Talking About OCD: A Conversation Guide for Professionals

Helping a patient break free from obsessive-compulsive disorder (OCD) can be a clinical challenge. Those affected often hide their symptoms, acutely aware that their obsessive thoughts are irrational and are not caused by external circumstances. As a result, people with OCD may withhold information and are often reluctant to reveal their condition to family members or health care professionals. And for many people, psychological disorders still carry a great deal of stigma.

This guide can help you engage in conversations with your patients about OCD so that they will know more about the disorder and treatment options.

Raising the Subject

  • Maintain sensitivity when asking about symptoms because patients are usually aware their symptoms are unusual or irrational, and they often feel embarrassed or ashamed.
  • Look for clues, such as chapped hands due to frequent hand washing, or repeated requests for a medical test without clinical indication.
  • Inquire about the presence of unwanted, intrusive, or disturbing thoughts the patient finds hard to get rid of or ignore. Determine if these thoughts involve themes common to OCD:
    • Constant, irrational worry about dirt, germs, or contamination.
    • Excessive concern with order, arrangement, or symmetry.
    • Fear that negative or aggressive thoughts or impulses will cause personal harm or harm to a loved one.
    • Preoccupation with losing or throwing away objects with little or no value.
    • Excessive concern about accidentally or purposefully injuring another person.
    • Feeling overly responsible for the safety of others.
    • Distasteful religious and sexual thoughts.
    • Doubting that is irrational or excessive.
  • Ask if the patient is performing any actions to help ease the anxiety that results from obsessive thoughts. Common compulsions are listed below:
    • Cleaning – Repeatedly washing one’s hands, bathing, or cleaning household items, often for hours at a time.
    • Checking – Checking and re-checking, sometimes several to hundreds of times a day that the doors are locked, stove is turned off, hair dryer is unplugged, etc.
    • Repeating – Inability to stop repeating a name, phrase, or simple activity (such as going through a doorway over and over).
    • Hoarding – Saving useless items such as old newspapers or magazines, bottle caps, or rubber bands.
    • Touching and arranging.
    • Mental rituals – Counting or endless reviewing of conversations; repetitively calling up “good” thoughts to neutralize “bad” thoughts or obsessions; excessive praying and using special words or phrases to neutralize obsessions.
  • Determine if the patient feels that these actions must be continued until stopping “feels right.”
  • Discuss how symptoms affect a patient’s daily function. Ask how much time is spent each day on unwanted thoughts or rituals.
    • Spending more than an hour a day on obsessions or compulsions may be a sign of OCD.
  • Find out if the patient feels his or her obsessions and compulsions are irrational and beyond control.
  • Explore the possibility of a family history of OCD.

General Tips

  • Help your patients learn as much as possible about OCD. Refer to the Resource List for more information.
  • Tell patients that OCD is an anxiety disorder that is not their fault.
    • The unwanted and intrusive thoughts (obsessions) that cause them to repeatedly perform ritualistic behaviors and routines (compulsions) to ease their anxiety are common symptoms, and effective treatments are available.
  • Learn about therapists in your area who are experienced in OCD management and cognitive behavioral therapy (CBT), as well as those who work within your patients’ health plans.
  • Let patients know that it may take time to find an appropriate treatment, but that you are committed to helping them get the treatment they need.
  • Make a follow-up call to see if patients need any additional encouragement to stay with their treatment.