Screening for Obsessive-Compulsive Disorder (OCD)
The most effective approach to screen for OCD is using standardized assessment tools such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) or its second edition (Y-BOCS-II), which includes both a symptom checklist and severity scale, or shorter screening instruments like the OCI-4 for initial detection in busy clinical settings. 1
Recommended Screening Approach
Initial Screening Tools
- OCI-4 (Obsessive-Compulsive Inventory-4): An ultra-brief 4-item screening tool that assesses key dimensions of OCD (washing, checking, ordering, obsessing) with excellent reliability and validity. Ideal for busy non-mental health settings where comprehensive assessment is impractical. 2
- Florida Obsessive-Compulsive Inventory (FOCI): A shorter alternative that includes a symptom checklist and five items to assess symptom severity and impairment. 1
Comprehensive Assessment Tools
For patients with positive screening results, more detailed assessment is recommended:
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS/Y-BOCS-II):
- Gold standard for OCD assessment
- Includes symptom checklist and severity scale
- Available in self-report format
- Strong internal consistency (α = .89) and high test-retest reliability 3
Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS):
- Allows more detailed assessment of OCD symptom dimensions and their severity
- Valid even in interview-only format 4
- Particularly useful for identifying treatment response patterns
Children's Y-BOCS (CY-BOCS):
- Adapted version for pediatric populations 1
Structured Diagnostic Interviews
For confirming diagnosis after positive screening:
- Structured Clinical Interview for DSM-5 (SCID-5): Available in clinician or research versions 1
- Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5): Available for both adults and children/parents 1
- Mini International Neuropsychiatric Interview (MINI version 7.0): A shorter instrument available for adults and children/adolescents 1
- Structured Clinical Interview for Obsessive-Compulsive Related Disorders (SCID-OCSD): Useful for assessing common comorbidities 5
Common Pitfalls in OCD Screening
Misidentification of OCD subtypes: Research shows significant variation in recognition rates depending on symptom presentation. Misidentification rates vary dramatically by symptom type:
- Homosexuality concerns (84.6% misidentified)
- Aggression concerns (80.0% misidentified)
- Saying certain things (73.9% misidentified)
- Pedophilia concerns (70.8% misidentified)
- Somatic concerns (40.0% misidentified)
- Religious concerns (37.5% misidentified)
- Contamination concerns (32.3% misidentified)
- Symmetry concerns (3.7% misidentified) 1
Diagnostic delays: OCD is frequently underdiagnosed with an average delay in diagnosis of almost 10 years 6
Inadequate treatment recommendations: Clinicians who misidentify OCD are less likely to recommend evidence-based treatments:
Assessment of Comorbidities
Given that 90% of OCD patients have comorbid conditions 6, screening should include assessment for:
- Anxiety disorders
- Mood disorders
- Impulse-control disorders
- Substance use disorders
- Tic disorders
- Other obsessive-compulsive related disorders
Implementation Tips
- Begin with the ultra-brief OCI-4 in general medical settings to identify patients who need further evaluation
- For positive screens, proceed to more comprehensive assessment using Y-BOCS/Y-BOCS-II
- Use structured interviews to confirm diagnosis and identify comorbidities
- Consider symptom dimensions carefully, as certain presentations (e.g., sexual orientation obsessions) are frequently misidentified
- Assess family accommodation to obsessive-compulsive symptoms, as this can maintain or worsen symptoms
By following this structured screening approach, clinicians can improve early detection of OCD, reduce diagnostic delays, and ensure appropriate treatment recommendations, ultimately improving patient outcomes and quality of life.