Obsessive compulsive disorder is listed as the fourth most common mental disorder in the world1 and its debilitating effects lead to reduced quality of life, impaired self and interpersonal functioning, and increased use of healthcare services.2, 3, 4 The ramifications of these effects on social, emotional, and societal engagement pose an important question: Does OCD qualify as a disability? The short answer is yes, however, the issue is more complex than it may seem.
Is OCD a Disability?
Disabilities are most often categorized according to the Americans with Disabilities Act (ADA), first published in 1990. This was a civil rights law passed in order to ensure individuals with disabilities were not discriminated against. Accordingly, the ADA outlines criteria for what qualifies as a disability and is therefore covered under the act.5
The ADA categorizes a person with a disability as someone who has at least one of the following:
- a physical or mental impairment that substantially limits one or more major life activities
- a history or record of such an impairment (such as cancer that is in remission)
- is perceived by others as having such an impairment
The different types of disabilities OCD falls under would primarily be limited to the realm of mental disorders. The Social Security Administration (SSA) lists OCD as a disability under section 12.06, Anxiety related disorders.6 Based upon the ADA and SSA, an individual suffering from OCD would need to meet certain qualifications for severity in order to obtain benefits.
Is OCD a Disability or a Mental Illness?
Answering this question is a matter of perspective. From the perspective of the ADA and SSA, Obsessive-compulsive disorder (OCD) may qualify as a mental disability for which an individual could receive benefits. From the medical perspective, OCD falls primarily under the category of a mental illness, although even this claim depends upon the school of thought one adheres to. More biological medical-based models suggest OCD symptoms result on the basis of faulty basal ganglia functioning,7 afflicted serotonin levels,8 or various other abnormalities in brain structures seen on fMRI machines.9 Meanwhile, other psychological perspectives would implicate social, cognitive, and emotional factors as contributing forces to the development of OC symptoms.10,11
Types of Disability Benefits for Someone With OCD
There are various types of disability benefits an individual suffering from OCD may qualify for. Those benefits would primarily be afforded through federal or state run institutions. The federal government provides disability benefits through Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). State specific disability programs fall under the federally run Rehabilitation Services Administration (RSA).12 Each state then has its own federally funded Vocational Rehabilitation (VR) services that cater to individuals within their jurisdiction.
Types of benefits individuals with OCD can qualify for include:
- Social Security Disability Insurance: SSDI is a government program that provides monthly income to individuals who are unable to work due to their disability. To qualify for SSDI, an individual must have paid Social Security taxes and have been previously employed, but now unable to work in order to qualify for these benefits. If approved, an individual can receive monthly compensation that is calculated based upon previous work history
- Supplemental Security Income: Qualifying for SSI is based upon the same guidelines as SSDI for disabilities. However, unlike SSDI, SSI is only a supplemental form of income. It is a needs-based program designed to provide financial assistance to individuals with disabilities who have limited income and resources. For both SSDI and SSI an individual’s disability must impair their ability to engage in “Substantial Gainful Activity” (SCG), i.e. one’s ability to earn a certain income each month.
- Rehabilitation Services and Vocational Rehab Programs: Each state is granted a certain amount of money by the Rehabilitation Service Administration. These grants are used to help individuals with various disabilities. This is typically a lesser known form of potential support but can provide substantial benefits to individuals suffering. For more information, individuals can look up their state vocational rehabilitation programs or Departments of Rehabilitation and speak to a vocational rehabilitation counselor.
Qualifying for OCD Benefits
Qualifying for disability benefits for OCD through the ADA would be governed by the SSA. The SSA would determine SSDI or SSI benefits. The SSA lists criteria within its Blue Book6 and approves mental disability as a form of impairment that may qualify for compensation. Section 12.06 of the Blue Book lists the qualifications for someone applying for benefits under Obsessive Compulsive disorder.
An individual must meet criteria A and B, or A and C:
A. Medical Documentation of a Disorder
Medical documentation of the requirements of anxiety disorder, panic disorder, obsessive-compulsive disorder.
Anxiety Disorder
Anxiety disorder is characterized by having three or more of the following:
- Restlessness
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
Panic Disorder
Panic disorder or agoraphobia, is characterized by one or both of the following:
- Panic attacks followed by a persistent concern or worry about additional panic attacks or their consequences
- Disproportionate fear or anxiety about at least two different situations (for example, using public transportation, being in a crowd, being in a line, being outside of your home, being in open spaces)
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder, characterized by involuntary, time-consuming preoccupation with intrusive, unwanted thoughts; or repetitive behaviors aimed at reducing anxiety.
AND
B. Extreme or Marked Limitation
Extreme limitation of one, or marked limitation of two of the following areas of mental functioning:
- Understand, remember, or apply information
- Interact with others
- Concentrate, persist, or maintain pace
- Adapt or manage oneself
OR
C. Serious & Persistent
Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least two years, and there is evidence of both:
- Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder and
- Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life
It is important to remember that the SSA determines if one meets these criteria and the process for doing so is often quite time consuming. Additionally, not all people who have OCD will qualify based upon their criteria for severity as listed.
Qualifying for benefits from State Vocational Rehabilitation services can often be quicker and provide support for individuals who may not qualify at the federal level. Be sure to check out your state’s Vocational Rehabilitation resource page for more information.
The Process of Obtaining OCD Benefits
When applying for benefits for OCD, an individual will go through a process of documentation and discussion with a specialist. This specialist can be a primary care provider, psychiatrist, or other specialist. The provider will listen to your needs and begin an evaluation for OCD. If it is determined that you meet criteria for an OCD diagnosis, the process may continue. You can request a copy of this medical letter from your provider to submit for ADA requirements.
The process for obtaining OCD benefits may look as follows:
- Obtaining a medical letter: The medical letter would be documented proof from a provider that you are suffering from impairments due to Obsessive Compulsive Disorder. In order to determine this, a provider will likely evaluate your subjective experience and compare it to diagnostic criteria outlined within the DSM-V, and in some instances, perform some form of diagnostic test.
- Potential Neurocognitive Assessments: As stated above, some clinicians will utilize assessment tools to substantiate their findings. The most common assessment tool for Obsessive Compulsive Disorder is an evaluation called the Yale Brown Obsessive Compulsive Scale (Y-BOCS). Other scales such as the WAIS may be used to substantiate deficits.13
Getting an OCD Diagnosis
An OCD diagnosis is made by a trained clinician such as a psychiatrist or psychologist. A skilled clinician would not only be sure you meet criteria labeled within the DSM-V under obsessive compulsive disorder, but conduct an evaluation of your relevant history. As the DSM-V itself notes, in diagnosing any mental disorder, considerations beyond specific criteria must be evaluated thoroughly as social, emotional, and behavioral considerations dramatically influence what symptoms appear.14
The DSM-V criteria for obsessive compulsive disorder are as follows. An individual must experience the presence of obsessions, compulsions, or both.
Obsessions
Obsessions are defined by:
- Recurrent and persistent thoughts, burgers, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action
Compulsions
OCD compulsions are defined by:
- Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
The obsessions or compulsions are time-consuming (e.g. take more than one hour per day) or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
Furthermore, a clinician will confirm that these symptoms are not attributable to the physiological effects of a substance or another medical condition and that they are not better explained by another disorder.
OCD Accommodations at Work
If you are diagnosed with OCD, the ADA mandates that employers provide accommodations so that you are able to perform your job. These accommodations must not cause the employer “undue hardship”, meaning that the cost of the accommodation cannot outweigh its benefit. It cannot cause excessive difficulty or financial costs on the employer. Since each individual’s OCD will present in a way that is unique to them, accommodations may differ.
Reasonable accommodations will usually be ones that allow the individual to better perform their specific job at an organization. Unreasonable accommodations would likely fall under the category of causing undue hardship to the employer. These may be forms of accommodation that impact the financial security of the company, impact large amounts of employees at the organization, or pose some sort of safety concern. It is important to note that it is the employer’s responsibility to show that an accommodation causes undue hardship.
Workplace accommodations operate on a case by case basis and there is no one-size-fits-all list of accommodations for someone who qualifies with an OCD diagnosis.
