by broader sociocultural risk and protective factors, including income, racism and discrimination, stigma, parenting practices, access to treatment, social support, racial socialization, ethnic identity, and religious coping [78]. These contextual factors likely influence how symptoms are experienced, interpreted, reported, and treated. Research suggests that resilience factors, including social support, racial socialization, and ethnic identity may buffer psychopathology among Black individuals broadly [79, 80], though some culturally salient values, including religiosity and heightened moral responsibility, may also exacerbate OCD symptoms by amplifying distress associated with intrusive thoughts or contributing to symptom themes such as scrupulosity [66, 78, 81]. Further, one study of social networks among Black individuals found that frequent contact with friends and family was not protective against OCD, whereas more frequent negative family interactions were associated with increased risk [82], highlighting the need for further research on sociocultural contributors to OCD in Black individuals.

Black individuals with OCD may also differ in developmental course and comorbidity patterns, though this information largely comes from a limited body of research. African Americans may be more likely to exhibit adult-onset OCD rather than the late-adolescent onset more commonly reported in European American samples [65], potentially reflecting the influence of racism contributing to OCD development. Additionally, Black individuals with OCD also appear to experience high rates of psychiatric comorbidity, with the same study finding that over 9 out of 10 Black individuals with OCD endorsed at least one comorbid diagnosis, including depressive, anxiety, and trauma related disorders [65].

Considerations for Assessment and Psychological Treatment

Cross-cultural differences in OCD symptom presentation and interpretation among Black individuals have important implications for assessment, particularly because many standardized diagnostic instruments were developed and validated in predominantly White samples. Several self-report OCD measures, including the Padua Inventory [83] and the Maudsley Obsessional Compulsive Inventory [84] demonstrate inadequate psychometric properties for Black adults. Additionally, even when administered by well-trained clinicians, the Structured Clinical Interview for DSM-IV Axis I Disorders failed to correctly identify OCD in 33.8% of African American adults in one investigation [85]. Although some evidence supports the validity of the Y-BOCS and Obsessive-Compulsive Inventory-Revised (OCI-R) for African American populations [86, 87], one measurement invariance study found substantial non-invariance in the Y-BOCS Obsessions scale for Black individuals, suggesting caution when comparing scores with White individuals. Thus, further work is needed in developing measures that are valid for this population.

Black individuals with OCD face multiple barriers to timely, accurate, and effective care. Prominent barriers include cost, stigma and fear of judgment, concerns about therapeutic processes (e.g., being forced change, unsure where to find help or what to expect, feeling treatment will not work), time constraints, and beliefs that treatment may not be necessary [88]. Concerns about unfair treatment based on race or ethnicity and historical medical mistreatment of Black individuals may further discourage engagement [78, 88], highlighting how anticipated discrimination and mistrust of healthcare systems can shape treatment participation. Reflecting this, fewer Black individuals receive treatment for their OCD than their White counterparts [53, 65, 88]. In one large recent study, fewer than 15% of African Americans endorsing obsessions and fewer than 8% endorsing compulsions reported seeking treatment for these concerns [89]. Greater perceived impairment and poorer self-rated mental health increased the likelihood of help-seeking, whereas lower socioeconomic status and education were associated with reduced help-seeking [89].

Research on OCD treatment outcomes among Black populations remains limited. Evidence suggests that ERP yields comparable outcomes among Black and European/White Americans [55, 66, 90]. However, a lack of cultural and contextual responsivity may negatively affect treatment seeking, therapeutic alliance, and adherence [90, 91]. As such, treatment considerations should extend beyond standard ERP delivery to include culturally responsive engagement, case conceptualization, and intervention. Clinical guidance emphasizes understanding how racism, stigma, religious values, family expectations, and community context may shape symptom meaning, disclosure, and treatment participation [66, 78, 91]. Although core mechanisms of ERP need not change, clinicians should carefully consider how exposures are framed, whether treatment rationales feel culturally relevant, and whether OCD symptoms have been adequately distinguished from realistic concerns shaped by lived experience [91]. For instance, it is critical to differentiate between maladaptive avoidance (i.e., related to OC symptoms) and adaptive avoidance (i.e., avoidance of environments with a higher likelihood of exposure to violence, discrimination) [92].

