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

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Type classification: this is an evidence-based assessment resource.

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What is a "portfolio"?

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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.

Preparation phase

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Diagnostic criteria for obsessive-compulsive disorder

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ICD-11 Criteria [1]

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

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Demography Setting Base Rate Diagnostic Method
National (U.S.) adult

sample (N=2073)[2]

National Comorbidity Survey Replication 2.3% World Health Organization Composite

International Diagnostic Interview (CIDI 3.0)

U.S. household sample

(N=18572)[3]

Epidemiological Catchment Area (ECA) Program 1.9-3.3% Diagnostic Interview Schedule (DIS)
Iranian adults

(N=25180)[4]

Iranian population-based study 1.8% DIS
NSAL adult study

(N=5191)[5]

African-American and Caribbean Households (U.S.) 1.6% CIDI Short Form
Epidemiological sample

(N=6616)[6]

Singapore Mental Health Study 3.0% CIDI 3.0

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

Prediction phase

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The following section contains a list of screening and diagnostic instruments for obsessive-compulsive disorder.

Screening Instrument Format Age Range Administration Time Where to Access
Children’s Florida Obsessive–Compulsive Inventory (C-FOCI) [7] Self-report 7-17 years 5 mins
Obsessive–Compulsive Inventory—Child Version (OCI-CV) [7] Self-report 7-17 years 21 items
Children’s Obsessional Compulsive Inventory-Revised-Self Report (ChOCI-R-S) [7] Self-report 7-17 years 32 items ChOCI-R-S

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

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  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
Screening Measure (Primary Reference) Area Under curve (AUC) and Sample Size LR+ (Score) LR- Clinical generalizability Download Link
Y-BOCS-II-SR[8] 0.75

(N=162)

5.50

(7)

0.50 Moderate: OCD among pregnant and postpartum women Y-BOCS-II-SR
OCI-R Total[9] 0.81

(N=322)

3.66

(14)

0.44 High: OCD (n=167) versus other anxiety disorders (n=155) at outpatient anxiety clinic OCI-R Total
OCI-R Total[9] 0.82

(N=458)

2.98

(18)

0.36 High: OCD (n=215) versus other anxiety disorders (n=243) at outpatient anxiety clinic OCI-R Total
Brown Assessment of Beliefs Scale[10] (N=50) BABS
  • “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).

Prescription phase

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Gold standard diagnostic interviews

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  • For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.
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Diagnostic Interview Format Age Range/ Administration Time Where to Access
Anxiety Disorders Interview Schedule[11] Semistructured interview 6-16 years 1.5-2 hours
Yale-Brown Obsessive Compulsive Scale Symptom Checklist[12] Semistructured interview 6-17 years Up to 60 mins Y-BOCS

Assessment Center Online Version

Brown Assessment of Beliefs Scale[10] Semistructured interview 16+ years 7 items BABS
OCD module of the Structured Clinical Interview for DSM-5 (SCID-5) Semi-structured interview 18+ years 90 mins SCID-5

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

Process phase

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Treatments

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

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  • Behavior therapy, specifically ERP, has been established as the treatment of choice for OCD.[13][14]
  • 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[15]
    • Cognitive Therapy of Obsessive-Compulsive Disorder: A Guide for Professionals (Wilhelm & Steketee)
    • Obsessive Compulsive Disorder: Advances in Psychotherapy [16]
  • Treatment alliance is a predictor of subsequent change in OCD symptoms.[17] The therapist should provide a “validating and
encouraging” environment so that clients can tolerate the emotional arousal associated with exposures.

Medication

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Process and outcome measures

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Clinically significant change benchmarks with common instruments and mood rating scales

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Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
Benchmarks Based on Published Norms
A B C 95% 90% SEdifference
Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR) Total 10.6 14.4 12.6 4.7 3.9 2.4
Obsessions 6.6 7.6 7.0 2.5 2.1 1.3
Compulsions 3.5 8.2 6.1 3.6 3.0 1.8
Obsessive-Compulsive Inventory – Revised (OCI-R) Total 1.0 41.0 23.0 14.8 12.5 7.6
Washing n/a 7.4 3.1 3.4 2.9 1.7
Checking n/a 8.0 3.7 3.0 2.5 1.5
Ordering n/a 10.5 4.6 3.1 2.6 1.6
Obsessing n/a 8.3 4.7 3.8 3.2 1.9
Hoarding n/a 9.8 4.1 2.8 2.4 1.4
Neutralizing n/a 6.2 2.3 3.0 2.5 1.5
Dimensional Obsessive Compulsive Scale (DOCS) Total n/a 31.7 19.0 10.3 8.7 5.3
Contamination n/a 7.8 3.4 2.4 2.0 1.2
Responsibility for Harm n/a 8.7 4.4 2.4 2.0 1.2
Unacceptable Thoughts n/a 9.6 5.4 2.5 2.1 1.3
Symmetry n/a 7.9 3.6 2.2 1.8 1.1

