Clinical Presentation
Obsessive Compulsive Disorder_Initial Assesment 1
Common Symptoms of Obsessive-Compulsive Disorder
Symptoms of obsessions include fear of contamination, fear of harm coming to self, fear of causing harm to someone else, fear of being unacceptable, fear of making a mistake, need for exactness, order, and symmetry, obsessions with the body or physical symptoms, sexual and religious thoughts, urge to hoard useless or worn-out possessions, and thoughts of aggression or violence.
Symptoms of compulsions include checking; cleaning or washing; mental compulsions; arranging, symmetry, and exactness; hoarding or collecting; counting; repeating words silently; ruminating thoughts; neutralizing thoughts; and asking for reassurance.
Tiền sử bệnh
A comprehensive medical history and mental status examination are fundamental to diagnosing obsessive-compulsive disorder, distinguishing it from other conditions, predicting outcomes, and building a treatment plan. Determine whether a patient experiences obsessions, compulsions, or a combination of both. Screen for other mental health issues (eg depression, bipolar disorder, and anxiety disorders) and review for past psychiatric and general medical histories, including medications, and known allergies. Gather psychosocial data regarding family dynamics, environmental stressors, and educational background, any family history of obsessive-compulsive disorders and other psychiatric conditions. Conduct safety assessments to identify any immediate risks to the patient or others.
Diagnosis or Diagnostic Criteria
Obsessive Compulsive Disorder_Initial Assesment 2
A clinical interview that elicits a history of intrusive thoughts or behavioral rituals is the primary method of establishing the diagnosis.
Obsessive-compulsive disorder diagnostic criteria based on DSM-5 are the presence of symptoms of obsessions, compulsions, or both.
Obsession symptoms include:
- Intrusive, unnecessary thoughts, urges, or images that are recurrent and persistent, causing significant anxiety or distress in an individual
- The individual takes efforts of ignoring or suppressing such thoughts, urges, or images or tries to neutralize them with some other thought or action (ie by performing compulsion)
Compulsion symptoms include:
- The individual feels impelled to do repetitive behaviors (eg hand washing, ordering, checking) or mental acts (eg praying, counting, repeating words silently) as a response to an obsession or according to rules that must be strictly applied
- The behaviors or mental acts are done to prevent or reduce anxiety or distress or to prevent some dreaded event or situation, but these acts are not associated in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
Based on DSM-5 criteria, the above disturbances should be:
- Time-consuming (>1 hour/day) or cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning
- Not secondary to any medication, substance of abuse, or another medical condition
- Not associated with symptoms of other mental disorders (eg generalized anxiety disorder, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriation disorder, stereotypic movement disorder, eating disorders, substance-related and addictive disorders, illness anxiety disorder, paraphilic disorders, disruptive impulse-control and conduct disorders, major depressive disorder, schizophrenia, or autistic disorder)
According to DSM-5, specify obsessive-compulsive disorder if:
- with good or fair insight when the patient knows that the disorder beliefs are definitely or probably not true or may or may not be true
- with poor insight when the patient thinks that the disorder beliefs are probably true
- with absent insight/delusional beliefs when the patient believes that the disorder beliefs are true
The presence of a tic disorder prior to or during evaluation should be included when making the diagnosis.