Symposia
Assessment
Jonathan Abramowitz, Ph.D.
Professor of Psychology
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Abramovitch Amitai, PhD
Associate Professor
Texas State University
San Marcos, Texas
Dean McKay, ABPP, Ph.D.
Professor
Fordham University
Bronx, New York
Obsessive-Compulsive Disorder (OCD) is a chronic condition that is underrecognized in non-mental health clinical (i.e., medical) settings; and no reliable and valid screening tools exist to date. There is also a need for a syndromally valid self-report measure of OCD. The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used instrument, yet it is too lengthy for use in busy clinical settings and its factor structure does not converge with contemporary models of OCD symptoms. Specifically, the hoarding factor is obsolete, and the neutralizing factor has poor face validity. We therefore aimed to (a) evaluate a syndromally valid modification of the OCI-R and (b) develop a brief screener that could be used to detect OCD in non-mental health clinical settings.
Samples of adults with OCD (n = 1087; 53% female), anxiety disorders (n = 1306; 50% female), and community volunteers (n = 423; 30% female) completed the OCI-R along with other measures of OCD and related psychopathology (e.g., worry). To address our first aim, we first excluded the 3 OCI-R items assessing hoarding. Item analyses suggested the removal of the 3 neutralizing items. This resulted in a 12-item version (the “OCI-12”) that included washing, checking, obsessing, and ordering subscales (3 items each). Confirmatory factor analysis indicated a good fit with this 4-factor model. Tests of internal consistency, test-retest reliability, and convergent and discriminant validity indicated strong properties as a measure of OCD symptoms. Sensitivity and specificity (i.e., ROC) analyses indicated the OCI-12 has robust diagnostic sensitivity in distinguishing OCD from undiagnosed individuals (AUC = .91) and those with anxiety disorders (AUC = .78). We also computed norms, severity benchmarks, and a clinical cutoff.
To address our second aim, we conducted item analysis of the OCI-12 and identified four items that optimally assess different presentations of OCD (washing, checking, ordering, obsessing; the “OCI-4”). The psychometric evaluation revealed good test-retest reliability and convergent/discriminant validity. The OCI-4 also demonstrated promise as a screener for OCD: ROC analyses indicated robust diagnostic sensitivity when distinguishing OCD from undiagnosed individuals (AUC = .86) and those with anxiety disorders (AUC = .76). Patients with a positive screen may be referred for further evaluation. The potentials and pitfalls of using the OCI-4 as an ultra-brief screening tool for OCD will be discussed.