Obsessive-compulsive disorder - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by the presence of persistent obsessions and/or compulsions. These are time consuming (e.g., take more than 1 hour per day) and/or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Differential diagnosis from other psychiatric disorders with recurrent thoughts and repetitive behaviors is nuanced and requires specialist guidance.
The Yale-Brown Obsessive-Compulsive Scale is useful in grading severity initially and following trials of therapy.
Patients tend to seek treatment from 3 to 4 doctors and spend on average around 9 years in treatment before a correct diagnosis is made. The average amount of time that lapses between onset of symptoms and appropriate treatment is 17 years.
Cognitive behavioral therapy in the form of exposure and response prevention alone or in combination with a selective serotonin-reuptake inhibitor (SSRI) or clomipramine is a first-line therapy.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
World Health Organization. International statistical classification of diseases and related health problems. 11th revision. Jan 2022 [internet publication].[Full Text]
American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007 [internet publication]. [Full Text]
American Psychiatric Association. Guideline watch (March 2013): Practice guideline for the treatment of patients with obsessive-compulsive disorder. March 2013 [internet publication].[Full Text]

Other Online Resources

National Institute of Mental Health: obsessive-compulsive disorder, OCD
International OCD Foundation
Anxiety and Depression Association of America, OCD

Referenced Articles

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
2. Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47:270-275.[Abstract]
3. Nazeer A, Latif F, Mondal A, et al. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr. 2020 Feb;9(suppl 1):S76-S93.[Abstract][Full Text]
4. Veale D, Roberts A. Obsessive-compulsive disorder. BMJ. 2014 Apr 7;348:g2183.[Abstract]
5. Ruscio AM, Stein DJ, Chiu WT, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:53-63.[Abstract][Full Text]
6. Maj M, Sartorius N, Zohar J, eds. Obsessive-compulsive disorder. 2nd ed. Chichester, England: John Wiley; 2002.
7. World Health Organization. International statistical classification of diseases and related health problems. 11th revision. Jan 2022 [internet publication].[Full Text]
8. Weissman MM, Bland RC, Canino GJ, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry. 1994;55:5-10.[Abstract]
9. Rasmussen SA, Eisen JL. The epidemiology and clinical features of obsessive compulsive disorder. Psychiatr Clin North Am. 1992;15:743-758.[Abstract]
10. World Health Organization. The World Health Report 2001 - Mental health: new understanding, new hope. Geneva, Switzerland: WHO; 2001.[Full Text]
11. Grados MA, Walkup J, Walford S. Genetics of obsessive-compulsive disorders: new findings and challenges. Brain Dev. 2003;25:55-61.[Abstract]
12. Jenike MA. Clinical practice. Obsessive-compulsive disorder. N Engl J Med. 2004;350:259-265.[Abstract]
13. Nicolini H, Hanna GL, Baxter L, et al. Segregation analysis of obsessive compulsive and associated disorders: preliminary results. Ursus Medicus. 1991;1:25-28.
