Assessing OCD: The Complete Guide for Clinicians

Summary

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Podcast Summary: Breaking the Rules – Assessing OCD: The Complete Guide for Clinicians

Podcast: Breaking the Rules: A Clinician's Guide to Treating OCD
Episode: Assessing OCD: The Complete Guide for Clinicians
Hosts: Dr. Celine Gelgec and Dr. Tori Miller
Date: August 10, 2026

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Episode Overview

In this episode, Dr. Celine Gelgec and Dr. Tori Miller revisit and update their foundational guidance on assessing Obsessive Compulsive Disorder (OCD) for mental health clinicians. With four years’ experience since their first discussion on assessment, the hosts integrate new insights, best practices, and practical advice for both new and seasoned clinicians. Their signature conversational and collaborative style balances clinical rigor with empathy and flexibility, emphasizing the importance of individualized, comprehensive assessment for OCD diagnosis and treatment planning.

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Key Discussion Points and Insights

1. Revisiting the Basics: Start Simple, Stay Comprehensive

• Comprehensive Clinical History: Both hosts emphasize the need to start where you would with any client—by understanding why they’re seeking help now, combined with a full developmental, family, and psychosocial history.
  • "Still get a genogram? Yes. Still do it. It is not enough to do an assessment where you don't know who is in their family system." (Dr. Tori Miller, 05:25)
  • "What was it like growing up for you?" (Dr. Celine Gelgec, 05:35)
  • Importance of mapping several generations for genetic history given the higher risk in first-degree relatives.
  • Recognize the two main clusters of age of onset—late childhood and early adulthood—by directly inquiring about long-standing symptoms. (06:28–06:44)
• Flexibility in Assessment: While comprehensive assessment is recommended, clinicians should adapt to client needs (e.g., those newly discharged or with a longstanding diagnosis may need a more present-day focus initially).
  • "Sometimes... people are presenting with a lot of distress and anxiety... They don't want to sit through an assessment" (Dr. Tori Miller, 11:18)
  • The process might not be linear; the information can be gathered over multiple sessions (13:32).

2. OCD-Specific Assessment: Recognizing Flags and Using Tools

• Red Flags for OCD: Listen for:
  • Intrusive thoughts (matching known OCD themes)
  • Responses to those intrusions: Are they followed by compulsions? How intense? Do they feel relentless? Impact on daily life? (14:25–16:13)
  • Prompts to clarify compulsions, avoidance behavior, and functional impact (15:10–16:07).
  • Example collaborative prompting:
    • "People who have thoughts... might also have thoughts about germs or have liking things a certain way, or they might check the door before they leave the house..." (Dr. Celine Gelgec, 15:00)
• When Less Experienced: For new clinicians or those less familiar with OCD, standardized assessment tools (psychometrics) are encouraged:
  • Y-BOCS (Yale Brown Obsessive Compulsive Scale):
    • Can be self-completed or, preferably, done as a clinical interview for better nuance.
    • "I definitely prefer to use it as an interview tool... it is literally just a tool for saying, I do or I don't have this behavior." (Dr. Tori Miller, 18:26)
    • Important to distinguish OCD compulsions from similar behaviors in other contexts (e.g., autistic rituals).
    • "Guys, it's important." (Dr. Celine Gelgec, 20:37)
    • Use the severity scale, and always review responses with clients for clarity.
  • Jonathan Grayson's Assessment (from "Freedom from OCD"):
    • Longer, more descriptive, and client-friendly. Good for new clinicians, detailed for building exposure menus. (25:00–26:21)
  • Other Tools: Mention of the Dimensional Obsessive Compulsive Scale (DOCS) and others; recommendation to refer to forthcoming show notes for comparisons. (27:27–27:49)

3. Diagnostic Criteria: Returning to the DSM

• Essential to cross-check findings with DSM criteria, regardless of themes.
  • Criteria A: Presence of obsessions and/or compulsions (emphasizing mental acts, not just behaviors). (28:52–30:17)
  • "Notice how no theme is present in the DSM... we get so caught up on themes... the theme is actually irrelevant." (Dr. Celine Gelgec, 29:06)
  • Criteria B/C: Distress, significant time consumption (>1 hour/day), and/or functional impairment.
    • "The hour per day is actually quite an important criteria to pay attention to... compulsive behavior can be seen in many disorders." (Dr. Tori Miller, 31:32–32:18)
  • Criteria D/E: Rule out substance/medical causes and other psychiatric disorders (differentials).
    • Comprehensive assessment is needed to differentiate OCD from GAD, health anxiety, autism spectrum disorder, depression, OCPD, ADHD, eating disorders, etc. (33:23–34:34)
• Complex Differential Diagnosis: Emphasis on ruling in and ruling out other causes, and the high co-morbidity and presentation overlap with other disorders.
  • "That's why the comprehensive assessment is so important. That's why we don't just assess specifically for OCD..." (Dr. Tori Miller, 34:50)

4. Medical Causes and Special Considerations

• PANDAS/PANS: Acute onset OCD secondary to infection (usually strep). This variant responds differently; antibiotic treatment is needed.
  • "It is not as responsive to ERP as... so you actually need to treat it medically first through antibiotics..." (Dr. Celine Gelgec, 35:58)
  • Personal anecdotes from both clinicians showcase the importance of medical investigations for refractory or sudden-onset cases.

