Is This OCD? Diagnosing Obsessive Compulsive Disorder

 

Common Assessment Tools for Identifying and Treating OCD

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.

OCD Assessment Tools

The Obsessive Compulsive Inventory (OCI)
The Obsessive Compulsive Inventory (OCI) is a 42-item measure and screening tool for some OCD symptoms that a patient can complete independently or during a structured interview. The OCI measures some OCD symptoms, including Checking, Doubting, Ordering, Hoarding, and Neutralizing. This assessment offers check box examples that a patient and provider can indicate the severity of each prompt on mild to severe ranges and scores are added to determine the occurrence and severity of one’s OCD. The measure can also be given periodically during treatment to measure progress made in each area and help providers target treatment.

(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)
One of the most widely used assessments is the Yale Brown Obsessive Compulsive Scale (YBOCS) or the Child Yale Brown Obsessive Compulsive Scale (C-YBOCS) and is considered the Gold Standard of OCD assessments. These assessments identify the presence of obsessions and compulsions by offering examples that a patient can check independently or during a structured interview with a provider. The Y-BOCS helps providers and patients identify current and past obsessions and compulsions, and can provide structure in treatment.

(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 OCD Scale is an assessment that breaks down OCD into four main categories, although there are some obsessions that may not fit neatly into these categories of Contamination and Sickness, Responsibility for Harm or Mistakes, Unacceptable or Taboo thoughts, and Incompleteness/Asymmetry. This assessment can be self-reported by the patient or given as an interview by the provider. The patient or provider will scale their symptoms in 5 domains, including estimated hours per day experiencing symptoms, degree of intensity of anxious distress, degree of avoidance behaviors, degree of impact on day-to-day functioning, and degree of difficulty in disregarding their compulsions. This assessment can be given at periodic intervals during treatment to measure improvements by comparing scores.

(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
With patients who are children or live with a family, we may often use the Family Accommodation Scale, which can identify potential accommodations performed by family members that can harm progress in treatment. A family member, spouse, or guardian may complete a Family Accommodation Scale alone or assisted by a provider. The prompts ask how many days a week a person may be performing common accommodations to help identify accommodations and to measure improvement in reduced accommodations over time. They can also help a family identify which accommodations to begin eliminating and help provide structure to treatment.

(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.)

Assessments help both professionals, patients, and their families understand the specific symptoms present in a disorder and can be used to identify areas of progress in treatment by comparing previous results with current scores.