Obsessive-compulsive disorder (OCD) is a chronic, disabling mental condition affecting 2.3% of adults in the United States. Unfortunately, OCD can be challenging to correctly identify, with individuals often waiting many years to get accurately diagnosed so they may begin treatment. As such, getting an accurate diagnosis as early as possible is an imperative first step toward recovery.
OCD assessments can help clinicians uncover vital pieces of information about symptoms during the initial interview and as treatment progresses. OCD assessment measures are also efficient and effective screening tools, helping clinicians identify potential cases of OCD among their patients.
Read on to learn about OCD and how it is diagnosed. Then learn more about the Yale-Brown Obsessive-Compulsive Scale and how it is used. Finally, review other assessments that clinicians may use when evaluating patients for OCD symptoms.
Obsessive-Compulsive Disorder (OCD) is a disorder where individuals ruminate over unwanted anxiety-producing thoughts and sensations (obsessions) and feel driven to perform time-consuming repetitive behaviors (compulsions).
Individuals are persistently distressed by their obsessions. Many realize their obsessive thoughts are unrealistic or not harmful, but they cannot release or resolve them through logic. Instead, individuals perform compulsions in an attempt to soothe themselves.
Individuals are rigid about compulsive behavior, and not doing them can cause significant distress. Compulsions are often exaggerated responses to the obsession, such as extreme checking to prevent the realistic but unlikely event of a house fire. Eventually, these compulsive behaviors become disruptive to daily activities and the individual’s relationships, taking at least one hour or more a day to perform compulsive behaviors, and the failure to do so can create significant distress.
Common OCD-related obsessions Include:
OCD-related compulsions are too numerous to count. That said, they do include the following, clarifying examples:
Obsessive-compulsive disorder (OCD) is among the most common psychological disorders, but it can take up to 13 years for individuals to be accurately diagnosed, with many cases being initially misdiagnosed by primary care physicians.
Clinicians primarily evaluate individuals for OCD with a structured clinical interview, but may also utilize assessments and recommend a medical exam. When diagnosing OCD, clinicians typically take a comprehensive look at the patient’s symptoms and current situation. A clinical interview is the primary OCD evaluation tool, while assessments and a medical exam may provide additional information.
Assessments help clinicians measure OCD symptoms as part of the diagnostic and treatment process. The value of OCD assessments is their standardized approach, helping clinicians quickly identify aspects of a patient’s symptoms that have been determined clinically valuable.
Screening tools for OCD are usually brief and can indicate the presence of specific symptoms that may warrant further exploration. OCD measurement scales such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) help define a patient’s symptom severity, an essential aspect of mental health conditions.
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is frequently used by clinicians when assessing individuals for obsessive-compulsive disorder. Its focus on symptom severity provides valuable insight into the impact OCD symptoms have on patients’ lives.
The Y-BOCS is a clinician-administered assessment consisting of a symptom checklist and a severity scale, widely considered the gold standard in assessments for OCD symptom severity. Understanding symptom severity is crucial because it influences the level of care, types of interventions, and even eligibility for government disability support due to severe impairment. OCD measures such as the Y-BOCS can expand a clinician’s understanding of an individual’s symptoms, but they are not designed to diagnose OCD.
Symptom Checklist
As part of the Y-BOCS test, the patient is asked to complete a checklist including 54 common OCD obsessions and compulsions, marking any symptoms they endorse as being present in the last week.
Severity Scales
The clinician, on their part, completes the 10-item severity scale portion of the assessment by conducting a semi-structured interview.
Additional Symptom Dimensions
The clinician also rates each symptom according to the following five dimensions: insight, avoidance, indecisiveness, responsibility, pervasive slowness, and doubting. However, these are not part of the standard core assessment and are not consistently used by most clinicians.
The Y-BOCS is often included as part of a more comprehensive diagnostic process, helping clinicians and researchers understand the severity of individuals’ symptoms. It can also be used throughout the treatment process to track symptoms and measure their response to interventions over time. Y-BOCS results can provide valuable information for a clinician doing an in-depth clinical interview and assessment for OCD. However, symptom severity is only one piece of the picture, and the Y-BOCS is not designed as a stand-alone tool to diagnose individuals with OCD. In other words, completing this assessment is not equivalent to being evaluated and diagnosed by a qualified clinician.
While the Y-BOCS remains the most widely used assessment tool for OCD, the following assessments can provide valuable non-clinical perspectives on an individual’s condition.
A clinical interview is the primary method for diagnosing patients with psychological disorders, providing clinicians an opportunity to observe emotional responses and body language as patients talk about their symptoms. Interview questions are intended to stimulate detailed discussions about OCD symptom presentation, duration, and triggers. Clinicians may also observe evidence of these symptoms, such as chapped hands from overwashing, or checking behavior during the interview.
Repetitive thoughts and behaviors are hallmarks of OCD, but they can also present as symptoms of other conditions, such as Parkinson’s disease, brain injury, or Tourette’s syndrome. Clinicians may refer individuals to their primary care providers or a specialist for a physical exam to rule out other conditions. Also, getting updated medical health information can assist clinicians as they consider the health implications of medications and other interventions.
The Yale-Brown Obsessive–Compulsive Scale – Self-Report (Y-BOCS-SR) is comprised of a symptom checklist and severity scale, mirroring the standard Y-BOCS. This self-administered test asks individuals to indicate symptoms they have experienced in the last week and rank their top three symptoms. Individuals rate all symptoms across the following dimensions: time spent, interference, distress, resistance, and control.
The Dimensional Obsessive–Compulsive Scale (DOCS) takes a deeper look into the severity of symptoms by examining four factors: germs and contamination; responsibility for harm, injury, or bad luck; unacceptable obsessional thoughts; and symmetry, completeness, and exactness. Individuals then rate these factors across the same dimensions as the Y-BOCS and Y-BOCS-SR: time spent, interference, distress, resistance, and control.
The Family Accommodation Scale (FAS) can be administered to family members of a child, adolescent, or adult with OCD symptoms to determine the extent of family accommodation. Studies report that 60-97% of family members of individuals with OCD accommodate their symptoms, meaning that family members help individuals feel less distressed by participating in or facilitating their compulsive and avoidant behaviors.
However well-meaning, this accommodation prevents individuals from learning to tolerate their distress and develop healthier coping methods. Understanding this dynamic can help clinicians involve and educate family members throughout the OCD treatment process.
Getting an accurate diagnosis is a vital part of managing obsessive-compulsive disorder, a common but disabling mental condition. While the clinical interview is the foundation of a thorough OCD evaluation, assessments such as the Y-BOCS can bring valuable clinical information into the picture.