5. Assessment Nuances and Formulation

• Insight Specifiers: Good insight doesn’t mean OCD is less severe; the inverse is often true—clients are aware and still struggle immensely.
  • "Just because a client has good insight doesn't mean their OCD is not severe..." (Dr. Celine Gelgec, 39:13)
• Formulation: Synthesis of history, psychometrics, and clinical data into a working case formulation.
  • The assessment process naturally generates intervention targets and psychoeducation content (trigger lists, treatment models).
  • "Your trigger list is half formed for you... this assessment process will set you up so beautifully to then proceed seamlessly into what is ERP." (Dr. Tori Miller, 43:12–43:49)

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Notable Quotes & Memorable Moments

• On Internal Process:
  • "Your therapist just looks like they're talking to you, but there are all these moving parts... we're just sitting there nodding, moving a million miles an hour in our mind." (Dr. Celine Gelgec, 14:01–14:08)
• On Psychometrics:
  • "I love using psychometrics to just quantify what we’ve already established, but also then fill in the gaps." (Dr. Celine Gelgec, 26:57)
• On Client Shame & Disclosure:
  • "Because people feel too much embarrassment or shame to tell you all of the things... it actually isn’t until you start getting to work where they start to build insight and start to recognize just how widespread their OCD is." (Dr. Tori Miller, 42:01–42:29)
• On Flexibility:
  • "We’re big believers of just be flexible with the treatment, but still have to hold in mind what you need." (Dr. Celine Gelgec, 13:38)

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Timestamps for Key Segments

• Introduction & Revisiting the Topic: 01:23–03:47
• Importance of Comprehensive History: 04:00–07:40
• Adapting the Assessment Process: 09:36–13:38
• OCD Assessment Flags: 14:25–16:22
• Use of Y-BOCS and Other Assessment Tools: 18:05–27:49
• DSM Diagnostic Criteria Breakdown: 28:21–35:15
• Differentiating OCD from Other Disorders: 33:23–35:15
• PANDAS/PANS Discussion: 35:41–38:59
• Insight, Severity & Specifiers: 39:13–40:14
• Synthesis and Case Formulation: 41:14–43:49

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Closing Thoughts

This episode delivers a thorough, up-to-date walkthrough of evidence-based and pragmatic approaches to assessing OCD for clinicians. The hosts blend clinical depth with warmth and real-world wisdom, guiding both novice and experienced practitioners on how to build a robust assessment foundation, adapt to diverse presenters, and always keep the client’s lived experience and collaboration at the heart of the process.

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Transcript

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[Dr. Celine Gelgich]

Hi, I'm Dr. Celine Gelgich.

[Dr. Tori Miller]

And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On Breaking the Rules, we talk about all things OCD.

[Dr. Celine Gelgich]

Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.

[Dr. Tori Miller]

Catch us every fortnight, wherever you get your podcasts.

[Dr. Celine Gelgich]

Hello, welcome to another episode of Breaking the Rules. Everybody. We just realized that we've been doing this for almost four years.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

If not four years.

[Dr. Tori Miller]

Well, it probably is. It probably is about four years.

[Dr. Celine Gelgich]

Yeah. It's like, where the hell did that go?

[Dr. Tori Miller]

I know. Yeah, I know. It's quite wild, isn't it?

[Dr. Celine Gelgich]

It is. Oh, I know, I know, I know.

[Dr. Tori Miller]

We're older, we're wiser.

[Dr. Celine Gelgich]

We are. And we are revisiting one of our earlier topics. Yes.

[Dr. Tori Miller]

Yes. I think, because this came out that. Yes. We were looking.

[Dr. Celine Gelgich]

Yes. We talked about for a while. Yeah.

[Dr. Tori Miller]

And we realized, oh, my gosh, it's been four Years since we introduced some of the sort of the fundamental, you know, kind of concepts of ocd, we were thinking that especially because we've got new listeners, people who. Yes. Haven't necessarily gone back to our back catalog and listened to. Let's have a look again at assessing ocd. Yes, let's have a look again.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

It. We talk a lot about.

[Dr. Celine Gelgich]

There's things we would have added to it by now based on what we talked about almost four years ago. Yeah, yeah. I think there's a few things we need to consider potentially. There's the. The black and white aspect of it, like, what is it, what do we look for, etc. But I think, which is something we keep talking about and coming back to in each one of our episodes is what else is going on for this person? So it's. Yes. What. How do we assess for ocd? But what are some other things worth listening for in terms of understanding the OCD picture?

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. So I think maybe talking about that.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Could be helpful.

[Dr. Tori Miller]

Yeah. Yeah. All right, well, why don't we start with. Let's start with simple. Yeah, let's start with simple. Let's not over complicate things from the beginning.

[Dr. Celine Gelgich]

Okay.

[Dr. Tori Miller]

Right. Because I think. Well, because if we're talking about it truly. Right. This is. This is what we would do if we had a client that we're meeting for the first time. You know, you don't start complicated. You start simple.

[Dr. Celine Gelgich]

100%.

[Dr. Tori Miller]

Yeah. Yeah. Okay. So OCD is going to really shock people. You start the same way as you do with any presenting difficulty.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

Yeah. Yeah. Take. Take a good comprehensive history.

[Dr. Celine Gelgich]

Yes, please. Please do. You'd be surprised at how many people actually skip that.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Which just blows my mind.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gelgich]

Thank you.

[Dr. Tori Miller]

I have a caveat to that, though.

[Dr. Celine Gelgich]

Yeah. Okay.

[Dr. Tori Miller]

Start simple. Oh, no. Okay.

[Dr. Celine Gelgich]

Yeah. Okay, here we go.

[Dr. Tori Miller]

I know my mind is strapped in. I know my mind is buzzing.

[Dr. Celine Gelgich]

All right.

[Dr. Tori Miller]

Okay. I'm gonna start with simple, but maybe you could help bring me back to this. Okay.

[Dr. Celine Gelgich]

I'm not sure I'm the best person for that, but anyway, I'll try.

[Dr. Tori Miller]

Okay. All right. So the place to start is, of course, understanding why someone is coming in to see you. Yes.

[Dr. Celine Gelgich]

And at that point in time.

[Dr. Tori Miller]

At that point in time, what's going on for them? What are they experiencing? What are they feeling? What are they thinking? What's their behavior? What are their concerns? What are their distress levels? All of those things. And now, just like with any presentation, get a good history of what it is that they're concerned about. But even, I mean, even with adults, I think practitioners who work with adults often forget this. Still get a genogram? Yes, still get a genogram.

[Dr. Celine Gelgich]

Yes, please.

[Dr. Tori Miller]

Still. Still do it. It is not enough to do an assessment where you don't know who is in their family system.

[Dr. Celine Gelgich]

Absolutely. And ask.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

What was it like growing up for you?

[Dr. Tori Miller]

Yes. Get. Get the early developmental history.

