Diagnosing OCD

diagnosing obsessive compulsive disorder

Simple screening questions can be used clinically to help diagnose OCD when the symptoms are significantly distressing or interfering in a person's life. NICE suggests the following questions:

• do you wash or clean a lot?
• do you check things a lot?
• is there any thought that keeps bothering you that you would like to get rid of but cannot?
• do your daily activities take a long time to finish?
• are you concerned about putting things in a special order or are you very upset by mess?
• do these problems trouble you?

A positive response to one of the above questions warrants onward referral (1).

Some patients may have symptoms which are easily observable and reported while some may be unaware of their symptoms or feel too ashamed and stigmatised to seek help. These patients may present with

• dermatological symptoms due to excessive washing
• genital or anal symptoms from excessive checking and washing
• general stress e.g. - from losing a job as a result of repeated lateness
• doubts about contracting HIV

Covert or stigmatizing compulsions are difficult to recognise especially since patients believe that their own intrusive thoughts or images are too shameful and try to hide it without revealing the content of their intrusive thoughts (owing to the fear of being misunderstood or being reported to social services). Onward referral after reassuring the patient that unacceptable or senseless thoughts are extremely normal in OCD (1).

Reference:

• (1) Veale D, Roberts A. Obsessive-compulsive disorder. BMJ. 2014;348:g2183