Who Will Diagnose Your Child?
Your choices for obtaining an expert medical opinion on your child's possible diagnosis of OCD depend largely on where you live. For example, a medical school with a psychiatry department and teaching hospital often provide outpatient psychiatric services with staff doctors or psychiatric interns who can perform OCD testing and treatment. A call to the office of the chairman of the psychiatry department should yield information on staff specialties.
An advantage of receiving treatment at a university-affiliated research or teaching hospital is the greater likelihood that its doctors are familiar with the latest research findings regarding OCD treatment. You can also learn about which university hospitals are leading OCD research centers by reading online, especially the news and resources sections on the Web site of the Obsessive-Compulsive Foundation (OCF).
Sources of OCD Expertise
A private hospital, HMO, health insurance company, or medical group in your area may list practitioners who treat anxiety disorders in general, if not OCD in particular. If you've scoured local medical directories and asked other parents, school counselors, teachers, and therapists for suggestions, but still haven't located a qualified practitioner, it's a good idea to directly contact one of the national advocacy organizations listed in the Resources section of this book. For example, the Obsessive-Compulsive Foundation can be contacted by e-mail or toll-free telephone to obtain the name of the nearest doctor or therapist experienced in OCD treatment, or someone who has recently attended one of the foundation's regional OCD trainings, called Behavior Therapy Institutes. Other organizations with national and state level chapters that may provide referrals in your area include the Anxiety Disability Association of America (ADAA) and the Association for the Advancement of Behavioral Therapy (AABT). Fortunately, all these organizations and professional associations have Web sites and helpful information online.
Who Can Diagnose OCD?
A diagnosis is the essential first step before treatment for OCD (using CBT therapy and/or medications) can begin. There are five categories of credentialed professionals permitted to make a formal diagnosis of OCD and other mental disorders. In most states, the professionals legally approved to do so include the following.
Pediatrician, psychiatrist, or other medical doctor (M.D. or D.O.)
Psychiatric nurse practitioner or psychiatric intern or resident (operating under the supervision of an M.D.)
Clinical Psychologist (Ph.D. or Psy.D in psychology)
Licensed marriage and family therapist (LMFT)
Social worker (MSW, LCSW) or other licensed counselor
While the professionals in each of these categories can legally diagnose OCD, not all of them have the specialized knowledge required to do so properly. In Chapter 8 there is a list of questions you can use to interview a potential doctor or therapist. Then there is the issue of medications. Regardless of a practitioner's specialized training or knowledge, only medical doctors (general practitioners and psychiatrists) and psychiatric nurse practitioners are permitted to prescribe medications.
What Does an OCD Diagnosis Mean?
The criteria for a diagnosis of OCD are set forth in a book called the DSM-IV, or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. This manual, specifically, the fourth edition published in 1994, is created and updated by the American Psychiatric Association (APA). The purpose of the DSM-IV is to create uniformity in symptoms for all currently recognized mental health disorders. As new research sheds light on causes and symptoms for a particular disorder, the DSM-IV is changed accordingly.
Each disorder in the DSM-IV, including those under the heading of anxiety disorders (OCD, social phobia, panic disorder, eating disorders, general anxiety disorder, post-traumatic stress disorder and attention deficit hyperactivity disorder) are given a code consisting of three to five letters and numbers. This code then appears on all tests, clinical treatment records, and insurance records for a given patient.
There are four main indicators set forth in the DSM-IV that are to be used by professionals in diagnosing obsessive-compulsive disorder. Their application to a given child in order to come up with a yes/no OCD diagnosis is based more on the experience of the professional than an obvious correlation with the indicators as written. They're listed here for your informational purposes.
Degree of control over the obsessive-compulsive behavior
Amount of distress caused by the behavior
Extent of impairment or interference with everyday routines
How much time behaviors consume (more than an hour a day?)
Given the wide spectrum of severity in OCD symptoms, these criteria must be applied and interpreted individually for each child or adolescent being diagnosed. For example, it's possible your child is driven to perform rituals to appease his safety fears. At the same time he does not worry about dirt or germs. In his case, the total amount of impairment caused by his OCD would be based on time consumed by those rituals he performs that relate to his safety concerns and the interference they cause to his daily routines.
A child, on average, goes through four obsessions before reaching adulthood, and each may be very different than the one before. Again, the main issue when determining whether he has OCD is to what extent any of these behaviors seriously disrupt his everyday life.