Disabling effects

People with a mild functional restriction are likely to:

• Be managed by the primary health care team
• Have never received treatment or received treatment with low intensity Cognitive Behavioural Therapy (CBT) (including Exposure and Response Prevention ERP) or Selective Serotonin Reuptake Inhibitors (SSRI).
• Alone if unable to engage in low intensity CBT.
• Live independently
• Enjoy contact with friends and family
• Have no loss of interests or hobbies
• Be able to leave the house unaccompanied

Mobility

They would normally have no physical difficulty in getting around.

They should not have difficulty finding their way around unfamiliar places and should not require guidance or supervision.

Care

They should not normally exhibit significant self-neglect.

They should not normally have any significant functional loss that will result in a reduction of their ability to carry out normal day-to-day activities.

Disabling effects

People with a moderate functional restriction are likely to:

• Be managed by either primary or secondary health care teams
• Have received more intensive CBT (including ERP) or SSRI alone
• Live independently
• Have reduced social interaction with friends and family
• Have a reduction in interests and hobbies
• Be unable to complete an unfamiliar journey without a companion

Mobility

They would normally have no physical difficulty in getting around.

They may have such severe obsessions and compulsions (for example, of contamination or fear of harm to self) that they are unable to leave the house or complete an unfamiliar journey without a companion for reassurance. Should the companion not be present the person may not be able to reach their destination.

Care

They may spend so much time performing rituals or have compulsive slowness to a degree that this may result in a loss of their ability to carry out normal day-to-day activities and may lead to self neglect

Disabling effects

People with a severe functional restriction are likely to:

• Have received previous treatment with drugs and CBT to little or no effect and are most likely to have been referred to more intensive specialist treatment services.

Mobility

They would normally have no physical difficulty in getting around. Some patients particularly with obsessions concerning perfectionism, have the urge to perform every action “correctly” and can be extremely slow in speech and in movement and can thus appear to have severe learning difficulties and mobility problems.

They may have such severe obsessions and compulsions (for example of contamination or fear of harm to self) that they are unable to leave the house or complete an unfamiliar journey without a companion for reassurance.

They may be so occupied by obsessional thoughts that their awareness is affected and may not be aware of common dangers, such as traffic.

Care

They may spend so much time performing rituals or have compulsive slowness to a degree that this is likely to result in a loss of their ability to carry out normal day-to-day activities and may lead to self neglect. Some individuals restrict fluid intake and may seriously harm their kidney function and physical health. Urinary or faecal incontinence can occur in patients who become “stuck” in their compulsive rituals and unable to attend to this aspect of self-care. Alternatively, they may be so occupied by obsessional thoughts that their awareness is affected, and may not be aware of common dangers, for example, leaving gas taps on. People with this level of disability will normally be considered for more intensive treatments, hospital admission or supported accommodation.