OCD Patient Interview
Content of the Obsessions
Clinicians need to remember that OCD is not simply about contamination and washing compulsions. There are numerous variations of OCD and, in many cases, unless specifically asked, the patient will not discuss certain obsessive thoughts. This is particularly true for the “taboo” obsessions of aggression, sex, and religion. Patients report feeling as if they will be judged by the clinician or even reported to the police for having such thoughts and then not treated if they divulge these obsessions.
The OCD interview starts with:
- 1) Ask the patient whether they have any thoughts that are intrusive, troubling, and that they cannot stop.
- 2) In addition, the clinician then needs to ask about any behaviors that are performed over and over again and that interfere with the person’s life or are distressing.
If the person does not fully understand the initial questions or seems reticent about answering, a follow-up question might be something such as:
“Many people have recurrent thoughts about any number of troubling ideas—contamination by germs, needing to have everything symmetrical, needing things “just right,” thoughts about their health, or even more troubling thoughts about sacrilegious, violent, or sexual behaviors—and they cannot seem to control these thoughts. Do you have any issues similar to these?”
Even when the patient endorses one particular theme of their obsessions, it is important to ask about the others as well. Many people with OCD have multiple obsessive thoughts and although one may be their primary obsession, it is important to assess and be aware of the others as well. Some people will report that the obsessive themes change over time resulting in the clinician feeling as if there is success when one obsession is gone without knowing another obsessive thought has become more significant.
If you feel you cannot remember all of the forms of OCD (of which there are many), going through the Yale-Brown Obsessive Compulsive Scale Symptom Checklist will allow for a thorough assessment of all types of OCD.