[Dr. Celine Gelgich]

Oh my God, that's so important.

[Dr. Tori Miller]

Get the story, get the narrative. Do the history taking. I mean, aside from the fact that we're talking about a human being and we need to understand who this person is and how they came to be at this point in their lives, we also know, like truly, if we're assessing for ocd, we're looking for genetic history.

[Dr. Celine Gelgich]

Absolutely.

[Dr. Tori Miller]

And you need a couple of generations in order to map that out properly.

[Dr. Celine Gelgich]

You do. Because what that tells you as well is, which is what the stats tell us is if you've got a first degree relative with OCD and it started off when they were younger, the rate of next generations developing OCD is 10 times higher.

[Dr. Tori Miller]

Right.

[Dr. Celine Gelgich]

So you want to know that information.

[Dr. Tori Miller]

You do. You do, yeah. So.

[Dr. Celine Gelgich]

And equally true in the same breath. We know too that the stats tell us that there are two age of onset clusters and they're in late childhood, the first cluster and early adolescence.

[Dr. Tori Miller]

Absolutely not.

[Dr. Celine Gelgich]

Early adolescence.

[Dr. Tori Miller]

Early adulthood.

[Dr. Celine Gelgich]

Early adulthood. Thank you. Is what I tried, what I was meaning to say. So if someone's coming to you in their 30s or their late 20s, you're going to miss out on the richness of that information that it's going to give you. Absolutely. Because a lot of the time clients are like, I think I've had this for a while.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

It's like, okay, well tell me about that.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

So we still want to do a really full, comprehensive assessment.

[Dr. Celine Gelgich]

Yeah. I always start with a semi structured clinic technical interview.

[Dr. Tori Miller]

Me too.

[Dr. Celine Gelgich]

Really? The whole shebang from. Which is what you're describing from like presenting issues. What's going on for you right now? Tell me about what's. What brings you in here today? The developmental history, what was, what was like growing up for you? Family atmosphere, relationships with your family members. It's about education. Yes. Transition to high school.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Did anything disrupt that? Hobbies, interests along the way, Extracurricular activities, friendships. Friendships in those moments.

[Dr. Tori Miller]

Family relations, family relationships. Major life event.

[Dr. Celine Gelgich]

Yes. Mental transition to adulthood. What that looked like, what brought you to where you are now? The whole story. But even then, past interventions.

[Dr. Tori Miller]

Absolutely. Have you been a psychologist Before.

[Dr. Celine Gelgich]

Yes. What was helpful, what was unhelpful? You can probably hear my son coughing in the background. What was helpful and unhelpful? So past interventions, past psychiatric history, we want to look at. Are you, you know, when things get really distressing, do you smoke, drink, like substance use and all that sort of stuff. We want to also know things like their mental state and previous risk factors and potential suicidal ideation and attempts and self harming behaviors. Like we want to know the full clinical picture.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right.

[Dr. Tori Miller]

My caveat. Yes, My caveat, which is something that I talk about with my supervisees a lot. Right. Is that. That is the framework.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

That I think we recommend and prefer.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And it must be done.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

However, my caveat is that in this space with OCD at the moment is that because there's a growing awareness around ocd, because people are educating themselves more and more because oftentimes people will come and you may not be their first or second psychologist, that they may actually be looking for someone who has a bit of experience with ocd, for example. Yeah, they may have done that before. That does not mean that you skip that part. However, in order to meet the person where they're at. If you meet someone who maybe has just been discharged from hospital or has just seen two clinicians or actually already has a diagnosis of OCD and has received treatment for it before and doesn't actually necessarily isn't looking for a second opinion.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

You can go straight to the. More like what brings you today?

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

You know, what are you looking for? It can be much more present day focus totally in the beginning to meet the client, where they're at. Because I think sometimes if someone was diagnosed with OCD 10 years ago.

[Monica Reinagle]

Yeah.

[Dr. Tori Miller]

They've seen two psychologists, they've had an inpatient admission and you come and you sit them down, you say for the first two sessions we are going to do this comprehensive assessment of your past.

[Dr. Celine Gelgich]

They're going to check out.

[Dr. Tori Miller]

Yeah. Like you're not really meeting the client where they're at. And sometimes that information can be gleaned from previous reports.

[Dr. Celine Gelgich]

Yes, exactly.

[Dr. Tori Miller]

From. From other practitioners. So you could get it a slightly different way.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

So what I say in those moments is that if you are meeting someone in, in an instance like that, it does. And also doesn't mean just because someone has been diagnosed with ocd. Yeah. You don't also form your own opinion.

[Dr. Celine Gelgich]

No, that's exactly right.

[Dr. Tori Miller]

Right. You still need to.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

But sometimes I think about it kind of like, like a triangle or an Inverted triangle, meaning you can start kind of narrow, meet the client where they're at, build rapport, connect with them, get a sense of shared goals and then get that extra information as things progress.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Or if you're truly meeting for the. Them for the first time, they're not sure exactly what they're looking for. They don't have much of a history. Maybe they haven't been diagnosed. You start broad and then you get narrower.

[Dr. Celine Gelgich]

Yeah. Ye. Yeah.

[Dr. Tori Miller]

So it's kind of like it's the same process, but it's just about. It's the same information, but it's just the process by which you guys.

[Dr. Celine Gelgich]

How you gather the information, which is really important because you do need to meet your clients where you're at.

[Dr. Tori Miller]

Sometimes people are presenting with a lot of distress and anxiety.

[Dr. Celine Gelgich]

Yes. And they need containment.

[Dr. Tori Miller]

Yeah. And they don't want to sit through and assessment. Tell me about what it was like when you were sort of, you know.

[Dr. Celine Gelgich]

Yeah, exactly.

[Dr. Tori Miller]

School. When it's like, but I can't sleep or eat or dress myself.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Why are we talking about what it was like when I was 8 years old.

[Dr. Celine Gelgich]

Yes, exactly.

[Dr. Tori Miller]

Yeah, yeah, yeah.

[Dr. Celine Gelgich]

100.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You do need to. But I think one thing to be really mindful of in those moments, because it can slip away, is especially in those presentations when the distress is so

[Dr. Tori Miller]

high, which often happens.

