Health Concerns

Obsessive-Compulsive Disorder (OCD)

Diagnosis

As is the case for many psychiatric disorders, there is no laboratory test for OCD. There are, however, specific clinical interview and assessment tools designed to aid in diagnosis. Even with the correct clinical diagnostic tools, it can be difficult to distinguish OCD from other psychiatric conditions (Seibell 2013; Sudak 2012).

The difficulty in correctly diagnosing OCD may stem in part from the frequency with which OCD is associated with other psychiatric disorders (Seibell 2013; Sudak 2012). In one study, 92% of patients with a primary diagnosis of OCD had at least one additional psychiatric diagnosis (de Mathis 2013). Nevertheless, in order to make an OCD diagnosis, a clinician must rule out other psychiatric conditions such as depression, anxiety disorder, psychosis, and ADHD (Masi 2006; Yip 2014; Sudak 2012).

Once an OCD diagnosis has been made, severity can be graded using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impressions (CGI) scale, or both:

  • The Y-BOCS is a clinician-administered 10-item questionnaire that rates the frequency, severity, and types of symptoms in an OCD patient, and can be used to monitor disease progression or treatment. Y-BOCS scores range from 0 to 40, with 40 being the most severe (Rosario-Campos 2006; Goodman 1989; Farris 2013).
  • The CGI scale can be used to assess the clinical severity of any mental disorder. It scores symptoms on two 7-point scales: severity of symptoms and response to treatment. The CGI usually rates the patient’s symptoms, behavior, and function over the previous seven days (Busner 2007; Seibell 2013).

Diagnostic Criteria for OCD

Both the World Health Organization (International Statistical Classification of Diseases and Related Health Problems; ICD-10) and the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders; DSM-5) have developed diagnostic criteria for OCD.

ICD-10 criteria (National Collaborating Centre for Mental Health 2006):

Obsessional symptoms or compulsive acts or both must be present on most days for at least two successive weeks and be a source of distress or interference with activities. Obsessional symptoms should have the following characteristics:

  1. must be recognized as the individual's own thoughts or impulses;
  2. must be at least one thought or act that is still resisted unsuccessfully, even though others, which the sufferer no longer resists, may be present;
  3. thought of carrying out the act must not in itself be pleasurable (simple relief of tension or anxiety is not regarded as pleasure in this sense);
  4. thoughts, images, or impulses must be unpleasant and repetitive.

DSM-V criteria (APA 2013):

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

  1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and in most individuals cause marked anxiety or distress.
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (by performing a compulsion).

Compulsions are defined by (1) and (2):

  1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming, taking more than one hour per day, or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (eg, a drug of abuse or a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder.