Evidence-based assessment/Obsessive-compulsive disorder (assessment portfolio)

What is a "portfolio"?
For background information on what assessment portfolios are, click the link in the heading above.

Want even more information about this topic? There's an extended version of this page here.

Diagnostic criteria for obsessive-compulsive disorder
ICD-11 Criteria Obsessive-Compulsive Disorder is characterized by the presence of persistent obsessions or compulsions, or most commonly both. Obsessions are repetitive and persistent thoughts, images, or impulses/urges that are intrusive, unwanted, and are commonly associated with anxiety. The individual attempts to ignore or suppress obsessions or to neutralize them by performing compulsions. Compulsions are repetitive behaviors including repetitive mental acts that the individual feels driven to perform in response to an obsession, according to rigid rules, or to achieve a sense of ‘completeness’. In order for obsessive-compulsive disorder to be diagnosed, obsessions and compulsions must be time consuming (e.g., taking more than an hour per day), and result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Inclusions
 * anankastic neurosis
 * obsessive-compulsive neurosis

Exclusions
 * obsessive compulsive behaviour (MB23.4)

Changes in DSM-5


 * The diagnostic criteria for obsessive-compulsive disorder changed slightly from DSM-IV-TR to DSM-5. Summaries are available here.

Base rates of obsessive-compulsive in different populations and clinical settings
Search terms:

[obsessive compulsive disorder OR ocd] AND [prevalence OR incidence] in PsycInfo and PubMed

[obsessive compulsive disorder OR ocd] AND [epidemiology] in PsycInfo and PubMed

Recommended screening instruments
The following section contains a list of screening and diagnostic instruments for obsessive-compulsive disorder. Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Likelihood ratios and AUCs of screening measures for OCD

 * For a list of the likelihood ratios for more broadly reaching screening instruments, click here.


 * “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Gold standard diagnostic interviews

 * For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic interviews for OCD
Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP)

 * Behavior therapy, specifically ERP, has been established as the treatment of choice for OCD.
 * Therapy incorporates ERP and emphasizes cognitive change.
 * Therapist will help individual identify anxiety-provoking thoughts and situations.
 * Therapist will develop a treatment plan and idiographic “fear hierarchy.”
 * Individuals will learn to encounter situations that invoke anxiety without engaging in rituals used to dispel anxiety (ERP).
 * Exposures will be done gradually at a pace that is comfortable for the client.
 * Therapy will include homework assignments and is designed to offer lifelong skills.
 * Therapy includes verbal techniques such as psychoeducation and cognitive restructuring.
 * Manuals for reference:
 * The therapist guide: Mastery of Obsessive-Compulsive Disorder: A Cognitive Behavioral Approach
 * Cognitive Therapy of Obsessive-Compulsive Disorder: A Guide for Professionals (Wilhelm & Steketee)
 * Obsessive Compulsive Disorder: Advances in Psychotherapy
 * Treatment alliance is a predictor of subsequent change in OCD symptoms. The therapist should provide a “validating and
 * encouraging” environment so that clients can tolerate the emotional arousal associated with exposures.

Medication

 * Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat OCD.
 * These antidepressants include:
 * fluvoxamine
 * fluoxetine
 * sertraline
 * paroxetine
 * citalopram
 * clomipramine
 * escitalopram
 * venlafaxine
 * High doses (relative to doses prescribed for depression) are needed for individuals with OCD.

Process measures

 * Quality of Life
 * Sheehan Disability Scale
 * Medical Outcomes Study (MOS) 36-Item Short Form (SF-36) Health Survey
 * SUDS Ratings