[Dr. Celine Gelgich]

Which often happens. And we need. We still need to collect this information. We can kind of get stuck in. In that and containing. And then. Not that we don't forget it, but we. We can sometimes kind of hit hurdles on the way, like, oh, shit, I got holes in my formulation. Or I don't know this information or whatever it is. So some of the things that I like to bring in in those moments is like spending some time working with the client so that they can feel contained and building that report, all that sort of stuff. But then at the same time, I'm like, okay, this can feel. This might feel really frustrating for you and I can see that. But I'm feeling some gaps coming up and I want us to make sure that we're still doing the work together. I'm going to need some extra. Can we spend a little bit of time talking about this? So just again, which is something we talk about in all of our episodes. Bring them with you. Explain why.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Talk to them about what the process is or going.

[Dr. Tori Miller]

Acknowledge what's happening. The process in the room.

[Dr. Celine Gelgich]

Exactly. You might feel like you're repeating yourself, but, you know, I've not met you before. I've tried to get this information, but I can't. If the GP is not responding or some other care team member or whatever, or it's that discharge letters taking forever to get to you, or whatever it is.

[Dr. Tori Miller]

Never comes.

[Dr. Celine Gelgich]

Slash, never comes, which is more. More often not the case. And so it's okay to also have those conversations in terms of saying, actually, yeah, I've me meeting you where you're at when we're doing all these things, but at the same time, I still need this.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Gelgich]

Like, you know, because it will help me to help you.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And a lot of the times clients like, oh, yeah, sure. Like, let's, you know.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

You might spend a bit time kind of bringing it in that way. And it might be session five or six.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

Three or four or whenever. It doesn't have to be linear.

[Dr. Tori Miller]

And that's.

[Dr. Celine Gelgich]

Which is, I think, where we're getting at.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

In terms of. Of we're big believers of just be flexible with the treatment, but still have to hold in mind what you need.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

So it's like so many moving parts.

[Dr. Tori Miller]

I know.

[Dr. Celine Gelgich]

Yeah. It reminds me of those memes that come up on Insta or wherever, where they're like, your therapist just looks like they're talking to you, but there are all these moving parts. And it's got this huge list of stuff that we're doing in the background.

[Dr. Tori Miller]

It's like we're just sitting there nodding.

[Dr. Celine Gelgich]

Yeah. Yes. Moving a million miles an hour in our mind.

[Dr. Tori Miller]

Cogs turning.

[Dr. Celine Gelgich]

Yeah. So true. Yeah.

[Dr. Tori Miller]

Okay, so we're getting the foundation. We're getting the whole story. We're doing a full comprehensive assessment.

[Dr. Celine Gelgich]

Right? Yep.

[Dr. Tori Miller]

But how do we then start narrowing down into ocd? What are the tools? What are your favorites? I think. I think we use the same tools.

[Dr. Celine Gelgich]

Yeah, yeah, yeah. Like, I. The first thing I like to do is just listen out for certain flags of ocd. And flags for me are themes of intrusive thoughts that correspond with known themes of ocd. But that doesn't mean that someone has ocd.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know, they might describe perfectionistic tendencies, but I want to know a little bit more about that. So I'll say it's. It's not so much someone having the intrusive thoughts or themes, it's what do they do when that pops up? Yeah, that's something I'm more interested in.

[Dr. Tori Miller]

Agreed.

[Dr. Celine Gelgich]

So are they followed by compulsions? How intense are those compulsions? Do they feel OCD like, in that? Are they repetitive? Do they feel relentless?

[Dr. Tori Miller]

What's it like to try to resist them.

[Dr. Celine Gelgich]

Yes. What happens if you try and stop them? Have you tried to stop them? How scary does it feel? How much does it impact your life? How much of the day does it take up? What does. What does it get in the way of you wanting to do or do? Have you started avoiding things that you never used to avoid? Do you find your world getting smaller and smaller? You know, are you doing less and less? You know, these are the kinds of questions I'll start asking. And if there's a lot. If there was a lot of yeses coming through, you know, I'll often start to then prompt for other themes, like people who talk about experiencing intrusive thoughts about. You know, so I'll say something like, people who have thoughts, like, for where you might think that you're going to accidentally hurt someone might also have thoughts about germs or have liking things a certain way, or they might check the door before they leave the house and, you know, bring up some other examples. And I'm like, oh, yeah, I do that too. Or I. Not necessarily that, but actually I do this. So it becomes this collaborative conversation and an exploration and a curiosity as to other things that might be going on. And then.

[Dr. Tori Miller]

Although, actually, I'm going to jump in there.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

So you have internalized all that knowledge.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

So you can have that conversation.

[Dr. Celine Gelgich]

Yes. Yes. Right. Yes.

[Dr. Tori Miller]

For someone who's new to the OCD space. Yes.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Who hasn't? Like, you and I both were.

[Dr. Celine Gelgich]

Yeah. You know, before we all start from zero. Yeah.

[Dr. Tori Miller]

You know, I still remember.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Studying the doctorate.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

How many of us. I don't know if it was the same in your cohort.

[Monica Reinagle]

Yeah.

[Dr. Tori Miller]

We're like, trying to like, memorize stuff. Memorize the dsm. Yeah. You know, like, that was so important to, like, know the. No.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Beyond. Beyond what was needed for an exam. Like to know off the top of your head exactly what all of the criteria for all of the.

[Dr. Celine Gelgich]

Yeah. 100.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And like nearly 20 years on, I still don't. Haven't memorized it.

[Dr. Celine Gelgich]

The whole thing. Why don't, you know all this 300. And however many pages are in the bloody thing, if there is, it's it's at least that. I don't know.

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[Dr. Celine Gelgich]

Yeah, It's a lot.

[Monica Reinagle]

Yeah.

[Dr. Tori Miller]

But no. Okay, so if you're early. If your early career or you're new to ocd, use it. Use assessment tools.

[Dr. Celine Gelgich]

Yeah. That's where I was going next. Because I then. You knowing that I then corroborate with psychometrics. But if you can't, like, if you don't know it off the top of your head, bring it in earlier. Yeah. 100 go there. Yeah. So I usually then go, okay, we've got all of this. Let's back it up with some numbers. So I'll say, can we fill in this questionnaire just to kind of give us a numerical value to what we've been talking about. But. But then equally, I'm like, you might even tell us something we haven't uncovered yet.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know, there might be something on there that I haven't prompted for or that you haven't thought about. But yeah, if you're not sure, absolutely. Bring it in earlier.

[Dr. Tori Miller]

Now with the Y box.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

It. It is a tool that you can give to your clients.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

However.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Now, this is a bit of a point of tension. That comes up a lot.

[Dr. Celine Gelgich]

Yeah, it does. Yeah. Yeah.

[Dr. Tori Miller]

Because I don't. I'd be interested to know what you think, but for me, I definitely prefer to use it as an interview tool.

[Dr. Celine Gelgich]

Yep.

[Dr. Tori Miller]

And the reason being is that I am not convinced that the Y box, as it's written, I think it's a fantastic assessment tool. It really is. However, the way that it's written it, it does. It's not sensitive enough to be able to differentiate between an ocd, say, compulsion, or let's say an autistic ritual.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Or the. The rash, like the reason or the function behind the behavior. It is literally just a tool for saying, I do or I don't have this behavior.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And so now you can get someone to fill it in at home and then come in. But then you still have to go through everything to say, okay, you've ticked. That you do. Checking. Tell me about checking.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

You've told me that before bed. You like to straighten your bed covers and put all of your things nice and neatly on the side of your bed. Tell me about that. You still have to check it out. I've had instances where I've had clients who have completed the Y box.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

With other practitioners, and the practitioner has diagnosed them with ocd.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And then when you go back and go through it, there actually wasn't any evidence for it that was very much based. The reason behind those behaviors was very, very different. So my personal preference. Yes. Is to do it as an interview, because I think we can tease it out.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

But as we go. But if you. If you don't, if you give someone to take home and then bring it back, then Just go over all of the. Yeah, someone don't just look at the Y box and go, oh my gosh. They've endorsed all of these compulsions.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Therefore this is really severe.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

The. And I think the reason that that sometimes comes up I think is because especially when there is pressure in relation to the fact that we only have if. If, you know, for some people who can't afford to pay a lot out of pocket for therapy, it can be. It can feel really hard to spend an entire session on doing something like a Y box. Yeah, I think. And I think that's what supervisors often supervise these rather bring to me, which is, yeah, my gosh, it takes so long sometimes it feels like it takes two sessions to do the Y box.

[Dr. Celine Gelgich]

Guys, it's important.

[Dr. Tori Miller]

It's like I don't want to keep. Like I don't feel like, you know, I feel like I'm wasting their time or whatever. But I don't know.

[Dr. Celine Gelgich]

No, it's not a time.

[Dr. Tori Miller]

I don't think it is a time waste.

[Dr. Celine Gelgich]

I always valuable. It is really valuable. I always give it when I'm writing up my. During psychoed. Yeah. After we've, you know, if we're being a bit more linear here, like just for purpose of demonstration, if it's a little bit more clear cut, I guess. But I mean there can still be complexity. But what I mean is like, you know what we're describing before, like there's no extreme distress. We're kind of like following a bit more protocol anyway, you know, when I'm. I usually give the Y box like we've done the semi structural clinical interview. I'll give the Y box during the psychoid moment when I'm writing the treatment model up on the whiteboard. Because it's just me writing it up on the way. I don't want them twiddling their thumbs, so I give them the Y box to fill in.

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[Dr. Celine Gelgich]

Oh, no.

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[Dr. Celine Gelgich]

But I think in my instance, because I prompt a lot during this in clinical interview, a lot of that I've already teased apart.

[Dr. Tori Miller]

It's almost like you're doing the Y box without the instrument in your hand.

[Dr. Celine Gelgich]

Yes, yes, yes, yes, exactly. But in the beginning. No, I had to. I would. It would be exactly how you described. I would do it with the client also, too, because I noticed a lot. And this in itself is diagnostic. A lot of my clients, especially with intense order and symmetry or moral scrupulosity or who had the need to know or the need to clarify everything.

[Dr. Tori Miller]

Yes. So true.

[Dr. Celine Gelgich]

It would be a really slow process.

[Dr. Tori Miller]

Process.

[Dr. Celine Gelgich]

So that, like, did for me to help guide along. Yeah. You know. Yeah. And so in the beginning, yes. But over the years, I've basically incorporated those questions into my clinical interview because, like you've said, I've internalized so much of it. I'm sure you have too. So it's just. Yeah, but when. When they do it, I'll say, you know, if you've got questions, please shout them out. Even though I'm writing on the whiteboard, I'm happy for you to interrupt me. Etc, so they will. And then we'll still review it afterwards. I'm like. So I'm just making sure this. You know, you told me when I asked you this, this, this, this and this. Is this what that means? Or if anything new pops up, I'll inquire about it. So it doesn't take as long, but I've kind of already.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Covered it anyway. And the other one I always go over is the severity rating.

[Dr. Tori Miller]

Yes. Yes.

[Dr. Celine Gelgich]

Because I think it. It asks the same questions for obsessions and compulsions and so they're like. I'm a bit confused by this. And it's like, it is a bit confusing. And so we have to guide through that too. Yeah, yeah.

[Dr. Tori Miller]

Now.

[Dr. Celine Gelgich]

But it's important.

[Dr. Tori Miller]

Yeah. Just in case anyone's listening. I've just realized we haven't said what the Y box is. It's the Yale Brown Obsessive Compulsive scale.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

It's a free assessment tool.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

There are readily available online, many versions available online. Just find the one that has been sort of formatted to your liking.

[Monica Reinagle]

Yeah.

[Dr. Tori Miller]

The other tool that sometimes I use, depending on circumstances and is not a bad one, I think, if you are new to the OCD space, is Jonathan Grayson's assessment in his book Scale in his book Freedom from ocd, which is a much more. It's a much longer assessment tool, but you could definitely give that to your client to fill in by themselves because it is much more specific, which means it like takes quite a long time. So that's actually probably better done at home.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

But it's literally like, do you have this obsession? Do you have this obsession? Do you have this obsession?

