If you have arrived on my page as you suspect you might have Obsessive Compulsive Disorder (OCD), it is important that you get an assessment from a psychologist or psychiatrist who can then tell you whether or not you have OCD. Getting a diagnosis is essential, as it is your diagnosis, that informs treatment. This simply means that different conditions have different treatments, and getting assessed and diagnosed tells the professional what treatment will help you best.
If you want to learn more about OCD I recommend you read my complete Guide to Obsessive Compulsive Disorder.
I appreciate this can feel like a minefield, especially if you battling symptoms of OCD, so the purpose of today’s article is to take the fear out of the process by telling you what happens. I will talk to you about what an OCD assessment entails, who can diagnose OCD in Ireland, and what to expect from the assessment session. I find that people are more likely to move ahead with the assessment process once they know what will happen before hand, and I hope that this information helps you. I will start of by telling you who can diagnose OCD.
Table of contents
Who Can Diagnose OCD?
In Ireland, a diagnosis of OCD can be made by:
- Clinical Psychologists / Counselling Psychologists: They are trained to assess mental health conditions through interviews and psychometric tests. They do not prescribe medication but often are the ones delivering therapy and thus commonly identify OCD.
- Psychiatrists: Medical doctors specialized in mental health. They can diagnose and also prescribe medication. A psychiatrist assessment might be accessed via GP referral if medication or a formal medical diagnosis letter is needed (for example, for insurance or occupational reasons). Psychiatrists often work in HSE mental health clinics or private practice.
- General Practitioners (GPs): A GP can recognize probable OCD, especially common patterns. While many GPs are adept at spotting it, typically they will still refer you to a specialist (psychologist or psychiatrist) for confirmation and treatment. But a GP is a good starting point to discuss your symptoms and get referrals.
If you are haven’t already done so, you can take my online OCD screening test, which maps your obsessions and compulsions and shows how ERP can help.
I think that the word itself ‘assessment’ can be a bit off-putting. I hear people asking me, or emailing me, asking about initial sessions – I’m not entirely sure where this wording comes from, maybe some counsellors in Ireland offer free sessions at the start, but when people see me for their first session, it is an assessment session. Most people are anxious when they first come in, but at ease as the session progresses. I want to tell you what you can do before the assessment, to help put you at ease and to make sure the get the most out of the session.
If you would like my help
Preparing for an OCD Assessment
To make the most of an assessment:
- Reflect on your symptoms: What are your intrusive thoughts or worries? What compulsions or habits are you doing (physical or mental) in response? In what situations do they worsen? Jotting down examples can help ensure you don’t forget to mention something important.
- Consider impact: How is OCD affecting your life? Note down if it’s impacting work (e.g., taking too long to get things done), school, relationships, daily routine (like hygiene, punctuality, sleep), etc. Also note roughly how many hours a day you spend on obsessions/compulsions – the assessor will likely ask that.
- Family history or medical history: OCD sometimes runs in families or co-occurs with other conditions. Be ready to mention if any relatives have OCD or other mental health issues (anxiety, depression, etc.). Also be ready to list any other conditions you have or medications you take.
- Be honest and open: This is crucial. No matter how bizarre or shameful a thought or ritual seems to you, pleasetell the assessor. They have truly heard everything before (the content usually falls into known categories). They won’t be shocked or judge you; instead, they’ll likely nod and perhaps ask for more detail to fully understand. Remember, their role is to help, not to moralize. If you hold back (common with sexual or harm obsessions due to fear of being misunderstood), it can lead to misdiagnosis. For instance, not mentioning violent intrusive thoughts might lead them to miss OCD and think it’s just generalized anxiety, thereby not addressing core issues. So, take a deep breath and share.
- Questions to ask: You can also ask the therapist questions, e.g. “Do you have experience treating OCD?” or “Is this something you see a lot?” A skilled clinician won’t mind – they’ll often give some reassurance like “Yes, this sounds like OCD which is quite treatable” as part of feedback.
What happens during the Assessment?
