Around 1 in 40 people will develop obsessive-compulsive disorder (OCD)—a chronic mental health condition characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing the anxiety these thoughts cause. However, it takes an average of 14 to 17 years to receive the correct diagnosis and begin effective treatment. As a result, many people coping with OCD often look back and see that their symptoms had emerged much, much earlier than they knew for sure.
So what does it take to actually get diagnosed with OCD? While there’s no specific test for OCD, a licensed mental health professional who is trained to spot the nuances of the disorder can provide a diagnosis.
OCD diagnosis: Tools therapists use
It’s important to seek out a mental health professional who specializes in diagnosing and treating OCD for a more accurate assessment and to prevent misdiagnosis.
A specialist makes an OCD diagnosis after asking you about your mental health history and your current symptoms. At NOCD, clinicians use tests like the Dimensional Obsessive-Compulsive Scale (DOCS) to assess your symptoms and evaluate how much distress they’re causing. Additionally, they rely on diagnosis criteria in the The Diagnostic and Statistical Manual of Mental Disorders, 5th ED (DSM-5).
The criteria include:
- Having obsessions, compulsions or both.
- Your obsessions or compulsions take up a lot of time (more than an hour per day).
- Your obsessions or compulsions cause distress and affect your ability to show up for school, work, social activities, or other responsibilities.
- Your symptoms aren’t caused by substances or another medical or mental health condition.
Part of the evaluation process for OCD may include being asked to respond to a set of screening questions by answering yes or no to indicate whether a statement applies to you. Such statements include:
- I have frequent thoughts, urges, or images that I don’t want to have (for example, thoughts about being contaminated even though I may not be, or that I may hurt someone else even though I don’t want to).
- I do repetitive behaviors (for example, hand washing or cleaning, ordering or arranging, checking things, or repeating behaviors over and over), or I repeatedly do things in my mind (for example, counting, saying certain words or phrases) in order to feel better or to prevent something bad from happening.
- I feel excessively anxious or worried about many things, a lot of the time (for example, I worry about finances, responsibilities at work/school, my health or the health of others).
“Based on the answers of the screener, the therapist will run through a diagnostic evaluation with you for the statements you answered yes to,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Challenges getting an OCD diagnosis
As mentioned early, delayed diagnosis is incredibly common with OCD, and a number of factors contribute to this. First, lack of proper training for mental health professionals can lead to many people with OCD receiving the wrong diagnosis for their symptoms.
It’s sometimes hard to diagnose OCD because some providers mistake the symptoms for those that are associated with obsessive-compulsive personality disorder (OCPD), general anxiety disorder (GAD), or other mental health disorders. Likewise, OCD often co-occurs with other mental health conditions, including major depressive disorder, attention-deficit hyperactivity disorder (ADHD), eating disorders, and specific phobias—and it’s possible for an untrained eye to miss one diagnosis due to the presence of the other.
What’s more, many people who have OCD are embarrassed about their symptoms and don’t want to share them with anyone, even a medical provider, explains McGrath. “Some people are afraid of being judged or evaluated by someone in a negative way,” says McGrath. “So, when you finally see that there is a place to go, where there are experts in OCD, and are trained and understand it, you may start to feel more comfortable talking about it.”
Are there different types of OCD you can be diagnosed with?
OCD can be categorized into themes based on the focus or their obsessions and compulsions. While OCD is one umbrella diagnosis, some therapists and patients will refer to certain OCD subtypes.
For one person, the fear of being exposed to germs might not be a big deal. For someone else, it could be completely debilitating. Another person might experience severe fears and doubts about whether their partner loves them, a symptom of relationship OCD. “OCD finds things that are meaningful to you in order to find the right buttons to push that trigger and scare you,” says April Kilduff, MA, LPC, LCPC, LPCC, LMHC, a clinical trainer and licensed therapist with NOCD.
There are many, many themes of OCD—so this is not an exhaustive list. But here are some common subtypes:
- Harm OCD: causes people to have intrusive thoughts, images, urges, or fears about harming themselves or others
- Contamination OCD: a constant worry about coming into contact with or spreading germs.
- Sexual orientation OCD: intrusive thoughts surrounding one’s sexual orientation.
- Pedophilic OCD: involves unwanted and intrusive thoughts about children.
- False memory OCD: features fears and doubts surrounding the validity of one’s memories.
- Just right (perfectionism) OCD: an extreme need for perfection, symmetry, or things to be “just right”
- Religious (scrupulosity) OCD: Consistent worry about violating religious, moral, or ethical beliefs
Keep in mind that the obsessive thoughts associated with any OCD subtype are followed by compulsions—repetitive behaviors or mental acts that people with OCD feel compelled to perform in response to their obsessions. So during an evaluation for OCD, a specialist would be on the lookout for any number of compulsions, which may include the following:
- Checking (i.e. repeatedly making sure the stove is off, or that the door is locked)
- Tapping/touching (i.e. tapping your knee a certain number of times in order to feel “okay” or “just right”)
- Reassurance-seeking (i.e. asking a loved one, “Did you see me push anyone when we were walking down that busy street?” or “Do you really love me?)
- Avoidance (i.e. refusing to go to places, be in situations, or take in stimuli that may trigger your intrusive thoughts)
- Excessive washing/cleaning (i.e. hand washing, showering, or disinfecting surfaces multiple times a day)
- Rumination (i.e. turning something over and over in your mind, even for hours a day)
- Mental reassurance (i.e. giving yourself reassurance, such as “I would never do anything awful like that because I’m not a bad person”)
- Thought-replacing (i.e. replacing a “bad” thought with a “good” one in your mind)
When and why does OCD begin?
The onset of OCD is usually in the teen or adolescent years. According to the DSM-5, the mean onset is age 19 and about 25% of cases start by the age of 14 years old. It is less common to see onset of OCD after the age of 35 years old, but it is certainly possible.
No matter how or when OCD symptoms arise, if they cause significant distress, take up a lot of time in an average day, or interrupt one’s ability to function in daily life, they warrant an evaluation for an OCD diagnosis.
The exact cause of OCD isn’t known, but research indicates that several factors may play a role in its development. These include biology, genetics—such as having a close family member with the condition—as well as environmental contributors, as OCD can start after a major life event including trauma or loss.
Exactly what to do after receiving an OCD diagnosis
It’s important to know that OCD is a highly treatable condition. Exposure and response prevention (ERP) is a form of therapy that was developed specifically to treat OCD, and it’s backed by decades of clinical research. ERP works by disrupting the cycle of obsessions and compulsions.
During ERP, you’re encouraged to gradually and carefully confront your obsessions, sit with the discomfort you feel, and resist the urge to perform compulsions. This might sound scary, but you’ll start small—and your therapist will guide you every step of the way.
“OCD wants you to believe that compulsions will make you feel better or keep obsessions from happening,” says McGrath. “But it doesn’t work. Obsessions always come back. In reality, compulsions teach you to run from obsessions, which only gives them more power,” he explains.
Over time, ERP teaches your brain that discomfort from obsessions will go away—or they’ll be drastically reduced—when you don’t give in to compulsions.
It bears repeating: It’s essential to see a therapist that specializes in ERP, as they have the right tools to help. Other therapists may use methods that unintentionally worsen OCD symptoms.
The bottom line, says McGrath: “You want somebody who is going to assess the right condition, give you the right treatment for it, and assure you get the help you need.”