Is This OCD? Diagnosing Obsessive Compulsive Disorder

 

By Whitney Peters LPCC
OCD Specialist, Lindner Center of Hope 

Beginning a successful journey in obsessive compulsive disorder (OCD) treatment starts with the right diagnosis. OCD occurs in people from any gender, age, or ethnicity, and happens to approximately 1 in 100 adults and 1 in 200 kids and teens. Many people think of OCD as being a germaphobe or preferring things to be organized, but the reality of OCD is far from the stereotype we think of.

People with OCD spend hours a day preoccupied with upsetting concerns that cause them feelings of anxiety and disgust, and in order to alleviate themselves or prevent those uncomfortable feelings, they must perform physical or mental acts. People with OCD can develop obsessions about anything they find to be important or valuable. This may include developing obsessions about things like their family, careers, spiritual beliefs, or identity, among many others.

For example, someone with Harm OCD might be bothered by an obsession around the possibility of having hit someone with their car. This obsession takes over their thoughts so that they spend a lot of time driving around looking for evidence, repeating memories of their drive to reassure themselves, and frequently checking their rear-view mirror. This is all to make sure they didn’t hit anyone. People with OCD realize what they are afraid of is unlikely, but the distress they face with these concerns make it difficult to resist checking, ruminating, or looking for reassurance that they are safe. OCD symptoms can become so intrusive that a person may have difficulty functioning in daily life or attending work or school. OCD is considered one of the top 10 most disabling conditions, and the symptoms of OCD can look very different depending on the person. It is critical that a clinician the individual is working with knows how to spot it. OCD assessment tools can help us more effectively identify symptoms, specific subtypes, and assess for severity.

Common OCD Assessment Tools and Screening Methods

The Obsessive Compulsive Inventory (OCI)

The Obsessive Compulsive Inventory (OCI) is a 42-item OCD screening tool and self-report measure used to identify common symptoms and track severity. This tool can be used independently by the patient or during a structured interview. The OCI measures OCD symptoms like Checking, Doubting, Ordering, Hoarding, and Neutralizing. This OCD inventory uses check boxes to rate the severity of symptoms and adds scores to determine how significantly OCD is impacting the individual. The OCI can also be used throughout treatment to track progress.

(Obsessive-compulsive Inventory (OCI) – Reproduced & adapted by permission of the authors: Foa, E.B., Kozak, M.J., Salkovskis, P.M., Coles, M.E., & Amir, N.)

Yale Brown Obsessive Compulsive Scale (Y-BOCS) and Child Yale Brown Obsessive Compulsive Scale (CY-BOCS)

The Yale Brown Obsessive Compulsive Scale (Y-BOCS), including the child version (C-YBOCS), is widely regarded as the gold standard obsessive compulsive scale. This assessment tool identifies both obsessions and compulsions by providing examples that patients can respond to independently or in a structured interview with a clinician. The Y-BOCS OCD assessment helps diagnose OCD and guides treatment by identifying specific thought patterns and behaviors.

(Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive Scale.” Arch Gen Psychiatry 46:1006-1011,1989; Scahill, L., Riddle, M.A., McSwiggin-Hardin, M., Ort, S.I., King, R.A., Goodman, W.K., Cicchetti, D. & Leckman, J.F. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry, 36(6):844-852.)

Dimensional OCD Scale (DOCS)

The Dimensional Obsessive Compulsive Scale (DOCS) is a diagnostic and progress-tracking tool that breaks OCD symptoms into four primary dimensions: Contamination and Sickness, Responsibility for Harm or Mistakes, Unacceptable or Taboo Thoughts, and Incompleteness/Asymmetry. This OCD scale asks patients or providers to rate symptoms based on five domains, including time spent, distress intensity, avoidance behaviors, day-to-day impact, and difficulty dismissing compulsions. The DOCS is used periodically to evaluate symptom change over time.

(Abramowitz, J. S.; Deacon, B.; Olatunji, B.; Wheaton, M. G.; Berman, N.; Losardo, D.; Timpano, K.; McGrath, P.; Riemann, B.; Adams, T.; Bjorgvinsson, T.; Storch, E. A.; Hale, L. (2010). “Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale”. Psychological Assessment. 22 (1): 180–198. doi:10.1037/a0018260. PMID 20230164. S2CID 7206349.)

Family Accommodation Scale

When working with children or individuals who live with others, the Family Accommodation Scale can be a valuable OCD assessment tool. It identifies accommodations that family members may perform to reduce the patient’s distress, such as reassurance or participation in rituals. The scale helps identify unhelpful behaviors that may interfere with treatment. By regularly using this screening tool for OCD, families and providers can track changes and support treatment planning.

(The Family Accommodation Scale for Obsessive Compulsive Disorder – Self-Rated Version (FAS-SR) Copyright © 2012 by Anthony Pinto, Ph.D., Barbara Van Noppen, Ph.D., & Lisa Calvocoressi, Ph.D. The Family Accommodation Scale for Obsessive Compulsive Disorder – Self-Rated Version (FAS-SR) includes a modified version of the Yale Brown Obsessive Compulsive Scale (YBOCS) Checklist, copyright © 1986, 1989, with permission.)

Why OCD Assessments Matter

Using validated OCD assessment tools supports effective diagnosing of OCD, tracks treatment progress, and identifies areas where patients and families need support. Whether it’s the Y-BOCS assessment, the OCI OCD inventory, or other tools, structured assessments provide insights that lead to better outcomes for those living with OCD.