Future Directions

Substantial gaps remain in understanding how OCD develops, presents, and is treated among Black individuals. Research examining developmental trajectories, etiological mechanisms, and youth presentations remains especially limited, constraining understanding of culturally relevant risk and resilience factors and opportunities for early intervention [78]. Emerging initiatives such as the Black EquaLity in OCD NeuroGenomics study [93] and the Black and Living with OCD project aim to address these disparities by increasing representation in OCD research and examining culturally relevant lived experiences, risk factors, and barriers to care among Black individuals. Continued investment in culturally informed and community-engaged research will be critical for improving assessment, treatment engagement, and equity in OCD treatment.

Sexual and Gender Minority Individuals

Prevalence

There has been increased empirical interest in OCD among sexual and gender minority (SGM) individuals in the last five years, where prior, virtually no research existed. Emerging studies are imperative given evidence showing increased risk for OCD among SGM individuals. Cisgender sexual minority (SM) men and women are 52–56% more likely to be diagnosed with OCD compared to their matched sex peers [94]. This discrepancy is magnified across gender identity, where OCD is nearly five times more prevalent among gender minority (GM) individuals compared to cisgender heterosexual individuals. Among undergraduates, 12-month rates of OCD diagnosis or treatment are 9% for SM and 8% for GM individuals, in stark contrast to rates of 1% and 1–2% for heterosexual and cisgender individuals, respectively [95, 96]. SGM individuals also represent 15% of OCD treatment-seeking samples [97, 98] despite accounting for only 8% of the general U.S. population [99]. Indeed, SM identification in OCD treatment samples has increased over five years, particularly for those with bisexual identities [100].

Clinical Presentation

Recent studies show elevated OCD severity among GM individuals compared to cisgender individuals [101, 102], yet no difference in OCD severity between SM and heterosexual individuals [97, 103]. There is some evidence that SM individuals, particularly bisexual individuals, report less emotion regulation capacity [98] and greater obsessive beliefs related to perfectionism/intolerance of uncertainty and responsibility to prevent harm/overestimation of threat compared to heterosexual peers [104]. Additionally, psychiatric comorbidity is potentially greater among SM individuals with OCD than heterosexual peers [102].

Findings regarding clinical presentation of obsessive-compulsive symptoms are inconsistent, with more differences found in non-clinical than clinical samples. In non-clinical samples, SM individuals report more severe unacceptable thoughts symptoms, less severe contamination symptoms [105], and greater endorsement of relationship-focused obsessive-compulsive symptoms, particularly relating to doubt about partners’ love, compared to heterosexual peers [106]. Non-clinical samples have also found greater perfectionism and negative affect traits among SM individuals, highlighting potential OCD risk factors [106].

In clinical samples, however, findings have not replicated. In a recent clinical sample, earlier symptom profiles did not replicate across sexual orientation groups; rather, individuals questioning their identity reported less severe symmetry symptoms, although the size of the subgroup (n = 17) limits conclusions [97]. A separate study found elevated contamination symptoms among GM versus cisgender males [102]. However, this study likewise included a small sample of GM individuals (n = 17), limiting conclusions, and has yet to be evaluated in subsequent samples. Collectively, findings suggest that differences in obsessive-compulsive symptom presentation may be less detectable within intensive treatment settings where there is less variability in symptom severity.

Presentation of OCD among SGM individuals may be amplified by minority stressors. Broadly within SGM literature, the minority stress model posits that individuals face distal (external) stressors including discrimination, identity-based violence, rejection, harassment, and non-affirmation of identity, which have a downstream effect on proximal (internal) stressors including internalized stigma, identity concealment, and rejection expectation [107, 108]. Recently, Pinciotti and Feinstein proposed a cognitive behavioral-minority stress model of OCD among SGM individuals that integrates minority stress processes into existing theoretical models of OCD [109]. The model posits that minority stressors contribute to cognitive patterns reflecting inflated responsibility to detect threat and prevent harm, the presence and content of intrusive thoughts, appraisals of intrusive thoughts as dangerous and personally meaningful, and to maladaptive behavioral and emotional responses that reinforce and ultimately maintain OCD symptoms. Preliminary research has supported these pathways [110], revealing unique OCD-related salience of rejection sensitivity and internalized stigma for SM and identity-based victimization for GM individuals. A subsequent study showing that living in a progressive city is associated with less severe OCD among SGM individuals offers further evidence for the impact of SGM-based stigma and discrimination on OCD [101].

Considerations for Assessment and Psychological Treatment

Limited research has evaluated the suitability of existing OCD measures for SGM populations. In one SGM sample, the DOCS, Y-BOCS-II-Self Report (SR), and Obsessive Beliefs Questionnaire (OBQ)-Short-Form demonstrated consistent response patterns with broader OCD samples and strong factor structures and loadings, internal consistency, and convergent validity [111]. However, in another study, while the DOCS and the OBQ-44 demonstrated measurement invariance, the Y-BOCS-SR did not demonstrate configural invariance between SGM and non-SGM patients [112]. Taken together, findings offer some support for the use of these measures in SGM populations, but caution may be needed in comparing scores using the YBOCS-SR. More work is needed to evaluate the suitability of pre-existing clinician administered measures for OCD in this population.

Studies show no differences in overall treatment outcomes across sexual orientation groups [97, 113], although there is some suggestion that rates of improvement may differ, with lesbian/gay patients demonstrating the slowest improvement across sexual orientation groups in quality of life and bisexual patients demonstrating more rapid improvement in OCD severity compared to heterosexual peers [103]. Only one study has evaluated treatment outcomes in a small sample of GM individuals, finding significantly longer lengths of treatment stay compared to cisgender patients and no significant improvement in contamination or just right symptoms [102].

Clinicians might consider incorporating assessment of minority stress when working with SGM individuals with OCD [114]. This information can not only inform a more holistic conceptualization of the patient’s presenting concerns and treatment-complicating factors, but identify where a justice-based approach to treatment may be needed [115]. Justice-based treatment considers the broader impact of treatment on patient, provider, and society at large, ensuring that individual treatment gains do not come at a cost to marginalized communities (e.g., conducting exposures that stereotype SM individuals to address sexual orientation obsessions). Among SGM individuals, justice-based ERP allows patient and provider to discuss more explicitly the learned stigma that may be contributing to symptoms and identify adaptive avoidance behaviors that may be “off limits” for exposure therapy (e.g., a transgender individual avoiding public restrooms due to fear of violence rather than contamination). Among individuals with identity-related OCD themes (e.g., obsessions about sexual orientation, gender identity, racism), justice-based ERP is strongly preferred over approaches to ERP that involve participation in overcorrection exposures that may unintentionally stigmatize or tokenize marginalized communities [116]. More detailed treatment recommendations for assessment and treatment of SGM youth with OCD have been previously published [114, 117].

Future Directions

Empirical understanding of OCD in SGM individuals is in its infancy and much remains unknown about how sexual and gender minority stress contributes to the development, exacerbation, and maintenance of OCD. Experimental and longitudinal studies are needed to better understand these proposed pathways. Treatment outcomes research is needed to evaluate the effectiveness of justice-based ERP, particularly among SGM individuals who may be drawn to its more overt values-based nature. Although the current research based is largely limited by small sample sizes and convenience sampling; several emerging initiatives to purposively sample SGM individuals with OCD, such as the Pride OCD study [110], will significantly improve SGM representation within the literature.

