Assessment

Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.

Most patients with OCD have both obsessions (which increase anxiety) and compulsions (which aim to decrease anxiety), particularly given that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition^[2] definition of compulsion includes mental rituals. The most common obsessions centre around concerns of contamination, harm, hoarding, and sexual, somatic and religious preoccupations, while the most common compulsions include washing, checking, repeating, ordering, counting, and hoarding.^[5] The disorder is highly comorbid with obsessive-compulsive and related disorders, major depressive disorder, anxiety disorders, alcohol dependence, eating disorders and tic disorders.^[6,7] 

Evaluation should include assessment of symptom pattern, severity, and functional impairment. Comorbid Axis I and II disorders, including tic disorders, as well as medical conditions (including pregnancy) and disorders need to be accurately identified.There is growing evidence that OCD and/or tics in some patients, particularly children, are precipitated or exacerbated by streptococcal or other infections.^[8]

Evaluation of the OCD patient also requires attention to psychosocial factors that may have precipitated or exacerbated OCD symptoms. For example, are family members involved in the patient’s rituals? 

What is the patient’s explanatory model of OCD - does he or she regard it as a sign of weakness or as evidence of brain dysfunction?