So, to summarise the last two posts, the diagnosis of OCD is not the exact science you might think. For me, it seems an exercise that is 40% clinical, 60% experiential. And even then, does one classify obsessive traits which aren’t unduly hampering a person’s life as OCD? The severity of OCD is a spectrum, it is also a multi-faceted condition with various themes, some of which are primary, some subordinate. It is a complicated matrix of obsessions and compulsions which can’t always be cross-referenced. It is a condition often characterised by the existence of co-morbid (existing alongside) other chronic conditions such as addictions, eating disorders and depression, among others. So, for my purposes, I’m going to re-phrase the question, “How would I know if I have OCD?” with “How would I know if I need treatment for my OCD?”. This is the question we are more focused upon and these are the criteria (mostly gained by experience) by which we, the OCDCentre, assess our clients:
- We look for at least one obsession AND one compulsion and it is not always easy to figure both out as clients often don’t know, e.g. a client may have 20 physical compulsions and then have no idea why they are doing them until we point out that the reason they are doing them is to avoid anxiety or panic, another may have obsessions but no physical compulsions yet they mentally negate the bad thought with a good thought (their compulsion)
- We ask the person why they think they have OCD? People with OCD are generally very bright and the reputed lead time between onset of OCD and seeking treatment is 11 years so most have a pretty good idea of what’s going on and how much it is affecting their lives
- We ask if the people around them are involved in their OCD? OCD is very lifestyle-invasive. Rarely do the people around them fail to notice, offer help, reassurance or collusion.
- We look for more than one OCD crisis in their life: some clients do come to us still shocked at the sudden attack of OCD from nowhere but very seldom can we not identify previous manifestations of OCD that they may not have recognized as such
- We look for various themes and subject matter: some of these are harm to self/others, loss of control, hyper-vigilance, contamination, perfection, certainty, intolerance of discomfort and many more
- We look at genetic links to OCD: even before research was published on the existence of a gene identified as significant in the development of OCD, we recognized that the occurrence of familial OCD was higher than might be expected
- We see how much of their day is spent on what they consider to be OCD: the DSM-IV criteria is more than one hour spent on an obsession or compulsion per day. I don’t want to sound patronizing but this seems a little naïve and the danger is that such a criteria could put doing your hair or fiddling with your scooter into this category. Truth to say, we haven’t had one poor client even close to this timescale. Would that this was the norm. We are looking for ratios much higher than this.
- We look at how well they are holding down their job and their significant relationships: as I said before, OCD is lifestyle invasive and these two criteria are critical in assessing the presence and severity of the condition
- We ask if they have been formally diagnosed elsewhere: healthcare professionals are becoming more aware of OCD, if still not sufficiently trained in how to treat it
- We have a checklist of the compulsions we consider to exemplify OCD (and they may not be what you think): because we have OCD and have recovered, we know the minutiae of the organized chaos that is OCD. I’m going out on a limb here but I’m not sure anyone who hasn’t got OCD will truly understand that multi-coloured thread that binds us together
- We look at co-morbid conditions: these are conditions that exist alongside OCD and complicate our diagnoses, e.g. depression, substance abuse, eating disorders, Autism, etc.
- We look at how they are achieving their goals and purposes in life: OCD isn’t like being pregnant or dead, it is actually a spectrum. Some people have mild traits that just show up when they are playing golf or reading the newspaper, others haven’t left their house for 4 years. If a person is getting their goals in life achieved and are not otherwise disturbed, they fall into the “OCD but not requiring treatment” category
- We ask them if they want to get better: yep, believe it or not, some people are “window shopping” or are encouraged to come by others and have no interest in getting better. Regardless of whether we think they have OCD or not and how severe, if they don’t think they have a problem they need to resolve, there is nothing we can say that will convince them
If you would like to take the OCDCentre assessment, click here.