Sunday, April 18, 2010

New Scale Helps Diagnose OCD

Imagine being in the cereal aisle of the grocery store when suddenly you see something that doesn’t look right: boxes of various heights, randomly mixed together. You break out into a cold sweat; your heart thumps hard. You try to resist the urge to reorganize the boxes, but you can’t.

You begin organizing the cereal boxes by height. A strange calm washes over you.

You’ve just experienced five minutes in the life of someone with obsessive-compulsive disorder.

Nearly everyone experiences some level of obsessive-compulsive behavior, or OCD, which is characterized by intrusive thoughts, or obsessions, and repetitive actions, or compulsions. In its most severe form, OCD can severely inhibit a person’s ability to function normally. Time that could be spent with friends is instead consumed by the need to respond to the obsessions.

Before a psychiatrist or psychologist begins therapy on a person with OCD symptoms, he or she must determine whether or not the patient indeed has OCD or a different anxiety disorder. To make a definite diagnosis, doctors use one of several diagnostic tests. However, according to Dr. Jonathan Abramowitz, each one has flaws.

So he and several of his colleagues from across the country developed their own measure for OCD, called the Dimensional Obsessive-Compulsive Scale (DOCS). In a 2010 peer-reviewed article in Psychological Assessment, Abramowitz introduces the DOCS and explains how it diagnoses symptom severity more accurately than the Obsessive-Compulsive Inventory-Revised (OCI-R), and distinguishes OCD symptoms more clearly than the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) the two most widely-used OCD measures.

A research psychologist from the University of North Carolina at Chapel Hill, Abramowitz argues that obsessions and compulsions work as pairs. He groups these obsession-compulsion pairs into four areas, or dimensions: Contamination, Responsibility for Harm, Unacceptable Thoughts, and Symmetry. The OCI-R and Y-BOCS also include Hoarding.

Unlike some other OCD diagnostic tests, the DOCS doesn’t separate obsessions from compulsions. In fact, it doesn’t ask questions about specific behaviors at all. The scale asks five questions for each OCD dimension: time spent on the behavior, avoidance of situations, distress over unwelcome thoughts, disruption of life, and difficulty in ignoring OCD thoughts. The DOCS introduces two new components to OCD diagnostics: adding the concept of avoidance, and removing Hoarding from the scale.

Abramowitz tested the DOCS on three different groups: people diagnosed with OCD, people diagnosed with other anxiety disorders, and college students from Tennessee, Florida, and Arkansas. Members from each group completed the DOCS and one or more of six other tests, including two tests for OCD, three scales for anxiety disorders and one scale for depression.

When compared with results from the other scales, the DOCS results were more similar to results from the other two OCD scales than they were to the anxiety or depression scales. In addition to being a useful clinical tool in diagnosing OCD, the DOCS also shows promise in measuring treatment outcomes.

Source: Abramowitz, J., et. al. (2010). Assessment of Obsessive-Compulsive Symptom Dimensions: Development and Evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22(1), 180-198.

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