14. Cavallini MC, Pasquale L, Bellodi L, et al. Complex segregation analysis for obsessive compulsive disorder and related disorders. Am J Med Genet. 1999;88:38-43.[Abstract]
15. Cavallini MC, Bertelli S, Chiapparino D, et al. Complex segregation analysis of obsessive-compulsive disorder in 141 families of eating disorder probands, with and without obsessive-compulsive disorder. Am J Med Genet. 2000;96:384-391.[Abstract]
16. Nestadt G, Lan T, Samuels J, et al. Complex segregation analysis provides compelling evidence for a major gene underlying obsessive-compulsive disorder and for heterogeneity by sex. Am J Hum Genet. 2000;67:1611-1616.[Abstract][Full Text]
17. Bjorgvinsson T, Hart J, Heffelfinger S. Obsessive-compulsive disorder: update on assessment and treatment. J Psychiatr Pract. 2007;13:362-372.[Abstract]
18. Samuels JF, Riddle MA, Greenberg BD, et al. The OCD collaborative genetics study: methods and sample description. Am J Med Genet B Neuropsychiatr Genet. 2006;141:201-207.[Abstract]
19. Welch JM, Lu J, Rodriguiz RM, et al. Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice. Nature. 2007;448:894-900.[Abstract]
20. Rachman S. A cognitive theory of obsessions. Behav Res Ther. 1997;35:793-802.[Abstract]
21. Rachman S. A cognitive theory of obsessions: elaborations. Behav Res Ther. 1998;36:385-401.[Abstract]
22. Rachman S. Progress toward a cognitive clinical psychology. J Psychosom Res. 1998;45:387-389.[Abstract]
23. Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther. 1997;35:667-681.[Abstract]
24. Neziroglu F, Anemone R, Yaryura-Tobias JA. Onset of obsessive-compulsive disorder in pregnancy. Am J Psychiatry. 1992;149:947-950.[Abstract]
25. Pallanti S, Quercioli L. Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic lines. Prog Neuropsychopharmacol Biol Psychiatry. 2006 May;30(3):400-12.[Abstract]
26. Hollander E, DeCaria C, Gully R, et al. Effects of chronic fluoxetine treatment on behavioral and neuroendocrine responses to meta-chlorophenylpiperazine in obsessive-compulsive disorder. Psychiatry Res. 1991;36:1-17.[Abstract]
27. Brem S, Hauser TU, Iannaccone R, et al. Neuroimaging of cognitive brain function in paediatric obsessive compulsive disorder: a review of literature and preliminary meta-analysis. J Neural Transm. 2012;119:1425-1448.[Abstract]
28. Perani D, Colombo C, Bressi S, et al. (18F)FDG PET study in obsessive-compulsive disorder. A clinical/metabolic correlation study after treatment. Br J Psychiatry. 1995;166:244-250.[Abstract]
29. Schwartz JM, Stoessel PW, Baxter LR Jr, et al. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:109-113.[Abstract]
30. Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry. 2004;9:900-907.[Abstract]
31. Saxena S, Brody AL, Maidment KM, et al. Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry. 2004;161:1038-1048.[Abstract]
32. Ravizza L, Barzega G, Bellino S, et al. Predictors of drug treatment response in obsessive-compulsive disorder. J Clin Psychiatry. 1995;56:368-373.[Abstract]
33. Coffey BJ, Miguel EC, Biederman J, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998;186:201-206.[Abstract]
34. Hollander E, Kaplan A, Schmeidler J, et al. Neurological soft signs as predictors of treatment response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci. 2005;17:472-477.[Abstract]
35. First MB, Williams JBW, Karg RS, et al. Structured clinical interview for DSM-5 disorders: clinician version (SCID-5-CV). Washington, DC: American Psychiatric Publishing, Inc.; 2016.[Full Text]
36. Brown TA, Barlow DH. Anxiety and related disorders interview schedule for DSM-5 (ADIS-5)® - adult version: client interview schedule. New York, NY: OUP USA; 2014.
37. Steketee G, Frost R, Bogart K. The Yale-Brown Obsessive Compulsive Scale: interview versus self-report. Behav Res Ther. 1996 Aug;34(8):675-84.[Abstract]
38. Guy W, ed. ECDEU assessment manual for psychopharmacology. Rockville, MD: US Department of Health, Education, and Welfare; 1976.
39. Zaider TI, Heimberg RG, Fresco DM, et al. Evaluation of the clinical global impression scale among individuals with social anxiety disorder. Psychol Med. 2003 May;33(4):611-22.[Abstract]
40. Spearing MK, Post RM, Leverich GS, et al. Modification of the Clinical Global Impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997 Dec 5;73(3):159-71.[Abstract]
41. Leon AC, Shear MK, Klerman GL, et al. A comparison of symptom determinants of patient and clinician global ratings in patients with panic disorder and depression. J Clin Psychopharmacol. 1993 Oct;13(5):327-31.[Abstract]
42. Heyman I, Mataix-Cols D, Fineberg NA. Obsessive-compulsive disorder. BMJ. 2006 Aug 26;333(7565):424-9.[Abstract]
43. Fineberg NA, Sharma P, Sivakumaran T, et al. Does obsessive-compulsive personality disorder belong within the obsessive-compulsive spectrum? CNS Spectr. 2007 Jun;12(6):467-82.[Abstract]
44. Zanarini MC, Frankenburg FR, Chauncey DL, et al. The diagnostic Interview for Personality Disorders: interrater and test-retest reliability. Compr Psychiatry. 1987 Nov-Dec;28(6):467-80.[Abstract]
45. Pfohl B, Stangl DA, Zimmerman M. Structured Interview for DSM-II Personality Disorders (SIDP). Iowa City, Iowa: University of Iowa; 1982.
46. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.
47. Aardema F, O'Connor KP, Emmelkamp PM, et al. Inferential confusion in obsessive-compulsive disorder: The inferential confusion questionnaire. Behav Res Ther. 2005 Mar;43(3):293-308.[Abstract]
48. American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007 [internet publication]. [Full Text]
49. Abudy A, Juven-Wetzler A, Zohar J. Pharmacological management of treatment-resistant obsessive-compulsive disorder. CNS Drugs. 2011 Jul;25(7):585-96.[Abstract]
50. Stanley MA, Turner SM. Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behav Ther. 1995;26(1):163-86.[Full Text]
51. Whittal ML, Thordarson DS, McLean PD. Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther. 2005 Dec;43(12):1559-76.[Abstract]
52. Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39.[Abstract][Full Text]
53. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;(14 suppl 1):S1.[Abstract][Full Text]
54. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008 Apr;69(4):621-32.[Abstract][Full Text]
55. American Psychiatric Association. Guideline watch (March 2013): Practice guideline for the treatment of patients with obsessive-compulsive disorder. March 2013 [internet publication].[Full Text]
56. Rosa-Alcázar AI, Sánchez-Meca J, Gómez-Conesa A, et al. Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev. 2008 Dec;28(8):1310-25.[Abstract]
57. Olatunji BO, Davis ML, Powers MB, et al. Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. J Psychiatr Res. 2013 Jan;47(1):33-41.[Abstract]
58. Jónsson H, Hougaard E. Group cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis. Acta Psychiatr Scand. 2009 Feb;119(2):98-106.[Abstract]
59. Anderson RA, Rees CS. Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial. Behav Res Ther. 2007 Jan;45(1):123-37.[Abstract]
60. Maina GR, Rosso G, Rigardetto S, et al. No effect of adding brief dynamic therapy to pharmacotherapy in the treatment of obsessive-compulsive disorder with concurrent major depression. Psychother Psychosom. 2010;79(5):295-302.[Abstract]
61. Soomro GM, Altman D, Rajagopal S, et al. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev. 2008;(1):CD001765.[Abstract][Full Text]
62. Price LH, Goodman WK, Charney DS, et al. Treatment of severe obsessive-compulsive disorder with fluvoxamine. Am J Psychiatry. 1987 Aug;144(8):1059-61.[Abstract]
63. Goodman WK, Price LH, Rasmussen SA, et al. Efficacy of fluvoxamine in obsessive-compulsive disorder. A double-blind comparison with placebo. Arch Gen Psychiatry. 1989 Jan;46(1):36-44.[Abstract]
64. DeVeaugh-Geiss J, Katz R, Landau P, et al. Clinical predictors of treatment response in obsessive compulsive disorder: exploratory analyses from multicenter trials of clomipramine. Psychopharmacol Bull. 1990;26(1):54-9.[Abstract]
65. Owen RT. Controlled-release fluvoxamine in obsessive-compulsive disorder and social phobia. Drugs Today (Barc). 2008 Dec;44(12):887-93.[Abstract]
66. Koran LM, Bromberg D, Hornfeldt CS, et al. Extended-release fluvoxamine and improvements in quality of life in patients with obsessive-compulsive disorder. Compr Psychiatry. 2010 Jul-Aug;51(4):373-9.[Abstract]
67. Ipser JC, Stein DJ, Hawkridge S, et al. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2009;(3):CD005170.[Abstract][Full Text]
68. Fineberg NA, Tonnoir B, Lemming O, et al. Escitalopram prevents relapse of obsessive-compulsive disorder. Eur Neuropsychopharmacol. 2007 May-Jun;17(6-7):430-9.[Abstract]
69. Medicines and Healthcare products Regulatory Agency (MHRA). Citalopram and escitalopram: QT interval prolongation - new maximum daily dose restrictions (including in elderly patients), contraindications, and warnings. December 2011 [internet publication].[Full Text]
