Obsessive-Compulsive Disorders

Abstract

PURPOSE OF REVIEW This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed. RECENT FINDINGS OCD affects 2% to 3% of adults worldwide and is associated with substantial individual disability and societal costs. Lack of recognition of common OCD symptom types, in addition to shame and fear of stigma on the part of patients, has created an average delay in diagnosis by almost 10 years and a delay in effective treatment (ie, a treatment gap) of nearly 2 years. Cognitive-behavioral therapy (CBT), specifically a form of CBT that includes a type of behavioral intervention called exposure and response prevention, remains the most effective form of treatment for OCD. If CBT is not effective or not available, pharmacologic treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a nonselective serotonin reuptake inhibitor, can also be of benefit. Neuromodulation approaches such as deep brain stimulation and transcranial magnetic stimulation are rapidly emerging as effective treatments for OCD, particularly for patients who have not experienced an adequate response to psychotherapy or pharmacologic management. SUMMARY OCD affects more than one in every 50 adults in the United States but is recognized and adequately treated in fewer than half of those affected. Early intervention and appropriate treatment can substantially reduce OCD symptom severity, improve quality of life, and minimize the functional disability associated with this chronic and often debilitating illness.

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

“…Depression and anxiety symptomatology were used as criteria because their comorbidity with OC symptoms is well established [ 11 , 14 , 40 , 41 , 42 ]. It is known that mothers’ depression severity is positively related to various aspects of intrusive thoughts’ severity and interference [ 10 , 18 , 43 ].…”

“…Until the development of the Perinatal Obsessive–Compulsive Scale (POCS) [ 17 ], the study of OCD in this period was hampered by the absence of a specific instrument. Because of the egodystonic nature of these infant-related intrusive thoughts, feelings of guilt and shame and the associated stigma, it is very rare for women to spontaneously report these symptoms, which are underdetected and undertreated [ 18 ], and may predispose to the development or exacerbation of OCD in vulnerable individuals [ 11 ]. These factors have led to recent calls for further screening of ppOCD in the postpartum period and the development of measures for this purpose [ 19 ].…”

The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses

“…It typically manifests as a chronic condition and often exists with comorbidities, responds partially to treatment, leading to significant impairment. 1,2 A large network meta-analysis evaluating the efficacies of psychotherapeutic interventions and pharmacotherapies in OCD has revealed that the serotonergic medications, including selective serotonin reuptake inhibitors and clomipramine, exhibit similar efficacy, while the combination of pharmacological and psychotherapeutic interventions are more effective than individual treatment modalities. 3 After the initiation of treatment with serotonergic medications, significant clinical improvements can be observed (in comparison to placebo) within the initial 2 weeks.…”

“…Obsessive-compulsive disorder (OCD) is a prevalent mental illness, affecting approximately 2%–3% of the population. It typically manifests as a chronic condition and often exists with comorbidities, responds partially to treatment, leading to significant impairment 1 , 2 . A large network meta-analysis evaluating the efficacies of psychotherapeutic interventions and pharmacotherapies in OCD has revealed that the serotonergic medications, including selective serotonin reuptake inhibitors and clomipramine, exhibit similar efficacy, while the combination of pharmacological and psychotherapeutic interventions are more effective than individual treatment modalities 3 .…”

“…However, over time, clinical improvement gradually diminishes 4 . For individuals with OCD who did not respond favorably to conventional therapy or medication, neuromodulation techniques such as deep brain stimulation (DBS) and repetitive transcranial magnetic stimulation (rTMS) are proving to be promising therapeutic options 1 …”