Clinical Interview: This is the core and it’s where I ( or another psychologist or psychiatrist) invite you to describe your concerns in your own words. You’ll be asked follow-up questions to get specific details. Here’s some questions you will be asked:
- “Can you describe the thoughts that bother you? Do you recognize them as your own thoughts, not voices from outside?” (They check insight – OCD usually has good insight vs. psychosis). Some clinicians can ask this as it helps them differentiate from psychosis.“What do you do in response to those thoughts or fears? Do you feel driven to repeat certain actions or thoughts?”“How long do these obsessions/compulsions take each day?”“What’s the impact on your life – are you avoiding things, have your routines changed?”“When did this start? Was there a particular trigger or has it built up over time?”“On a scale of 0-10, how strong is your urge to do these rituals when anxiety hits? How distressed do you feel during obsessions?”They’ll also ask about mood (many with OCD also have periods of depression due to the stress), and any other anxiety issues or past trauma (some events can flare OCD, etc.).They might ask about substance use – not to judge, but because sometimes things like heavy alcohol use can worsen OCD or complicate treatment.
Questionnaires: Often, you’ll be asked to fill out standardized forms. Common ones:
- Y-BOCS (Yale-Brown Obsessive Compulsive Scale): a semi-structured interview or self-report that quantifies the severity of obsessions and compulsions (frequency, intensity, insight, resistance, etc.). You can read that this type of assessment is standard in NICE Guidance.
- OCI-R (Obsessive-Compulsive Inventory – Revised): a self-report checklist that covers different subtypes of OCD symptoms and gives a score.
- Beck Depression/Anxiety Inventories or similar: since co-occurring depression or general anxiety is common, they might measure that too.
Differential Diagnosis: A skilled assessor will consider if it’s really OCD or something that mimics OCD. They might ask questions to rule out:
Generalized Anxiety Disorder (GAD): GAD involves excessive worry, but not usually specific compulsions. If your “compulsions” are more like reassurance-seeking or overthinking without clear rituals, they’ll delineate whether it’s OCD or GAD. Sometimes one can have both.
OCD vs OCPD (Obsessive-Compulsive Personality Disorder): OCPD is a personality style of perfectionism and orderliness, but doesn’t have the classic ego-dystonic obsessions or anxiety-driven compulsions of OCD. The interviewer may ask if your habits cause you distress and if you wish you could stop (pointing to OCD) or if you feel they’re just part of your values and others are the ones distressed (more like OCPD).
Psychotic disorders: They might lightly screen for any delusional beliefs or hallucinations. OCD people usually know their fears are irrational (at least to some degree) and they don’t hear voices commanding them (they experience internal thoughts). Strong religious obsessions or bizarre intrusive thoughts in OCD can sometimes sound superficially like delusions, but the difference is insight and the person’s torment over them. They may ask, “Do you ever believe these thoughts are messages or that you have to act on them because a force says so?” OCD people generally say “No, I hate them, I don’t want them.” That clarifies it.
Tics or Tourette’s: If you mention physical tics or repeating words due to a neurological urge, they’ll note if it’s separate from OCD or part of a Tourette’s spectrum (OCD and tic disorders often co-occur). This might influence medication choice or referral to a neurologist if needed.
Other anxiety disorders: Like phobias, which are more circumscribed, or PTSD if there’s trauma history (trauma can lead to OCD-like rituals in some cases, but then PTSD needs addressing too).
Eating disorders or Body Dysmorphic Disorder (BDD): OCD checking or rituals around food or appearance might actually be ED or BDD. They’ll check if the root concern is weight/shape (points to ED) or a specific perceived defect (BDD) vs. an unrelated OCD fear.
Autism Spectrum Disorder (ASD): Sometimes autistic individuals have rigid routines that look like compulsions or intense interests that look like obsessions. The assessor might ask about childhood development, social understanding, sensory issues to see if ASD is a factor. It’s possible to have both ASD and OCD too.
Feedback and Diagnosis: After gathering information, the professional should provide you with feedback. If criteria are met, they’ll explain “It appears you meet criteria for OCD.” They might share what severity level they gauge (mild, moderate, severe) based on your description and questionnaires. If they think it’s not OCD, they’ll explain what else might be going on (e.g., “Your symptoms seem more like health anxiety than OCD, because you don’t report compulsions just worry – we’d treat that similarly in therapy, but technically it’s GAD” or “Your rituals seem solely around weight and calories, which is more indicative of an eating disorder that we should address.”)
In many cases, people have a mix (like OCD and health anxiety, or OCD stemming from a trauma, etc.). They will outline that complexity too.Don’t hesitate to ask, “Do I have OCD then?” if they don’t explicitly say. Clarity helps your peace of mind to finally put a name to it. Most will say outright, “Yes, this is OCD, often known as the ‘doubting disease’ and you have classic signs of that.”