70. Skapinakis P, Caldwell D, Hollingworth W, et al. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess. 2016 Jun;20(43):1-392.[Abstract][Full Text]
71. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007 Apr 18;297(15):1683-96.[Abstract]
72. Fineberg NA, Pampaloni I, Pallanti S, et al. Sustained response versus relapse: the pharmacotherapeutic goal for obsessive-compulsive disorder. Int Clin Psychopharmacol. 2007 Nov;22(6):313-22.[Abstract]
73. Batelaan NM, Bosman RC, Muntingh A, et al. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017 Sep 13;358:j3927. [Erratum in: BMJ. 2017 Sep 25;358:j4461.][Abstract][Full Text]
74. Van Noppen BL, Pato MT, Marsland R, et al. A time-limited behavioral group for treatment of obsessive-compulsive disorder. J Psychother Pract Res. 1998 Fall;7(4):272-80.[Abstract]
75. AuBuchon PG, Malatesta VJ. Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy. J Clin Psychiatry. 1994 Oct;55(10):448-53.[Abstract]
76. Shusta SR. Successful treatment of refractory obsessive-compulsive disorder. Am J Psychother. 1999 Summer;53(3):377-91.[Abstract]
77. Rector NA, Cassin SE, Richter MA. Psychological treatment of obsessive-compulsive disorder in patients with major depression: a pilot randomized controlled trial. Can J Psychiatry. 2009 Dec;54(12):846-51.[Abstract]
78. US Food and Drug Administration. FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. August 2011 [internet publication].[Full Text]
79. Ipser JC, Carey P, Dhansay Y, et al. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Database Syst Rev. 2006;(4):CD005473.[Abstract][Full Text]
80. Diniz JB, Shavitt RG, Fossaluza V, et al. A double-blind, randomized, controlled trial of fluoxetine plus quetiapine or clomipramine versus fluoxetine plus placebo for obsessive-compulsive disorder. J Clin Psychopharmacol. 2011 Dec;31(6):763-8.[Abstract]
81. McDougle CJ, Epperson CN, Pelton GH, et al. A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2000 Aug;57(8):794-801.[Abstract][Full Text]
82. McDougle CJ, Fleischmann RL, Epperson CN, et al. Risperidone addition in fluvoxamine-refractory obsessive-compulsive disorder: three cases. J Clin Psychiatry. 1995 Nov;56(11):526-8.[Abstract]
83. Hollander E, Baldini Rossi N, Sood E, et al. Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. Int J Neuropsychopharmacol. 2003 Dec;6(4):397-401.[Abstract]
84. Pfanner C, Marazziti D, Dell'Osso L, et al. Risperidone augmentation in refractory obsessive-compulsive disorder: an open-label study. Int Clin Psychopharmacol. 2000 Sep;15(5):297-301.[Abstract]
85. Li X, May RS, Tolbert LC, et al. Risperidone and haloperidol augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder: a crossover study. J Clin Psychiatry. 2005 Jun;66(6):736-43.[Abstract]
86. Komossa K, Depping AM, Meyer M, et al. Second-generation antipsychotics for obsessive compulsive disorder. Cochrane Database Syst Rev. 2010;(12):CD008141.[Abstract][Full Text]
87. Muscatello MR, Bruno A, Pandolfo G, et al. Effect of aripiprazole augmentation of serotonin reuptake inhibitors or clomipramine in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. J Clin Psychopharmacol. 2011 Apr;31(2):174-9.[Abstract]
88. Bloch MH, Landeros-Weisenberger A, Kelmendi B, et al. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006 Jul;11(7):622-32.[Abstract]
89. Fineberg NA, Stein DJ, Premkumar P, et al. Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: a meta-analysis of randomized controlled treatment trials. Int Clin Psychopharmacol. 2006 Nov;21(6):337-43.[Abstract]
90. Delgado PL, Goodman WK, Price LH, et al. Fluvoxamine/pimozide treatment of concurrent Tourette's and obsessive-compulsive disorder. Br J Psychiatry. 1990 Nov;157:762-5.[Abstract]