Process measures

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  • Quality of Life
    • Sheehan Disability Scale[18]
    • Medical Outcomes Study (MOS) 36-Item Short Form (SF-36) Health Survey[19]
  • SUDS Ratings
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References

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Click here for references
  1. ↑ "ICD-10 Version:2016". apps.who.int. Retrieved 2018-03-01.
  2. ↑ Ruscio, AM; Stein, DJ; Chiu, WT; Kessler, RC (January 2010). "The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.". Molecular psychiatry 15 (1): 53-63. PMID 18725912. 
  3. ↑ Karno, M; Golding, JM; Sorenson, SB; Burnam, MA (December 1988). "The epidemiology of obsessive-compulsive disorder in five US communities.". Archives of general psychiatry 45 (12): 1094-9. PMID 3264144. 
  4. ↑ Mohammadi, MR; Ghanizadeh, A; Rahgozar, M; Noorbala, AA; Davidian, H; Afzali, HM; Naghavi, HR; Yazdi, SA et al. (14 February 2004). "Prevalence of obsessive-compulsive disorder in Iran.". BMC psychiatry 4: 2. PMID 15018627. 
  5. ↑ Himle, JA; Muroff, JR; Taylor, RJ; Baser, RE; Abelson, JM; Hanna, GL; Abelson, JL; Jackson, JS (2008). "Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the National Survey of American Life.". Depression and anxiety 25 (12): 993-1005. PMID 18833577. 
  6. ↑ Subramaniam, M; Abdin, E; Vaingankar, JA; Chong, SA (December 2012). "Obsessive--compulsive disorder: prevalence, correlates, help-seeking and quality of life in a multiracial Asian population.". Social psychiatry and psychiatric epidemiology 47 (12): 2035-43. PMID 22526825. 
  7. ↑ 7.0 7.1 7.2 Eric A. Youngstrom, Mitchell J. Prinstein, Eric J. Mash, & Russell A. Barkley. (2020). Assessment of Disorders in Childhood and Adolescence, Fifth Edition: Vol. Fifth edition. The Guilford Press
  8. ↑ Steketee, G; Frost, R; Bogart, K (August 1996). "The Yale-Brown Obsessive Compulsive Scale: interview versus self-report.". Behaviour research and therapy 34 (8): 675-84. PMID 8870295. 
  9. ↑ 9.0 9.1 Foa, EB; Huppert, JD; Leiberg, S; Langner, R; Kichic, R; Hajcak, G; Salkovskis, PM (December 2002). "The Obsessive-Compulsive Inventory: development and validation of a short version.". Psychological assessment 14 (4): 485-96. PMID 12501574. 
  10. ↑ 10.0 10.1 Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., & al, e. (1998). The brown assessment of beliefs scale: Reliability and validity. The American Journal of Psychiatry, 155(1), 102-8. Retrieved from http://libproxy.lib.unc.edu/login?url=https://search.proquest.com/docview/220481418?accountid=14244
  11. ↑ Brown, T.A., Di Nardo, P.A., Barlow, D.H., 1994. Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV-L). Psychological Corporation, San Antonio, TX.
  12. ↑ Steketee, G. "The Yale-Brown Obsessive Compulsive Scale: Interview versus self-report". Behaviour Research and Therapy 34 (8): 675–684. doi:10.1016/0005-7967(96)00036-8. http://linkinghub.elsevier.com/retrieve/pii/0005796796000368. 
  13. ↑ Whittal M.L., McLean P.D., Söchting I., Koch W.J., Taylor S., Anderson K., Paterson R.OCD treatment outcome using behavioral and cognitive approaches Paper presented at the meeting of the Association for Advancement of Behavior Therapy, Miami Beach, FL (1997)
  14. ↑ Foa, Edna B.; Kozak, Michael J.. "Beyond the efficacy ceiling? Cognitive behavior therapy in search of theory". Behavior Therapy 28 (4): 601–611. doi:10.1016/s0005-7894(97)80019-6. https://doi.org/10.1016/S0005-7894(97)80019-6. 
  15. ↑ E. Foa, M. Kozak Mastery of obsessive–compulsive disorder: A cognitive-behavioral approach Graywind Publications (1997)
  16. ↑ S., Abramowitz, Jonathan (2006). Obsessive compulsive disorder. Cambridge, MA: Hogrefe & Huber Publishers. ISBN 9780889373167. OCLC 70659789. https://www.worldcat.org/oclc/70659789. 
  17. ↑ Keeley, M. L., Geffken, G. R., Ricketts, E., McNamara, J. P., & Storch, E. A. (2011). The therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive–compulsive disorder. Journal of Anxiety Disorders, 25(7), 855-863.
  18. ↑ Sheehan DV, Harnett-Sheehan K, Raj BA. 1996. The measurement of disability. Int Clin Psychopharmacol 11(Suppl 3): 89–95.
  19. ↑ McHorney, C., Ware, J., & Raczek, A. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs. Medical Care, 31(3), 247-263. Retrieved from http://www.jstor.org/stable/3765819

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