ICD-10 code: F42.8
Obsessive-compulsive disorder (OCD) is part of a cluster of diagnoses called the obsessive-compulsive and related disorders. Obsessive-compulsive and related disorders are a group of psychiatric conditions that include:
These disorders are characterized by the occurrence of repetitive behaviors, often called compulsions. Individuals with obsessive-compulsive disorder might engage in compulsive behaviors such as excessive washing, checking, arranging, or counting. Individuals with body dysmorphic disorder might engage in frequent checking of their appearance in the mirror, or excessive grooming-related behaviors. Individuals with hoarding disorder may engage in excessive acquiring of objects, combined with a strong need to save items. Individuals with trichotillomania engage in excessive hair pulling, and individuals with excoriation disorder engage in excessive skin picking.
In some cases, the obsessive-compulsive and related disorders are also characterized by intrusive, unwanted, or distressing thoughts, called obsessions, which come to mind again and again. People with obsessive-compulsive disorder might have obsessive thoughts about dirt or germs, thoughts of harming others, fears of making mistakes, or distress about things being out of order. People with body dysmorphic disorder have repetitive, negative thoughts about their own appearance. However, people with certain other obsessive-compulsive and related disorders (such as trichotillomania or excoriation disorder) often do not experience obsessive thoughts.
OCD is a psychiatric disorder that affects approximately 1-2% of adults. OCD is characterized by two main symptoms:
Compulsions, which are repetitive behaviors that the person does in response to obsessions or fears.
There are many different kinds of obsessions and compulsions. Some of the more common ones are:
OCD severity can range from mild to debilitating. In severe cases, OCD can lead to inability to work, go to school, or have enjoyable relationships. Many people with OCD also have other psychiatric conditions, most commonly depression and anxiety disorders.
OCD is characterized by abnormalities of brain function which are thought to contribute to symptoms. In particular, evidence points to a hyperactive loop extending from the frontal cortex to the basal ganglia, which affects inhibition of thoughts and behaviors, modulation of emotion, and other aspects of the disorder. In addition, compulsive behavior and avoidance of feared situations are thought to contribute to the persistence of obsessive fears. The disorder has a genetic component, although having a genetic predisposition to OCD does not necessarily mean that someone will develop OCD.
OCD is treatable. Published treatment guidelines for OCD include those from the American Psychiatric Association, the Society of Clinical Psychology, and the National Institute for Clinical Excellence.
First Line Treatments
For more information about drug prescribing in OCD, click here.
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Third Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.