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

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## 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.

## Preparation phase
### 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

| Demography | Setting | Base Rate | Diagnostic Method |
| National (U.S.) adult sample (N=2073) | National Comorbidity Survey Replication | 2.3% | World Health Organization Composite International Diagnostic Interview (CIDI 3.0) |
| U.S. household sample (N=18572) | Epidemiological Catchment Area (ECA) Program | 1.9-3.3% | Diagnostic Interview Schedule (DIS) |
| Iranian adults (N=25180) | Iranian population-based study | 1.8% | DIS |
| NSAL adult study (N=5191) | African-American and Caribbean Households (U.S.) | 1.6% | CIDI Short Form |
| Epidemiological sample (N=6616) | 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
### Recommended screening instruments

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) | Self-report | 7-17 years | 5 mins | |
| Obsessive–Compulsive Inventory—Child Version (OCI-CV) | Self-report | 7-17 years | 21 items | |
| Children’s Obsessional Compulsive Inventory-Revised-Self Report (ChOCI-R-S) | 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

* 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 | 0.75 (N=162) | 5.50 (7) | 0.50 | Moderate: OCD among pregnant and postpartum women | Y-BOCS-II-SR |
| OCI-R Total | 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 | 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 | (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
### 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

| Diagnostic Interview | Format | Age Range/ | Administration Time | Where to Access |
| Anxiety Disorders Interview Schedule | Semistructured interview | 6-16 years | 1.5-2 hours | |
| Yale-Brown Obsessive Compulsive Scale Symptom Checklist | Semistructured interview | 6-17 years | Up to 60 mins | Y-BOCS Assessment Center Online Version |
| Brown Assessment of Beliefs Scale | 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
### Treatments
#### 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 and outcome measures
#### Clinically significant change benchmarks with common instruments and mood rating scales

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

### Process measures

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

## External Links

* Society of Clinical Child and Adolescent Psychology
* EffectiveChildTherapy.Org information on rule-breaking, defiance, and acting out
* For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com