Obsessive Compulsive Disorder (OCD)- Diagnostic Interview

OPEN QUESTIONS

• Are you the sort of person that needs to do things in a particular order and if you don’t you get distressed about it?
• What about constantly checking things, feeling dirty or having annoying thoughts pop into your mind over and over?
• Would you consider yourself an obsessive person?

INTRUSIVE THOUGHTS (OBSESSIONS)

• Do you ever have thoughts or impulses that come into your mind even though you try not to have them?
• Do you find them intrusive?
• How do they make you feel in yourself? (anxiety-producing thoughts)
• Where do they come from?  Are they your own thoughts?  ( c.f. Thought insertion in schizophrenia where the thoughts come from an outside source) (This is no longer necessary in the DSM-V)
• Resistance: How hard is it to resist the thoughts or actions?
• Are there any situations that you avoid related to these thoughts or actions?

COMPULSIONS

• What do you do to relieve the anxiety?
• Does it make you feel less anxious?
• What would happen if you didn’t perform the action?
• Do you have any other ways of neutralising the distressing thoughts?
• Some people may pray or repeat words or count.  Do you do anything like that?
• Do you think these thoughts are senseless/excessive or unreasonable?
• How do they affect you?
• Does it affect your work / relationships?

IMPORTANT POINTS IN CLINICAL PRACTICE

• There may be specific domains of symptoms, e.g. aggressive thoughts, sexual/religious, symmetry/counting, hoarding, collecting and somatic.
• Be aware of Schizo-Obsessive Disorder, in which obsessive thoughts lie on a spectrum which may encroach on to the psychotic spectrum. Here, thoughts are bizarre and may have the characteristic of an overvalued ideation. This is relevant as an antipsychotic may be required
• Major Depressive Disorder (MDD) may exacerbate an underlying OCD. Treatment of MDD reduces OCD.
• OCD may be associated with Tourette’s disorder, trichillotomania and stereotypic movement disorder, e.g. skin picking, scratching, etc.
• Body Dysmorphic Disorder is classified under Obsessive-Compulsive and related disorders

Learn more:

Neurobiology, Diagnosis and Management of OCD