In the previous post, I showed how OCD first impacts a person’s life in a creeping fashion, and then affects the social structure in which he/she is living. Incidentally, the effects of OCD can be very, very grave; loss of friendships, divorce, substance abuse, suicidal thoughts, and becoming bankrupt and homeless all are seen in people with very serious forms of the disorder.
But we are at the point now where a patient has found an expert (see last post, Aug 18, 2010). What does the clinician actually do to assess a person’s (degree of) OCD?
Basically, there are five instruments that are being used. These are:
- the clinical interview: this is a type of interview that is not defined exactly beforehand. The expert asks about features of the problem (e.g. which dimension(s) are involved), about the way in which it affects the subject’s life, about how it exerts influence on his/her social life, if there is some form of comorbidity, such as depression or tic disorder, and also positive factors are a topic of inquiry: how is the motivation of the patient regarding efforts that will have to be made; what does he/she think of institutionalization for a limited time; and what aims and prospects can the subject formulate for himself regarding his/her condition at half a year ahead in time?
- self-report instruments: numerous questionnaires have been developed over the years to assess the gravity of OCD in a person. Usually the subject is required to fill in a form that lists questions about obsessions and compulsions; the ways in which the disorder presents itself are addressed, as well as the time it consumes, and the burden it places on one. The answers provide an end result, e.g. in the form of a number of points, and this then is an indication of the grades of illness. Best-known are the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Padua Inventory. For those more deeply interested in these questionnaires, links to PDF and Word versions can be found (amongst others) at: http://www.goodmedicine.org.uk/goodknowledge/panic-ocd-depersonalization-information-assessment;
- structured interviews: this method means that the clinician himself presents the questions of the Y-BOCS questionnaire to a patient, and guides him/her through the procedure. It may be effective when a patient has obvious difficulties in trying to grade his/her own problems on a scale from zero to four points (example);
- behavioural observations: these can be useful in detecting types of behaviour that may be directly linked to OCD: for instance, some forms of the disorder involve a panical fear to lose or forget something. A clinician rapidly sees whether a client is prone to look back, or at the floor, intensely, for fear of having dropped something held dear;
- family reports: information coming from a client’s inner family circle can be helpful. Even in a clinical setting, a patient can be prone to ‘under-present’ his/her problems (e.g. for fear of institutionalization). Others then can add more objective reports about the condition under scrutiny, so that the best treatment can be proposed, based on a number of sources.