How is Obsessive Compulsive Disorder (OCD) Diagnosed?
Obsessive Compulsive Disorder, or OCD, is a common mental health condition that impacts over 8 million US adults over the course of their lifetime. If you feel that OCD may be impacting your life, you may be curious about how OCD is formally diagnosed. Dr. Holly Betterly MD, Board-Certified Psychiatrist, provides an overview of the diagnostic process for OCD, including some common instruments used by mental health professionals.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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What is Obsessive Compulsive Disorder (OCD)?
The Obsessive Compulsive Inventory (OCI)
What is Obsessive Compulsive Disorder (OCD)?
Obsessive Compulsive Disorder (OCD) is a common mental health condition that can seriously impact your daily functioning and overall quality of life. It’s characterized by the presence of obsessions, or unwanted, intrusive thoughts, images or urges, and/or compulsions, or repetitive behaviors aimed at reducing the distress associated with obsessions.
OCD impacts millions of people worldwide, and can be seen in both children and adults. OCD often develops gradually during adolescence or young adulthood, and can take many years to be diagnosed.
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), known as the DSM-5, outlines a set of diagnostic criteria for OCD.
The four diagnostic criteria found in the DSM-5 can be summarized as:
Criterion A: Presence of obsessions, compulsions, or both
Criterion B: The obsessions or compulsions are time-consuming (e.g. take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Criterion C: The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition.
Criterion D: The disturbance is not better explained by the symptoms of another mental disorder
The DSM-5 defines obsessions and compulsions as follows:
Obsessions:
“Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.”
“The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion)”
Compulsions:
“Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., 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.”
“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.”
Who can diagnose OCD?
A formal diagnosis of OCD can only be provided by a professional who is licensed to diagnose mental health conditions. The specific types of professionals who are able to provide a formal diagnosis is often determined by state law and varies from one state to another, but generally includes psychiatrists and psychologists, among others.
Psychiatrists are medical doctors (MD or DO) who specialize in the diagnosis and treatment of mental health conditions, like OCD. They are licensed to prescribe medications used to treat OCD, such as SSRIs.
Psychologists are professionals trained in the field of psychology, the study of the mind and human behavior. Clinical psychologists usually require a doctoral degree, such as PsyD or PhD. Like psychiatrists, they are trained in the diagnosis and treatment of mental health conditions. They may have experience in conducting psychological testing. In most states, they are unable to prescribe medications.
How is OCD diagnosed?
OCD is a clinical diagnosis, which means that there is no one specific test that can provide a definitive diagnosis in the way that some other medical conditions may be diagnosed. While the flu virus may be diagnosed with a nasal swab, or high blood pressure may be diagnosed with a measurement from a blood pressure cuff, OCD can only be diagnosed after a comprehensive evaluation by a mental health professional licensed to provide a diagnosis.
A comprehensive psychiatric evaluation, conducted by a psychiatrist, involves a thorough assessment of many different factors.
Some factors that may be included in the evaluation include:
Checking your vital signs, such as your heart rate and blood pressure.
Questions about your current and past mental health concerns.
Questions about various aspects of your daily functioning, such as your sleep patterns, appetite, and energy levels, your performance at work or school, or your social relationships.
Questions about various different mental health symptoms in order to screen for various mental health conditions
Questions about your medical history, such as your medical conditions, medications, allergies, and any surgical procedures you may have had
Questions about your family’s medical history
Questions about your mental health history, including any past diagnoses or treatments, such as medications or therapy
Questions about current or past drug or alcohol use
Questions about various aspects of your background, such as developmental milestones, childhood, education, employment, living situation, relationships, religion, and traumatic events or abuse.
Your psychiatrist may also administer screening tools or instruments aimed at taking a closer look at specific symptoms and the ways that they may be impacting you. These may help to assess for the presence of specific mental health conditions, like OCD. Some common tools which may be used when assessing for OCD include the Obsessive Compulsive Inventory (OCI) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which we will review in the next section.
After your psychiatrist has finished gathering all of the information that they need, they will consider all of the different potential causes for the mental health symptoms that you are experiencing in order to provide you with a diagnosis. They consider whether the symptoms that you are experiencing meet the DSM-5 diagnostic criteria for a specific mental health condition.
In some cases, they may need to obtain additional information before they can provide a diagnosis. This may include blood tests, imaging, or referrals to medical specialists, such as a neurologist. It may also include a referral to a psychologist for the administration of formal psychological testing measures.
The Obsessive Compulsive Inventory Revised (OCI-R)
The Obsessive Compulsive Inventory Revised, or OCI-R, is a self report questionnaire that assesses for the presence and severity of various symptoms of OCD. While it can be a helpful tool to use as part of a comprehensive evaluation for OCD, the OCI-R alone is not diagnostic.
The OCI-R contains 18 different items, which measure symptoms across 6 different sub scales of OCD, including washing, checking, neutralizing, obsessing, ordering, and hoarding. For each item, the patient must select a number on a four point scale that best describes the extent to which the symptom in question distressed or bothered them over the past month. The scores from each of the 18 items are added together to calculate a total score ranging from 0 to 60. This score can be compared to a recommended cutoff score. The questionnaire can be repeated over time, comparing the scores to measure response to treatment.
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
The Yale-Brown Obsessive Compulsive Scale, or Y-BOCS, is the most commonly used rating scale for OCD. The Y-BOCS is administered by a mental health professional, however self-report versions are also available. It contains 10 different items aimed at assessing the severity of various symptoms of OCD. While it can be a helpful tool to use as part of a comprehensive evaluation for OCD, the Y-BOCS alone is not diagnostic.
Before completing the rating scale, the patient is provided with a checklist of various symptoms of OCD, which allows them to identify both current and past symptoms. After completing the checklist, the 10 item rating scale is administered, which involves assigning a numerical score from 0 to 4 for each item based on the severity of the symptom in question. The first 5 items assess the severity of obsessions, while the second 5 items assess the severity of compulsions. The scores for each item are added up to provide an overall score, which corresponds to different OCD symptom severities, ranging from subclinical to extreme. The Y-BOCS can be repeated over time, comparing the scores to measure response to treatment.
How do I find a professional to evaluate me for OCD?
If the symptoms of OCD sound familiar to you, reach out to a psychiatrist or psychologist for further evaluation.
To locate a psychiatrist in your area, you can utilize the free search tool from the American Psychiatric Association.
To locate a psychologist in your area, you can utilize the free search tool from the American Psychological Association.
Located in Florida? Dr. Holly Betterly, MD is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome OCD. She offers appointments at her office in Weston, FL, as well as appointments via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