91. Connor KM, Payne VM, Gadde KM, et al. The use of aripiprazole in obsessive-compulsive disorder: preliminary observations in 8 patients. J Clin Psychiatry. 2005 Jan;66(1):49-51.[Abstract]
92. Pessina E, Albert U, Bogetto F, et al. Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 12-week open-label preliminary study. Int Clin Psychopharmacol. 2009 Sep;24(5):265-9.[Abstract]
93. Maher AR, Maglione M, Bagley S, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011 Sep 28;306(12):1359-69.[Abstract]
94. Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry. 2013 Nov;70(11):1190-9.[Abstract]
95. The Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. The Clomipramine Collaborative Study Group. Arch Gen Psychiatry. 1991 Aug;48(8):730-8.[Abstract]
96. Goodman WK, McDougle CJ, Price LH. Pharmacotherapy of obsessive-compulsive disorder. J Clin Psychiatry. 1992 Apr;(suppl 53):29-37.[Abstract]
97. Jenike MA, Rauch SL. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry. 1994 Mar;(suppl 55):11-7.[Abstract]
98. McDougle CJ, Goodman WK, Leckman JF, et al. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol. 1993 Oct;13(5):354-8.[Abstract]
99. McDougle CJ, Goodman WK, Leckman JF, et al. The psychopharmacology of obsessive compulsive disorder. Implications for treatment and pathogenesis. Psychiatr Clin North Am. 1993 Dec;16(4):749-66.[Abstract]
100. Piccinelli M, Pini S, Bellantuono C, et al. Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review. Br J Psychiatry. 1995 Apr;166(4):424-43.[Abstract]
101. Pigott TA, Seay SM. A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. J Clin Psychiatry. 1999 Feb;60(2):101-6.[Abstract]
102. Rasmussen SA, Eisen JL, Pato MT. Current issues in the pharmacologic management of obsessive compulsive disorder. J Clin Psychiatry. 1993 Jun;(suppl 54):4-9.[Abstract]
103. Ackerman DL, Greenland S, Bystritsky A. Clinical characteristics of response to fluoxetine treatment of obsessive-compulsive disorder. J Clin Psychopharmacol. 1998 Jun;18(3):185-92.[Abstract]
104. Foa EB, Liebowitz MR, Kozak MJ, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005 Jan;162(1):151-61.[Abstract]
105. Fernandez Cordoba E, Lopez-Ibor Alino J. Use of monochlorimipramine in psychiatric patients who are resistant to other therapy. Actas Luso Esp Neurol Psiquiatr. 1967 Jun;26(2):119-47.[Abstract]
106. Bloch MH, McGuire J, Landeros-Weisenberger A, et al. Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Mol Psychiatry. 2010 Aug;15(8):850-5.[Abstract][Full Text]
107. Atmaca M, Kuloglu M, Tezcan E, et al. Quetiapine augmentation in patients with treatment resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study. Int Clin Psychopharmacol. 2002 May;17(3):115-9.[Abstract]
108. Denys D, de Geus F, van Megen HJ, et al. A double-blind, randomized, placebo-controlled trial of quetiapine addition in patients with obsessive-compulsive disorder refractory to serotonin reuptake inhibitors. J Clin Psychiatry. 2004 Aug;65(8):1040-8.[Abstract]
109. D'Amico G, Cedro C, Muscatello MR, et al. Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2003 Jun;27(4):619-23.[Abstract]
110. Bystritsky A, Ackerman DL, Rosen RM, et al. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine: a placebo-controlled trial. J Clin Psychiatry. 2004 Apr;65(4):565-8.[Abstract]
111. Shapira NA, Ward HE, Mandoki M, et al. A double-blind, placebo-controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder. Biol Psychiatry. 2004 Mar 1;55(5):553-5.[Abstract]
112. Szegedi A, Wetzel H, Leal M, et al. Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data. J Clin Psychiatry. 1996 Jun;57(6):257-64.[Abstract]
113. Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003 Apr;14(2):225-35.[Abstract]