Below are some common examples of reasonable requests for accommodations:
- A private workspace to reduce triggers and resultant anxiety
- A work from home option
- More frequent breaks to manage anxiety
- Adjusted schedule to attend therapy sessions on work days
- Adjustments to workplace environment including lighting, sanitation, noise levels, etc. to modulate sensory triggers
Accommodations in a Company With Less Than 15 People
The ADA legislation regarding accommodations within the workplace for individuals receiving disability benefits extend to companies with 15 or more people. This means that at a company with less than 15 people, an employer is not legally mandated to provide accommodations. However, individual states have various legislations that could extend to companies with fewer than 15 people. This is where checking your state disability resources page is important. Once again, the Vocational Rehabilitation services for each state may also be able to provide some disability services regardless of company size.
OCD Accommodations at School
In 1973 the Rehabilitation Act was signed into action and Section 504 of the act features important legislation regarding accommodations for individuals within the education system. Section 504 mandates that individuals with disabilities have equal access to education and that schools must provide reasonable accommodations to ensure such access.15 These accommodations include modifications to curriculum, assignments, and extracurricular activities.
A further protection for individuals with disabilities in the educational sector is the Individuals with Disabilities Education Act (IDEA).16 The IDEA is a federal law that provides grants and financial assistance to programs in order to ensure individuals with disabilities receive special education and accommodations in the hopes of providing free and appropriate education in the least restrictive manner. Under this provision, a qualifying individual receives an Individualized Education Program (IEP) that outlines the specific accommodations the individual is to receive.
What If I Am Refused OCD Accommodations?
If an individual seeks accommodations for OCD and is refused, there are still courses of action that can be taken. First, it is imperative to make sure that one has documentation of their disability. In the event that one has documentation of their disability and is refused the accommodations they feel are guaranteed to them by the ADA, they can contact the U.S. Equal Employment Opportunity Commission (EEOC). This is a government agency that handles claims pertaining to violations of regulations in place to protect against discrimination in the workplace.
If you or your child is refused accommodations at school for OCD and you believe this is a violation, you can also seek support from the Office of Civil Rights (OCR) which is a branch of the U.S. Department of Education.
It is important to note that a helpful first step may be to meet with your employer, the HR representative at your work, or the school’s disabilities service office to attempt to reach an agreement prior to any legal action being taken. However, if this is unsuccessful and you still feel that you are being denied your rights, then the above steps can be taken. Further, as a last resort, one may look into consulting with an attorney or firm who specialize in disability lawsuits.
Disadvantages of Labeling OCD As a Disability
While receiving benefits for OCD can often be a way an individual gains a sense of agency in receiving support for something very painful they have lived with, it is important to realize some of the disadvantages that come with receiving benefits such as the ones outlined already. The main disadvantage is that labeling OCD as a disability and putting accommodations in place can sometimes lead to exacerbation of symptoms. Additionally, labeling it as a disability potentially puts one in a position to feel that the symptoms are a more or less permanent fixture of their life.
Possible disadvantages of labeling OCD as a disability include:
Accommodations Can Exacerbate OCD
It may seem counterintuitive, but with a little knowledge about how OCD symptoms function, it will hopefully become apparent. OCD is classified as an anxiety disorder. And anxiety is a natural bodily reaction to emotional states that we have learned are dangerous.17,18 The emotions trigger anxiety and to reduce the anxiety, a compulsion is enacted.
The compulsion functions to reduce anxiety being triggered by the underlying emotional arousal. So, while an accommodation may reduce the chances that someone needs to perform a compulsion, it may not address the underlying emotional difficulty that causes the anxiety that the compulsion is attempting to assuage in the first place. It amounts to treating the smoke instead of the fire. In some cases this is necessary, but over time, the fire continues to burn and more situations are affected by the anxiety. To address the underlying emotional conflict causing the anxiety and, in turn, the compulsion, amounts to truly attacking the source of the flames.
