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Dr. Eric Storch is Professor and McIngvale Presidential Endowed Chair at the Baylor College of Medicine. Dr. Storch specializes in the cognitive-behavioral treatment of adult and childhood obsessive-compulsive disorder (OCD), as well as other anxiety and OCD-related disorders.
Dr. Storch has been the principal investigator on multiple federally funded grants, is a Fulbright Scholar, and has published 12 books and 500 peer-reviewed articles. He is on the IOCDF Scientific Advisory Board and is the Chair of the Pediatric Behavior Therapy Institute.
According to the World Health Organization, OCD is one of the top 10 causes of disability worldwide. nView had the opportunity to sit down with Dr. Eric Storch who has devoted his career to the study of OCD and related disorders. He is co-author of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) I & II and Florida Obsessive-Compulsive Index (FOCI) that help physicians and mental health specialists measure OCD symptom severity to build more appropriate treatment plans. We wanted to know his thoughts on making sure physicians of all types have access to OCD measurement tools and training. Here’s what he had to say:
ES: The National Institutes of Health estimates that 3% of the population has OCD, and according to the World Health Organization, it is one of the leading causes of disability. Like many mental health disorders, if not identified and properly treated early on, it can escalate to a lifelong disability, not only for the person suffering it but also for loved ones who are living with and caring for the individual.
ES: There is a bi-model distribution of the onset of OCD. We typically see 50%-70% of cases emerge during childhood, around the age of 10 or 11 years old. Over time, some period of time may be better than others, but it always progresses up and to the right.
The other group of patients we typically see are in early adulthood. In many cases, symptoms emerge when a woman has her first child. In fact, a Northwestern University study that was published in the Journal of Reproductive Medicine found that 11% of new mothers experience significant OCD symptoms. Other factors contributing to the emergence of symptoms could just be the way the brain matures over time or how it adapts to the increased responsibility of adulthood.
ES:The way we diagnose patients with OCD is to start by having a mental health professional conduct a clinical interview with the individual. A core component of that interview is a measure called the Yale-Brown Obsessive-Compulsive Scale, better known as the YBOCS, that Dr. Wayne Goodman and I created. The YBOCS, YBOCS II, and the YBOCS for Children (CYBOCS) all focus on measuring the type of obsessions separately from compulsions and measuring the severity of the disorder without being biased toward or against the type of content the obsession or compulsions might present. This gives the mental health professional a better idea of how problematic the disorder is, which can then inform the right treatment plan.
In kids, we want to embrace the whole family to make sure we are getting every angle on the nature of the symptoms, which is particularly relevant in children who may not have the same sense or ability to think about their OCD as their parent who is observing them.
ES: What the YBOCS did that was revolutionary is it really focused on assessing the symptoms that compose the condition but also how we can conceptualize the associated severity of the symptoms. It has been a model for multiple other severity scales.
Historically, the severity of the disease was measured by evaluating how bad the symptoms were and summing up the total. But the problem with this approach is all of the symptoms are collectively summed up to get an overall composite severity score, and therefore all symptoms are considered equal weighting. The composite score provides this weighting on certain systems that may not correspond with overall symptom severity.
The YBOCS takes a different approach. It actually measures which symptoms are present that link up to the condition, such as the amount of time affected by a patient’s symptoms, the level of impairment and distress the symptoms cause, and even a patient’s ability to control the symptoms.
This has withstood the test of time in terms of a way of thinking about the severity of an illness. Since the YBOCS’ release, multiple people across different illness states have applied this model to the way they think about assessing the severity of different illnesses.
Some estimates put the average timeframe from symptom onset to first treatment to be between seven and 10 years. Imagine you had cancer and you waited that long to do something about it. We see individuals miss out on huge chunks of their lives, like being successful in school, building relationships, finding a soul mate, and even reduced occupational success.
When patients go untreated, they often develop additional psychological conditions, such as depression and anxiety as individuals feel anxious all the time. We tend to see people have a complex course when they have delayed diagnosis. On the other hand, when we are able to intervene early, that gives us a better outcome because we aren’t having to rehabilitate the person so much.
One of the biggest challenges with OCD is the stigma that remains in society. Cost is another huge barrier. While we may have achieved some successes within parity of mental health to physical illness, the reimbursement rates set by insurance plans are still relatively low. That makes it difficult for providers who have to choose whether to go with the rates that have been set and process those claims or do a self-pay arrangement. Cost is a real issue.
One of the other challenges that persists with OCD is the nature of training. We are fortunate to be in a field that has many brilliant clinicians, but at the same time, there are different ways of providing training that may or may not be robustly tested. For OCD, we know that there is a specific type of psychotherapy that works well, but not everyone knows this or does this. If you’re looking at your insurance, it's often a challenge to find someone outside of a medical center who is providing this type of treatment. And so, we need to be mindful in psychology and psychiatry, to provide the most effective treatments that have success rates exactly the way we would do it in any other discipline of medicine.
There are a number of reasons for optimism. When I started 20 years ago, it was nearly impossible for someone with OCD to get good care. They could not get access to good quality exposure-response prevention. At best, they could get access to pharmaceuticals.
Now, there are more training programs available for clinicians, which is increasing the number of trained mental health specialists. We are also seeing advances in understanding this illness and how it relates to different treatments. And as a result of COVID-19, we are seeing a broader adoption of telepsychiatry visits that are giving people greater access to care from their homes.
I would encourage people to visit the International OCD Foundation that has an array of resources and articles by numerous scholars in the field.
In Summary: OCD is a serious behavioral health disorder that often leads to the development of additional disorders, robbing individuals of living happy, productive lives for decades if not identified and treated early. The YBOCS I&II, CYBOCS I&II, and FOCI are valuable tools that physicians of all specialties can use to help measure the severity of symptoms and treat patients appropriately. All of these scales can be purchased from nView Health. Contact us for more information.
