Definitions, measures and examples

Definitions 

Obsessions: recurring and persistent thoughts, images or impulses that are intrusive and inappropriate and cause high levels of anxiety. This is the cognitive side of the disorder.

Compulsions: repetitive behaviours or mental acts that a person engages in to neutralise, counteract or get rid of the obsessions. This is the behavioural side of the disorder.

For a diagnosis of OCD, the person must:

• Recognise that the obsessions and compulsions are excessive and unreasonable.
• Consume at least 1 hour a day for their obsessions and compulsions and these might interfere with the person’s life.

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Measures 

1. Obsessive compulsive Inventory – 

• 42-item questionnaire using likert scale from 0 to 4
• Patients answer questions on their symptoms during the previous months.
• There are 7 sub-scores (Washing, Checking, Doubting, Ordering, Obsessions, Hoarding, Neutralising) that are added together to form a total OCI score.
• If the score is equal or higher than 42, it suggests that OCD is present.

2. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) – 

• It is used a semi-structured interview technique.
• There are two parts to the measurement – symptom checklist and the interview.
• The first contains a list of 67 symptoms that the interviewer marks as current, past or absent (in this case it would not be recorded).
• The second part involves 19 items for the interviewee to complete based on responses and observations.
• A person is given a score out of 20 for obsessions as well as compulsions. 

3. Maudsley Obsessive Compulsive Inventory – 

• There are 30 items/statements to classify as true or false.
• These are divided in 4 sub-scales (Checking, Cleaning, Slowness, Doubting)

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Examples

CHARLES BY RAPOPORT (1989) – “The Boy who couldn’t stop washing”

• At age of 12 Charles began to wash obsessively, kept it under control for a while but eventually spent most of his time at school washing, meaning he had to leave.
• His ritual was to hold the soap on the right hand, put the hand under water for 1 minute and then switch to his left hand. This would continue for an 1 hour, then he washed for 2 hours and got dressed.
• At one point he started cleaning things with alcohol and refused to have visitors at the house for the fear of them bringing ‘germs’ inside.
• He was given drug therapy and this made his symptoms disappear for one year. However, he developed a tolerance to the drug and began to engage in his compulsions again but limited them to the evening.