If you have OCD, you know that sometimes obsessions and compulsions can be very embarrassing and upsetting, especially when concerning themes of sexuality and/or violence. As such, when speaking with health care providers, many people with OCD hold back information or fail to disclose the true nature of their symptoms due to fears that they will be reported to the police, that family members will somehow find out or that they may even lose their job.
It is important to keep in mind, however, that health care professionals are required by law to regard all information gathered and recorded in the course of an appointment as confidential – that is, private and not to be released without your permission – except under a few unique circumstances. These so-called limits on confidentiality are there to protect both you and those around you and it is important that you be familiar with them when receiving either medical or psychological treatment for OCD.
Limits of Confidentiality
Although almost everything you tell a health care provider is protected by law as confidential, there are times when confidentiality must be breached for ethical and/or legal reasons. In other instances, it may be in your best interest to have your health care provider share information gathered during the course of an appointment. Let’s explore these situations.
Risk of Harm to Self or Others.
If your health care provider were to discover that you were in danger of harming yourself or somebody else, your healthcare provider would not be able to keep this private. They would be legally and ethically obligated to take the proper steps (e.g., calling the police; notifying the person who is danger) to prevent this from happening. Hospitalization of the patient may be important to, and this is known as a "duty to protect."
Current or Imminent Danger to a Child.
If your health care provider were to discover that a child (usually someone under the age of 18) was being physically and/or sexually abused or neglected or was simply in danger of being physically and/or sexually abused or neglected, then your healthcare provider would be legally and ethically obligated to report this to the proper authority.
Abuse by Another Healthcare Provider.
If in the course of an appointment you disclose that you are being abused by another health care provider (e.g., doctor, nurse, psychologist), then your current health care provider is obligated to report this to the professional college that governs that profession.
Disclosure of Information to Another Healthcare Provider Within Your Circle of Care.
In order for you to get the best treatment, your health care provider may share information gathered in the course of an appointment with members of the health care team who are directly involved in your care. For example, it might be necessary for your psychiatrist to speak with your social worker about some specific symptoms you’ve been experiencing that are making things difficult at home. Typically, you are asked for your permission before such information is shared, however.
Audit by a Regulating Professional.
Sometimes the professional college governing a particular health care provider will audit patient files to ensure that the health care provider is doing their job properly. In these instances, it is possible that someone outside of your circle of care will see confidential information within your file.
Although rare, there are circumstances (e.g., disability insurance dispute) in which your health care provider could be forced to disclose information contained within your file in court. Although most health care providers will go to great lengths to protect the confidentiality of their client’s data, there are times when this is unavoidable and they are bound by law to do so.
Sexual and/or Violent Obsessions and Confidentiality
Although the nature of some obsessions can lead people with OCD to fear that they are child molesters, rapists or murderers, it is important to remember that people with OCD almost always never end up actually being any of these things. As there is no blood-test or x-ray that can be used to tell when someone is going to carry out a sexual or violent act, clinicians use their judgment and training to determine whether someone presents a danger to themselves or the public or not.
Most health care professionals with training in OCD will immediately recognize a sexual or violent obsession as being a symptom of OCD and in the absence of any other risk factors (e.g., previous conviction of a sexual offence or physical assault) will be able to quickly reassure the client that there is nothing to be alarmed about.
On the other hand, if a person were to indicate experiencing pleasure from or fantasizing about the theme of a violent sexual obsession (usually obsessions of this nature are perceived by the person as unwanted, intrusive and extremely distressing) then that would likely be cause for further investigation. Again, however, it is very important to emphasize the vast majority of people with OCD present no danger to either themselves or others.
In the end, no matter how embarrassing or distressing, your health care provider will be in the best position to help you if you disclose the full nature of the symptoms you are experiencing. However, it is also important to trust that your health care provider will work ensure your confidentiality to the extent that this is possible. Finally, if you have any questions related to the confidentiality of your health information, don’t hesitate to inquire about the policies and procedures they have in place.