Conclusions

This manuscript provided an overview of OCD research among Latino, Black/African American, and SGM individuals (see Table 1 for summary). Overall, OCD exhibits similar core phenomenology and responsiveness to ERP, while also being meaningfully shaped by sociocultural context, minority stress, and systemic inequities. Although prevalence estimates among Latino and Black populations generally appear comparable to those observed in the broader population, emerging evidence suggests elevated OCD rates among SGM individuals, particularly GM individuals. Further, while the literature provides examples of theoretical conceptual models to consider for Black and SGM individuals with OCD, no models for Latinos have been proposed. Across populations, treatment recommendations generally emphasized that the core principles of ERP need not fundamentally change, but that culturally responsive implementation is critical. Common themes included the importance of distinguishing culturally normative, identity-related experiences, or adaptive avoidance from OCD symptoms, incorporating sociocultural and minority stress factors into case conceptualization, attending to family, religious, and community contexts, and ensuring that exposures are delivered in ways that avoid reinforcing stigma, invalidating lived experiences, or damaging therapeutic rapport.

Table 1.

  Overview of OCD literature findings among latino, black, and sexual & gender minority individuals

	Prevalence	Clinical presentation	Assessment	Treatment
Latino American	1–3% lifetime	-Phenotypic variability is common, with Latino cultures and sociodemographic factors (e.g., gender, country) influencing presentation -Symptom severity contributes to lower quality of life -Stigma and adverse life experiences are common -Suicidality risk is heightened	-Validated measures have been developed in both Spanish and Portuguese and are recommended for clinical use.	-Misdiagnosis, especially among “taboo” presentations may be common -Many Latinos & individuals in Latin America likely do not receive treatment due to cultural and systemic barriers -ERP is effective, with worse insight, symptom severity, and comorbidity linked with worse response
Black and African American	1.6-2% lifetime	-Contamination/washing, animal-related fears, and hoarding may be common -Racism and discrimination are contributory to OCD severity -Sociocultural Model of OCD help explain OCD among Black and African American individuals.	-Yale-Brown Obsessive Compulsive Scale should be interpreted cautiously -Padua Inventories and Maudsley Obsessional Compulsive Inventory lack support -Obsessive-Compulsive Inventory- Revised has some support	-Barriers to treatment are common, including structural and attitudinal -ERP is effective, though exposures should be designed with cultural sensitivity to minimize inadvertent risk
Sexual and Gender Minority (SGM)	8–9% 12-month among university students.	-Elevated symptom severity among gender minorities, but not sexual minorities -Research on specific symptom presentations is mixed, and inconclusive -Cognitive behavioral-minority stress model is a new model specific to OCD among SGM individuals	-Validated measures may be useful, but should be interpreted with caution, clinical expertise, and sensitivity to SGM status	-ERP is effective across SGM groups, but limited research suggests slower responses among gay/lesbian individuals -Justice-based ERP may be more preferrable

Note. OCD Obsessive-Compulsive Disorder, ERP Exposure and Response Prevention

It is important to consider several caveats to this review. First, the authors recognize the considerable heterogeneity within each population discussed and do not intend for these findings to serve as broad generalizations. Relatedly, individuals hold multiple intersecting identities that may uniquely shape OCD experiences and outcomes. Indeed, one study of intensive residential treatment found that greater cumulative marginalization was associated with higher baseline OCD severity and obsessive beliefs, as well as lower quality of life at discharge [118]. It should also be noted that only three historically underrepresented populations were addressed here, despite many other groups – including Middle Eastern, Asian, and Native American individuals – remaining substantially understudied in the OCD literature. Despite these caveats, this review provides an informed overview of emerging and ongoing efforts to expand the OCD literature across historically underrepresented populations and underscores the importance of continued research aimed at reducing disparities and advancing equitable care.

