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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2016

Identifying and Treating Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder, affecting as many as five million Americans at some point in their lives. The symptoms are often hidden or poorly articulated (especially in younger patients), but OCD can cause significant disability. OCD is characterized by recurrent obsessions, compulsions, or both.

Obsessions are persistent, intrusive thoughts or urges that often cause debilitating anxiety or stress. Compulsions are the repetitive behaviors OCD sufferers feel driven to perform as a means of easing the anxiety evoked by their obsessions. Common examples include hand washing, counting, repeating words silently, and excessive checking of locks. These symptoms can reach extreme levels that cause severe discomfort and interfere with day-to-day functioning. A significant added hurdle regarding OCD is its potential for being present simultaneously with depression and other anxiety disorders, or for being confused with them.

Assessing and treating OCD

Recognizing the characteristics of OCD is an important first step in diagnosing, treating, and coordinating care for patients affected by it. The American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder includes 11 recommended assessment and treatment practices. These recommendations are also included in the Obsessive-Compulsive Disorder Clinical Practice Guideline for Primary Care created by Harvard Pilgrim and Optum/UBH.

This Clinical Practice Guideline states that cognitive behavioral therapy (CBT) is typically the first line of treatment for mild to moderate cases of OCD in children and adolescents. Additionally, patients presenting with more moderate to severe OCD symptoms may benefit from first line medications — selective serotonin reuptake inhibitors (SSRIs) — combined with CBT. Practitioners should be aware of any SSRI side effects that are more likely in younger children.

Prevalence of misdiagnosis

It can be difficult to diagnose OCD because its symptoms are similar to those of other psychiatric disorders, such as depression and anxiety disorders. Additionally, patients with OCD are at high risk for having certain behavioral comorbidities. A mental disorder particularly noteworthy for its potential for confusion, or concurrent presence, with OCD is body dysmorphic disorder. Many people with this disorder may also have OCD, or may be misdiagnosed as having OCD — or vice versa. Body dysmorphic disorder is a body image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance. The intrusive thoughts and repetitive behaviors representative of this disorder, such as excessive mirror checking and grooming, are similar to the obsessions and compulsions of OCD. Other conditions commonly confused for, or present alongside, OCD include hoarding disorder, impulse control disorders, and body-focused repetitive behavior disorders.

How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at
800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum/UBH at 888-777-4742.

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