Conception of Self
Another potential downside to labeling OCD as a disability could be linked to this labeling’s effect on one’s self conception. In some cases realizing one has a particular disorder can be validating for their experience, but it can also have an opposite effect. Labeling OCD as a disability could lead one to think that this condition is “a part of them”, as if they must live with it forever. It can lead to feelings of shame if one internalizes it as part of their identity and compares themselves to others who do not suffer in similar ways. It can also lead one to limit themselves because they fear their OCD will hinder their capabilities in some way.
Stigmatization
Labeling OCD as a disability can also increase its stigmatization and the misunderstanding of the disorder that is common. OCD is a set of symptoms that are experienced by certain individuals as a means of regulating anxiety. If it is understood primarily as a disability, this can collectively lead to an assumption that it is, again, something relatively fixed and untreatable.
Increased Fears
By labeling OCD as a disability and receiving accommodations for it, one could potentially begin to fear that it will limit their opportunities. It could create a fear of discrimination and misunderstanding in both professional and personal relationships.
Treatment for OCD
Many clinicians do not adequately understand how to treat this debilitating disorder. Just as accommodations can exacerbate symptoms by not addressing the root causes of the anxiety but actually perpetuating them, so can many treatment methods. It was found that over 50% of individuals being treated for certain symptoms return for therapy for the same conditions as quickly as 6-12 months later.19 Furthermore, some treatment methods that claim to be the ‘gold standard’ have increasingly been criticized for their lack of efficacy and durability.20
The truth regarding OCD is that it is a highly misunderstood and complex phenomena with many overlapping diagnoses often being present. Therefore, it is imperative that one suffering from it realize that effective treatment will not just manage symptoms, but target their roots in order to eliminate them. Working with a therapist specializing in OCD treatment offers the best results.
Common treatment options for OCD include:
- Eye Movement Desensitization Reprocessing Therapy (EMDR): EMDR for OCD can target the distressing emotions, thoughts, and memories associated with specific obsessions and compulsions with the goal of decreasing their intensity.
- Cognitive behavior therapy (CBT): CBT for OCD helps break the automatic bond between obsessions and compulsions by training you to avoid ritualizing when you’re feeling anxious.
- Exposure therapy: Exposure therapy for OCD interrupts the OCD cycle and helps you learn that obsessional stimuli can be confronted without using rituals. this is often a helpful first step in the treatment journey.
- Specialized forms of psychodynamic therapies: Specifically developed psychodynamic therapies help target the underlying emotional difficulties conditioning the obsessive and compulsive rituals and can lead to increased gains beyond the course of therapy.22
When to Seek Professional Support
If you find that you are suffering from any of the symptoms listed above and that these symptoms are significantly interrupting your daily life, it’s advisable to consider seeking professional help. For those seeking therapy, online therapist directories or online therapy platforms can be a viable option to find licensed mental health professionals who specialize in OCD treatment.
It is important to consult with the therapist to make sure that they are confident in treating the complexities of OCD. In some cases, medication may be a helpful adjunct to therapy for those who find that therapy alone is insufficient. In this case, seeking a consultation with a psychiatrist may prove helpful. It is always helpful to consult in person, especially when seeking to add a new medication into one’s life. An in person consultation can provide helpful data to the clinician that may be missed in a telehealth appointment. However, this is not always an option and in these cases seeking an online appointment with a reputable psychiatrist is helpful as well.
In My Experience
Living with OCD is agonizing. Because of its pervasiveness and level of internal struggle, individuals with OCD often suffer in silence, appearing “fine” on the outside, while questioning every decision internally. An internal critic often chastises the smallest of decisions and makes day to day living profoundly difficult and tiring. The good news is, there are resources available for those suffering from this condition. Individuals can receive financial support and workplace accommodations that are protected by law for those that qualify.
In my experience, treatments that provide the most long-lasting and effective interventions for OCD remain those therapeutic modalities that are focused on underlying emotional functioning. When seeking treatment, it is important to keep this in mind and when consulting with a potential therapist, to ask them about their approach and let them know–if that is your desire–that you would like to process the underlying emotional difficulties that are creating the outward symptoms of your OCD.
For Further Reading
Is OCD a Disability? Infographics
