How can I effectively assess the severity of OCD symptoms in a primary care setting?

To effectively assess the severity of obsessive-compulsive disorder (OCD) symptoms in a primary care setting, healthcare professionals should begin with a thorough clinical interview that explores the presence, frequency, and impact of obsessions and compulsions. Direct questions such as "Do you wash or clean a lot?", "Do you check things a lot?", and "Is there any thought that keeps bothering you that you would like to get rid of but cannot?" help identify symptom presence and distress ¹.

Assessment should include evaluating the degree of functional impairment caused by OCD symptoms, considering how much the symptoms interfere with daily activities, work, or social interactions ². The impact on the patient’s life and the time consumed by compulsive behaviors are key indicators of severity ¹.

Risk assessment is critical, especially for self-harm and suicide, particularly if comorbid depression is present. Patients with intrusive sexual, aggressive, or death-related thoughts require careful evaluation, and if uncertainty exists, consultation with or referral to a specialist is advised ¹,².

Using standardized tools such as the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) or questions derived from it can provide a structured measure of symptom severity and allow comparison over time ².

In addition, assessing comorbidities (e.g., anxiety, depression, substance misuse) and psychosocial factors is important as they may influence severity and treatment needs ¹.

Involving family members or carers in the assessment can provide additional insight into the impact of OCD symptoms and the extent of functional impairment ¹.

For patients with mild functional impairment, low-intensity psychological interventions may be appropriate, while those with moderate to severe impairment should be considered for referral to specialist mental health services ².

Recent meta-analytic evidence supports the use of cognitive-behavioral therapy (CBT), including exposure and response prevention (ERP), as an effective treatment, underscoring the importance of accurate severity assessment to guide appropriate intervention [Öst et al., 2022].