OCD Diagnosis
Obsessive Compulsive Disorder (OCD) Diagnostic Criteria
The initial criterion necessary for an OCD diagnosis is the presence of obsessions or compulsions. The American Psychiatric Association (APA, 2000) defines obsessions as recurrent and persistent thoughts, impulses or images that are experienced as intrusive and inappropriate, causing marked anxiety or distress. The thoughts, impulses and images are not excessive worries about existent life problems. The person attempts to ignore, suppress or neutralize obsessions with other thoughts and actions. Obsessional thoughts, impulses and images must be recognized by the person as a product of his or her own mind and not resulting from external thought insertion (APA,2000). If obsessions are not present one must have compulsions in order to be diagnosed OCD.
Both obsessions and compulsions can be present and may be related or occur independently of each other (Riggs & Foa, 2006). Compulsions include repetitive behaviors that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly (APA, 2000). If these behaviors are not completed the person will experience great distress, despite the lack of necessity. The DSM-IV-TR states that the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however they are not connected in a realistic way with what they are designed to neutralize or prevent and are clearly excessive. The person, unless they are a child, must recognize the obsessions or compulsions as excessive or unreasonable. Compulsions can be behavioral or mental, also known as overt or covert (Riggs & Foa, 2006). For example, a person who is constantly cleaning has a behavioral compulsion, while those who are continuously counting experience a mental compulsion.
The final criteria for an OCD diagnosis include marked distress or interference in daily functioning which are not related to other mental illness, substance abuse, or a general medical condition. The DSM-IV-TR states that obsessions and compulsions must be time consuming, taking more than one hour per day, or significantly interfere with the person’s normal routine, occupational or academic functioning or usual social activities and relationships.
Common Obsessions and Compulsions to Assist in the Diagnosis of OCD
Merlo & Storch (2006), identified in The Journal of Family Practice, common obsessions and compulsions related to OCD. Common obsessions include those of contamination, aggression, sexual, hoarding, magical thinking, health related, mortality and religion amongst many other miscellaneous topics of concern. Contamination obsessions are often evidenced by distress caused by dirt, germs, disease, illnesses etcetera. Aggressive obsessions may include the harming of oneself or others due to acting on impulses behaviorally or through thoughts. Frightening and violent mental images are examples of compulsions marked by aggression. Sexual obsessions include forbidden thoughts, images, impulses, desires and sexual acts toward others. Obsessional hoarding or saving is characterized by distress due to losing things or throwing away objects that may hold some significance or value. Magical thinking encompasses obsessive thoughts or beliefs holding great significance such as lucky or unlucky numbers, colors and names. Health or body obsessions may be related to fear of contracting an illness, physical appearance, and physical abnormalities that may be real or imagined. Obsessions related to mortality and religion are often associated with dying and not going to heaven, offending God, being sinful, and right vs. wrong. The final miscellaneous obsessions include memorization, music, numbers or the avoidance of the use of specific words (Merlo & Storch, 2006). These obsessive concerns are commonly present when diagnosing OCD and are used in the Yale-Brown Obsessive-Compulsive Scale, as are the following compulsive rituals.
Common compulsions in the diagnosis of OCD include washing and cleaning, checking, repeating, counting, ordering or arranging, hoarding and saving, superstitions, reassurance seeking as well as miscellaneous compulsive rituals (Merlo & Storch, 2006). Merlo & Storch (2006) compiled the following descriptions as derived from the Yale-Brown Obsessive-Compulsive Scale. Washing and cleaning compulsions include excessive cleansing and avoidance of contamination. Checking is often characterized by rituals to ensure safety such as inspection of locks and alarms. Checking also includes intense scrutiny to avoid mistakes. Repeating includes rewriting, rereading, recopying and repetitious actions. Counting can be related to specific objects that a subject counts such as stairs, tiles and chewing or mental counting until reaching a magic number. Ordering or arranging includes lining objects in a specific manner, sometimes including patterns or even groups that create symmetry in appearance. Hoarding and saving includes keeping unimportant and unnecessary objects, sometimes including trash. Superstitious compulsions are completed to prevent bad things from happening such as the avoidance of stepping on cracks or repetitive touching or tapping. Reassurance seeking compulsions can include repeatedly asking the same questions or forcing family members to operate in certain ways while avoiding specific things or activities.
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Corcoran, J. & Walsh, J. (2006). Clinical assessment and diagnosis in social work practice. New York: Oxford University Press.
Merlo, L. & Storch, E. (2006). Obsessive-compulsive disorder: Tools for recognizing its many expressions. The Journal of Family Practice, Vol. 55, No.3.
Riggs, D. & Foa, E. (2006). Obsessive compulsive disorder. Medical College of Pennsylvania. Philadelphia: Psychiatric Institute.