Discussion of Treatment Plan: After diagnosis, the next step is discussing how to tackle it. They’ll usually introduce the idea of CBT/ERP as the frontline treatment. If you’re with a psychologist, they might offer to work with you on that (and schedule further sessions). If you’re with a psychiatrist, they might discuss starting an SSRI and also refer you to a therapist for ERP. If you came via GP and it’s a psychologist doing the assessment under referral, they’ll send a report back to GP or the mental health team recommending therapy, possibly medication. In any scenario, you should leave with a sense of “what now.”
They might set some therapy goals with you (e.g., “Be able to reduce handwashing by 80%” or “Resume driving on motorway” or whatever functional goals apply). The treatment goals I just used in the example use a model of therapy called Exposure and Response Prevention (ERP) and you can see the model in action in the following two articles
If medication is suggested, they’ll explain pros/cons and it’s up to you. Many psychologists will say “Medication is something to consider especially if symptoms are severe – you can discuss with your GP or a psychiatrist about starting it. Either way, we can begin therapy.”
They might provide some psychoeducation: reassuring you that OCD is common (1-2% of people, meaning tens of thousands in Ireland, for example), that it’s not your fault (it’s a known neurobiological condition exacerbated by stress, etc.), and that effective treatments exist (therapy, meds, or both). Often just hearing “You have OCD” already is a relief: clients often report a sense of validation because they knew something was wrong and now it has a name and solution path.
After the Diagnosis
Some feelings people have after being diagnosed:
- Relief: “I’m not alone or crazy; this is a real condition that others have too.”
- Apprehension: “Now I have to confront this through therapy; can I do it?” That’s normal – try to focus on the fact that now you have a roadmap and your clinician will guide you.
- Stigma concerns: OCD is less stigmatized than in the past, but you might worry about who knows. Remember, your information is confidential. You only need to tell those you want to. Some find it helpful to tell close family so they understand behaviour changes you’ll be making in therapy; others tell a trusted friend or even their boss if they need a bit of flexibility for appointments. But it’s your choice. OCD is a medical condition – you have every right to privacy and also to understanding if you do choose to share.
- Curiosity: Many start reading up more on OCD after diagnosis (just be careful not to overdo Googling in a way that becomes reassurance seeking!). Stick to reputable sources (like OCD Ireland, International OCD Foundation, etc., or books by experts). Often your clinician can recommend good reading (e.g., “Brain Lock” by Dr. Jeffrey Schwartz is a classic book on OCD).
- Motivation: Sometimes a diagnosis empowers people: “Right, I have OCD. Time to beat it!” Use that momentum to engage fully with the treatment plan recommended, be it ERP, medication or both.
Getting an Assessment in the Irish Healthcare System
If you’re going via the public route:
- Start with GP: Tell them your suspected OCD symptoms. GPs can make an initial call; many will start an SSRI if you agree, while referring you to a psychologist or psychiatrist. They might refer to the local Primary Care Psychology (for mild/moderate cases – but wait times vary from a few weeks to several months) or to a Community Mental Health Team (for more severe or if meds likely needed – wait might be quicker if marked urgent).
- CAMHS (for under 18s): Typically via GP or paediatrician referral. If OCD is affecting a child, mention at GP and push for CAMHS referral. CAMHS teams in many areas do see a lot of OCD in teens and have clinical psychologists who do ERP.
- If you have insurance: you may go straight to a private psychologist (self-referral) or a private psychiatrist (some require GP referral, some not). Check what your insurance covers. VHI, Laya often cover a portion of outpatient psychologist fees up to a limit per year; hospital plans may cover a stay in St. Pat’s if inpatient is needed. If waiting lists publicly are too long and you can afford even a few private sessions for assessment and start of therapy, it might be worth it.
- OCD Ireland: The charity doesn’t do formal assessments but can point you to resources. They might have a list of professionals or support groups. They also have information events which can supplement your professional guidance.
Remember, diagnosing yourself is not enough – a professional assessment is valuable to tailor the treatment correctly. But identifying OCD tendencies in yourself is a valid reason to seek that assessment. You might literally say to a GP or therapist, “I suspect I have OCD because [examples].” This can expedite the conversation.
Conclusion
The assessment is the first therapeutic step – many feel better after just telling someone all their “secrets” and hearing, “Yes, it sounds like OCD and I know how to help you.” It transforms this big, nebulous monster into a defined problem with a plan. So, try to approach the assessment as a positive, collaborative meeting rather than an interrogation. You’re the expert on your experience, and the clinician is the expert on OCD knowledge – together you get a full picture and can move forward.