Key References

• Cervin M, Miguel EC, Güler AS, Ferrão YA, Erdoğdu AB, Lazaro L, et al. Towards a definitive symptom structure of obsessive−compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals. Psychol Med. 2022 Oct;52(14):3267–79.

  • ○This paper presents a comprehensive analysis of symptom clustering in OCD among a mostly Latino sample.

• Dromer E, Jacob G, Williams MT, Moshirian Farahi SMM, Darius W, Kogan CS, et al. Obsessive-compulsive symptoms and related risk and protective factors in Black individuals in Canada. Front Psychol. 2025 Mar 6;16.

  • ○This reference presents recent data on the presence of obsessive-compulsive symptoms in Black individuals, and the role of discrimination, racism, and social support in predicting symptoms.

• George JR, Taylor RJ, Rouleau TM, Turner ED, Williams MT. Seeking Care for Obsessive-Compulsive Symptoms Among African Americans: Findings from the National Survey of American Life. Behav Ther. 2025 Jan 1;56(1):1–15.

  • ○This investigation provides recent data on treatment seeking among Black individuals in the USA

• Pinciotti CM, Castillo AA, Avery JE, Storch EA, Feinstein BA. Identity-Related Stress and Obsessive-Compulsive Disorder in Sexual and Gender Minority Individuals: A Test of the Cognitive Behavioral-Minority Stress Model. Behav Ther. 2026 Mar 1;57(2):295–313.

  • ○This reference provides an overview and testing of a theoretical model explaining how minority stress may influence presentation among SGM individuals.

• Pinciotti CM, Upshaw BM, Spencer SD, Park JM, Franklin ME, Wadsworth LP, et al. Preferences for Justice-Based Exposure and Response Prevention Among Individuals With Identity-Related Obsessive-Compulsive Disorder. Behav Ther. 2025 Jul;56(4):753–67.

  • ○This manuscript briefly overviews justice-based ERP principles and details findings suggesting preference for this approach compared to overcorrection exposures.

• Stein DJ, Ruscio AM, Altwaijri Y, Chiu WT, Sampson NA, Aguilar-Gaxiola S, et al. Obsessive-compulsive disorder in the World Mental Health surveys. BMC Med. 2025 Jul 9;23(1):416.

  • ○This paper presents data on OCD prevalence and treatment rates across many countries, including those in Latin America.

• Storch EA, Cheng JSC, Higham M, Muñoz JS, Cruz VZ, Berrones D, et al. Psychometric properties of the Spanish Yale-Brown Obsessive-Compulsive Scale – Second Edition. Psychiatry Res. 2025 Jun 1;348:116456.

  • ○This reference overviews the recent validation of the Spanish YBOCS-II for use among Latinos.

Author contributions

R.M. led the conceptualization of the manuscript. R.M., O.O., C.P., wrote the original draft of the manuscript text. A.W. prepared Table 1. All authors reviewed and edited the manuscript.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Disclosures

Dr. McCarty has no disclosures to report. Dr. Onyeka reports receiving research support from the Texas Child Mental Health Care Consortium and the International OCD Foundation. Dr. Pinciotti reports receiving research support from the Texas Child Mental Health Care Consortium and fees to be a consultant and workshop presenter with The Knowledge Tree and OCD Training School. Dr. Wiese reports receiving research support from the Texas Child Mental Health Care Consortium. Dr. Storch reports receiving research funding to his institution from the International OCD Foundation, Wellcome Trust, and NIH. He receives direct funding from the International OCD Foundation as well as MHNTI for providing training on treating obsessive-compulsive disorder with psychotherapy. He was a consultant for Brainsway and Biohaven Pharmaceuticals in the past 36 months. He owns stock options less than $5000 in NView (for distribution of the Y-BOCS and CY-BOCS) and receives royalties from OCD Scales LLC (for distribution of the Y-BOCS and CY-BOCS). He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, Routledge, and Jessica Kingsley.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.