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Do you have this compulsion?

[Dr. Celine Gelgich]

But it's fairly detailed.

[Dr. Tori Miller]

It's very detailed.

[Dr. Celine Gelgich]

As in, like when it says do you have this obsession? It fully describes what that is. Yeah, like it's quite a lengthy description.

[Dr. Tori Miller]

So it's, I think it's, it's, it's. Yeah, it's really nice and specific. So actually that's, that's, that's, I think a really good. And then that actually then you can turn that into a beautiful exposure menu.

[Dr. Celine Gelgich]

Yes, you can.

[Dr. Tori Miller]

Yeah. Whereas the Y box relies a lot more on you filling in the information, having a bit more OCD knowledge in your mind.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

In order to kind of bring examples like do you do this or could you do that? Or what about this? Whereas the Jonathan Grayson scale is.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Much more specific. So it's kind of gives you a bit of a leg up if you're new to the space. So you could almost like start there, experiment.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

And then move on to the why box.

[Dr. Celine Gelgich]

And also help you understand what kind of questions to ask.

[Dr. Tori Miller]

Yes.

[Dr. Celine Gelgich]

And also help you understand what to hear and listen for when your client is talking. Because a lot of the times when you're asking, even when you ask like, what brings you here today and they start telling their story, you'll hear it. Yeah, you'll hear it come up in what they're telling you. So you'll be like, oh, this is that, this is that, you know, and you'll start to be able to map that for yourself. But there are so many sacrament. Like I'm. I love using psychometrics to just quantify what we've already establishing, but also then fill in the gaps too.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And. Yeah. So. But there are a few other psychometrics out there for ocd. The docs I forgot at Least the dimensional obsessive compulsive thing I've ever used. Eventually. Jonathan Abramowicz is one that's also a really good one to use. I don't use it as often as I. I'm a big white. Like, I love the white. Like, I just use the Y box. It's especially because I find the severity rating, because it's so sensitive to use fairly regularly, I kind of like to help use it to help us track our treatments progressing.

[Dr. Tori Miller]

Yeah,

[Dr. Celine Gelgich]

yeah. And there's the Okie. There's so many. We can probably put a link in the show notes. There's a research article I've got in my repertoire that we can link to the show notes and just. Which compares all the different. Yeah, psychometrics for a city.

[Dr. Tori Miller]

Yeah, yeah, Great idea, Great idea. Okay.

[Dr. Celine Gelgich]

See my. Oh, Bubba. My little one just started learning how to roll and when he rolls onto his front, he, like, does this skydive thing going, I'm a bit stuck. I don't know what to do now. And that's what he's just done on the floor. So we're just observing him stuck in the. He's flipped over and now he's like, what do I do now?

[Dr. Tori Miller]

Okay, all right, so. All right, so we've done the compreh. We've brought in some OCD psychometrics.

[Dr. Celine Gelgich]

Yep.

[Dr. Tori Miller]

The next thing to do is you got to go back to the diagnostic criteria.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Yes. We got to bring it back to the dsm.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And we've got to make sure that even though people. Like, there might be lots of things coming up in the Y box, we've still got to make sure that we're meeting all of those criteria. I know. You know, you know these ones off by heart.

[Dr. Celine Gelgich]

Only because I do the workshop. Okay. I don't have to justify it. No, you don't.

[Dr. Tori Miller]

No, you don't.

[Dr. Celine Gelgich]

But, yeah, like, it's.

[Dr. Tori Miller]

It's presence of obsession.

[Dr. Celine Gelgich]

Presence of obsessions. So criteria A is obsessions. Notice how no theme is present in the dsm. I say this all the time because I think we get so caught up on themes and we say this time.

[Dr. Tori Miller]

And I think the theme actually is irrelevant.

[Dr. Celine Gelgich]

Yes, that's right. And anything can be a theme as well. Like as long as, again, if it looks like a duck and quacks like a duck, it's a duck. So if it fits obsessions in criteria A, being unwanted, intrusive thoughts, images, etc, I would put feeling, sensations, urges in there as well.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

That feel really distressing. And and there's a need to want to suppress them or avoid them. So that's the obsession followed by criteria. No, sorry. As well as compulsions still in criteria A, which are behaviors or notice mental acts. So we're now thinking about pure obsessional. So the misnomer there is. It's still a compulsion.

[Dr. Tori Miller]

Even if it's internal. It's still a behavior.

[Dr. Celine Gelgich]

Exactly. So we've got behaviors or mental acts performed in response to the obsessions to alleviate the distress. So we've got the thing that we think and then the thing that we do. So the obsession and the compulsion. A compulsion can also be a ritual or a rumination.

[Dr. Tori Miller]

Yep.

[Dr. Celine Gelgich]

Rituals are basically compulsions. They're just compulsions with a certain pattern to them or a style, I guess, or. Or away like whatever you want to call it. I'd throw rumination under compulsion as well. Definitely. So that's criteria A. Right. Now just because someone might have some obsessions and compulsions doesn't necessarily mean they have ocd.

[Dr. Tori Miller]

No, it doesn't.

[Dr. Celine Gelgich]

So the next step we have to think about criteria B is how distressing is it? Or does it occur for greater than an hour a day? So how much time is it taking up? Or C, which I always get stuck on C. So we've got functional impact. Right. So we've got functional impairment. How much does it impact day to day functioning? Now there is an OR in between each of those in the dsm, but I like to do the. And or because it could be all of the above. So we now have obsessions, compulsions which are. Then are they distressing? How much time is it taking up? Is there functional impact? Relationships, work, school, friendships, family life. Think about the whole shebang.

[Dr. Tori Miller]

And I think the hour per day is actually quite nimble. Important criteria to pay attention to.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Because as we've talked about many times before in previous episodes, compulsive behavior can be seen in many disorders.

[Dr. Celine Gelgich]

That's right.

[Dr. Tori Miller]

In. In many. In many.

[Dr. Celine Gelgich]

Yes. Ritualistic behaviors like think about stimming behaviors in autism.

[Dr. Tori Miller]

Absolutely.

[Dr. Celine Gelgich]

Or reassurance seeking in gad.

[Dr. Tori Miller]

Absolutely. There are. It's present all the time, however, that you don't tend to see that. You know, the. The combination of the distress. Yes, the distress and it being. And. And it happening for over an hour a day.

[Dr. Celine Gelgich]

Time consuming.

[Dr. Tori Miller]

Outside of ocd.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Yeah. Yeah. You might see lots of, like. Lots. Little things.

[Dr. Celine Gelgich]

Yeah, but little episodes.

[Dr. Tori Miller]

Little episodes. Or you might. Might see say in autistic individuals who are engaging in rituals. Yeah. Might be half the day. But not distressing.

[Dr. Celine Gelgich]

That's right.

[Dr. Tori Miller]

Not distressing.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Yeah. So this is. This is something that is actually quite specific. It is OCD and really helps differentiate.

[Dr. Celine Gelgich]

It does things. Yeah, yeah, yeah, yeah, yeah. As well as the ego dystonic nature of the obsession component. That is a huge factor when it comes to differentiating between the bajillion. They're not attributed to other mental. Sorry, next. Next line.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Okay, so A, B, C, not attributed to substance use. Then the next one D not attributed to another mental health condition. That list is the biggest paragraph I have ever seen in my entire. Like in the entire dsm. It basically lists every other bloody thing that's in there.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

So there's a huge differentiator. The ones I usually may like focus on a lot because these are the ones that co occur quite a lot. You've got the anxiety disorders. So you've got health anxiety in particular, Generalized anxiety disorder, Social phobia, specific phobias. Panic disorder too can co occur. But the ones that are hard to differentiate are usually the ones I listed just then. Major depressive disorder. CO occurs but we don't really like. It usually happens secondary. So the anxiety disorders come first and then OCD will develop. So OCD is secondary. Usually. The other one that's difficult to differentiate is autism and ocd. Obsessive compulsive personality disorder. And OCD is really hard to differentiate as is dependent personality disorder and sometimes psychosis and ocd. Yes, psychosis and ocd. Avoidant personality disorder and OCD can be really tricky to differentiate too. And then some eating disorders. And OCD is another one. Did I miss one? Adhd And OCD is another one that comes up too.

[Dr. Tori Miller]

Yep.

[Dr. Celine Gelgich]

So yeah, we won't go into. We've talked about differentials in so many different episodes. Won't delve into that right now because it will be here for hours. But important to have a think about. So we've. Yeah. So where are we at now with the assessment?

[Dr. Tori Miller]

And that's.

[Dr. Celine Gelgich]

And that is why.

[Dr. Tori Miller]

That is why the comprehensive assessment is so important.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

That's why we don't just assess specifically for ocd because we need to understand the differentials, but we also need to understand co occurring conditions. And what's really important is if you. It's ruling in OCD means ruling out other things. And you can't do that.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Unless you have really done a full comprehensive developmental assessment. Even if your client is an adult.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Still need to understand 100%.

[Dr. Celine Gelgich]

Even if they've been to therapy 10 million times before they're new to you.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Right. So you still need that. Yeah.

[Dr. Tori Miller]

And you can't do that bit unless you really understand if you're going to say that it is ocd, you have to say what it is not and why it is not those.

[Dr. Celine Gelgich]

Yes, yes. Or if it's both.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

You know, and so I think. Oh, the other thing that's in there is not attributed to a medical condition. But the interesting thing is, and one thing that's worthy of note and not many people know about, is pandas and pans.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Which is basically acute onset of OCD due to an infection. Yeah. Usually a staph infection. It is not as responsive to ERP as. So you actually need to treat it medically first through antibiotics and other physical.

[Dr. Tori Miller]

And then the ERP is what medical stuff.

[Dr. Celine Gelgich]

Yeah, exactly. Exactly. But you definitely need to treat the infection first. So. I've only had two clients along the way in my career with pandas.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Have you had any?

[Dr. Tori Miller]

Yes, I have. I have. It's been quite interesting because, I mean, I think it's. Sometimes I think what I've had because it's not a widely recognized condition and it's still a little contentious in Australia.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And so a lot of. I know. Practitioners aren't comfortable.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

Kind of diagnosing it and pediatricians too, I think. Yeah. That's what I mean. And so I think we've. I've had some families who have been looking back and saying, I wonder. I wonder if actually now that I look back, if it might have been. Yeah. Now that we. We know a bit more about it.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

But otherwise I've. I've probably had three or four.

[Dr. Celine Gelgich]

Yeah.

[Dr. Tori Miller]

But again, I. I don't think that anyone actually was comfortable saying, yeah, this

[Dr. Celine Gelgich]

is what it is.

[Dr. Tori Miller]

This is what it is. However.

[Dr. Celine Gelgich]

Interesting.

[Dr. Tori Miller]

Yeah. Treated for it. Sort of.

[Monica Reinagle]

Yeah.

[Dr. Tori Miller]

But, yeah, it was my.

[Dr. Celine Gelgich]

For me, my first one was just by chat, like, it was the young person and it was such a cute, intense ocd. And, like, why isn't this responding? There's something not right here. And I'm like, there's something missing. And I just by chance had read about pandas.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And I was like, like, oh, maybe. So I asked the question to the. I'm like, have she had, like an infection or something, like an ill, like, lately? And like, oh, yeah, actually. And I was like, okay, we need to. I reckon this might. Let's just rule it out. If it's. If it's a no, it's a no. Because it's not harmful. Yeah, right. In, in looking into it and yeah, once she was treated with it, it settled right down.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And we were like, oh, thank goodness.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

But also like it was. If I hadn't read that article at that time, we just would have just been. Just keep going in like this circle of.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

And I likely would have disengaged.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

To be honest. Yeah.

[Dr. Tori Miller]

So presume that it wasn't. Wasn't.

[Dr. Celine Gelgich]

Wasn't working or whatever. Yeah, exactly.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Yeah. So that was great. I was grateful for that. But like. Yeah, it's really full on. But I can see why. But you're not wrong. Like it was very much when I did look into it, I was like, oh, this feels a bit woo woo, A bit like, like with anything new.

[Dr. Tori Miller]

Right, everyone, we're always evidence based. Yeah.

[Dr. Celine Gelgich]

Yes. Yeah, yeah.

[Dr. Tori Miller]

Still being researched. Yes, yeah, yeah, that's right.

[Dr. Celine Gelgich]

But there's been a good decade since that, that client that I had. So. Yeah, yeah, it's been interesting. So. Yeah, there's that too.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

Have I missed anything in the criteria I should know?

[Dr. Tori Miller]

No, I don't. Look, I don't think so. I didn't think so, but.

[Dr. Celine Gelgich]

Oh, actually there are specifiers. We need to think about those two. So we've got insight specifier. Good, fair, poor, absent and delusional beliefs is a specifier. But just because a client has good insight doesn't mean their OCD is not severe.

[Dr. Tori Miller]

Yeah, absolutely.

[Dr. Celine Gelgich]

Because a lot of the time our clients insight is really good. Yes.

[Dr. Tori Miller]

But their distress is so severe. It's so severe.

[Dr. Celine Gelgich]

Yeah. And. And I think that's part of the torture of ocd. Because our clients know. Yeah, they know it's silly, they know it's irrational, they know it doesn't make sense. But when they're in that moment and they're in that loop, they can't, they can't stop themselves. They can't stop it.

[Dr. Tori Miller]

Fear is so great that they, it's. Yeah. They feel like they can't risk it.

[Dr. Celine Gelgich]

Exactly. So in or as in other conditions, insight can be a predictor of outcomes.

[Dr. Tori Miller]

Yeah. And again, it can be a protective factor.

[Dr. Celine Gelgich]

Yes, exactly. But not in ocd. We don't actually have that luxury with ocd.

[Dr. Tori Miller]

That's right.

[Dr. Celine Gelgich]

And then the other one is tic disorder that we need to specify and.

[Dr. Tori Miller]

Fuck.

[Dr. Celine Gelgich]

There was one more. I forgotten.

[Dr. Tori Miller]

Is it severity rating? Is it no severity rating specifier for ocd.

[Dr. Celine Gelgich]

No, they don't. Tick disorder. And I can't remember what the other one was.

[Dr. Tori Miller]

Yeah, I Mean, it's. I mean, we're getting very specific.

[Dr. Celine Gelgich]

We are getting really specific. Look it up.

[Dr. Tori Miller]

Yeah, that's right.

[Dr. Celine Gelgich]

As a. One of my lecturers once told me, the reason why we have resources is so we can look this stuff up. That's right.

[Dr. Tori Miller]

That's right. Yeah. Okay. Okay. So comprehensive assessment followed by psychometrics.

[Dr. Celine Gelgich]

Yep. Followed by double checking with the dsm.

[Dr. Tori Miller]

Double checking with the dsm.

[Dr. Celine Gelgich]

Yep.

[Dr. Tori Miller]

Writing your formulation.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

All right, this is the next part and this is where we're weaving it all together. And this is where you may need to consider some additional psychometrics.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Outside of OCD space, if you're wondering about co occurring conditions, but this way you write your formulation at this point in time. That is, I think that is the heart of an OCD assessment. I think the only other thing I would add is that you won't always have all of the information. Just like with any condition, you won't necessarily have all the information up front. You may be able to make a diagnosis, but sometimes it's because people feel too much embarrassment or shame to tell you all of the things.

[Dr. Celine Gelgich]

Huge factor. Yeah.

[Dr. Tori Miller]

All of the, the obsessions and compulsions that they're, that they have, that they're experiencing. But also people who, particularly those who have lived with OCD for a long time, may not actually be aware that some of the things that they're doing are actually part of their OCD presentation.

[Dr. Celine Gelgich]

It's been a huge part of their lives.

[Dr. Tori Miller]

And so it actually isn't until you start getting to work where they start to build insight and start to recognize just how widespread.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

You know, their OCD is. And so sometimes, you know, it's just about time. But, but if you do those things, if you do the Y box, if you do the big assessment, if you're working with kids, you know, you're getting the information from the child, but also the parents, you're getting that collateral information that should be sufficient to make diagnosis.

[Dr. Celine Gelgich]

Yeah, absolutely.

[Dr. Tori Miller]

And then you should also, at that point in time, particularly from the psychometrics you've used, but also your clinical interview, you should also have enough, enough data then.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

And information to get started in the intervention. Yes, you will, then that's, that's part of the great thing about this process.

[Dr. Celine Gelgich]

Your trigger list is half formed for you.

[Dr. Tori Miller]

Absolutely. So you can, you can get straight into psychoeducation.

[Dr. Celine Gelgich]

Yep.

[Dr. Tori Miller]

In which, in fact, most of the time you've already started doing anyway because you tend to start educating your clients as you're doing the assessment, anyway.

[Dr. Celine Gelgich]

Yes, that's exactly right. And so normalizing intrusive thoughts and all that.

[Dr. Tori Miller]

Absolutely. So you can, you know, you are well set up. This assessment process will set you up so beautifully to then proceed seamlessly.

[Dr. Celine Gelgich]

Yes.

[Dr. Tori Miller]

Into what is erp, why are we doing it? And then this is what we're doing. Let's.

[Dr. Celine Gelgich]

Let's go.

[Dr. Tori Miller]

Let's go. It actually sets you up beautifully. The flow on from that.

[Dr. Celine Gelgich]

That is really. Yeah, it's true.

[Dr. Tori Miller]

Yeah, yeah.

[Dr. Celine Gelgich]

Amazing.

[Dr. Tori Miller]

I think that's a sense. Yeah, it really is. Yeah.

[Dr. Celine Gelgich]

Rock and roll.

[Monica Reinagle]

Yeah.

[Dr. Celine Gelgich]

Thank you guys so much for joining us. If you like what you're hearing, please follow and subscribe so you can stay up to date with our fortnightly episodes with little breaks in between.

[Dr. Tori Miller]

Yeah.

[Dr. Celine Gelgich]

All right, catch you guys next time. Thanks for listening and watching. Bye.

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