114. U.S. Food and Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Aug 2018 [internet publication].
115. Carmi L, Tendler A, Bystritsky A, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry. 2019 Nov 1;176(11):931-8.[Abstract][Full Text]
116. Nuttin B, Cosyns P, Demeulemeester H, et al. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999 Oct 30;354(9189):1526.[Abstract]
117. Graat I, Mocking R, Figee M, et al. Long-term outcome of deep brain stimulation of the ventral part of the anterior limb of the internal capsule in a cohort of 50 patients with treatment-refractory obsessive-compulsive disorder. Biol Psychiatry. 2020 Aug 28;S0006-3223(20)31877-1.[Abstract][Full Text]
118. Aouizerate B, Cuny E, Martin-Guehl C, et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg. 2004 Oct;101(4):682-6.[Abstract]
119. Sturm V, Lenartz D, Koulousakis A, et al. The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat. 2003 Dec;26(4):293-9.[Abstract]
120. Mallet L, Mesnage V, Houeto JL, et al. Compulsions, Parkinson's disease, and stimulation. Lancet. 2002 Oct 26;360(9342):1302-4.[Abstract]
121. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Biol Psychiatry. 2010 Mar 15;67(6):535-42.[Abstract]
122. Huff W, Lenartz D, Schormann M, et al. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: outcomes after one year. Clin Neurol Neurosurg. 2010 Feb;112(2):137-43.[Abstract]
123. Denys D, Mantione M, Figee M, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010 Oct;67(10):1061-8.[Abstract][Full Text]
124. Staudt MD, Pouratian N, Miller JP, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines for deep brain stimulations for obsessive-compulsive disorder: update of the 2014 guidelines. Neurosurgery. 2021 Mar 15;88(4):710-2.[Abstract][Full Text]
125. National Institute for Health and Care Excellence. Deep brain stimulation for chronic, severe, treatment-resistant obsessive-compulsive disorder in adults. Apr 2021 [internet publication].[Full Text]
126. Di Nardo P, Moras K, Barlow DH, et al. Reliability of DSM-III-R anxiety disorder categories. Using the Anxiety Disorders Interview Schedule-Revised (ADIS-R). Arch Gen Psychiatry. 1993 Apr;50(4):251-6.[Abstract]
127. Denys D, van Megen HJ, van der Wee N, et al. A double-blind switch study of paroxetine and venlafaxine in obsessive-compulsive disorder. J Clin Psychiatry. 2004 Jan;65(1):37-43.[Abstract]
128. Denys D, van der Wee N, van Megen HJ, et al. A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder. J Clin Psychopharmacol. 2003 Dec;23(6):568-75.[Abstract]
129. Albert U, Aguglia E, Maina G, et al. Venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder: a preliminary single-blind, 12-week, controlled study. J Clin Psychiatry. 2002 Nov;63(11):1004-9.[Abstract]
130. Soltani FS, Sayyah M, Feizy F, et al. A double-blind, placebo-controlled pilot study of ondansetron for patients with obsessive-compulsive disorder. Hum Psychopharmacol. 2010 Aug;25(6):509-13.[Abstract]
131. Pallanti S, Bernardi S, Antonini S, et al. Ondansetron augmentation in treatment-resistant obsessive-compulsive disorder: a preliminary, single-blind, prospective study. CNS Drugs. 2009 Dec;23(12):1047-55.[Abstract]
132. Koran LM, Aboujaoude E, Gamel NN. Double-blind study of dextroamphetamine versus caffeine augmentation for treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2009 Nov;70(11):1530-5.[Abstract]
133. Koran LM, Aboujaoude E, Bullock KD, et al. Double-blind treatment with oral morphine in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2005 Mar;66(3):353-9.[Abstract]
134. Hollander E, Dell'Osso B. Topiramate plus paroxetine in treatment-resistant obsessive-compulsive disorder. Int Clin Psychopharmacol. 2006 May;21(3):189-91.[Abstract]
135. Berlin HA, Koran LM, Jenike MA, et al. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2011 May;72(5):716-21.[Abstract]
136. Coric V, Taskiran S, Pittenger C, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial. Biol Psychiatry. 2005 Sep 1;58(5):424-8.[Abstract]
137. Pallanti S, Quercioli L, Bruscoli M. Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study. J Clin Psychiatry. 2004 Oct;65(10):1394-9.[Abstract]
138. Koran LM, Gamel NN, Choung HW, et al. Mirtazapine for obsessive-compulsive disorder: an open trial followed by double-blind discontinuation. J Clin Psychiatry. 2005 Apr;66(4):515-20.[Abstract]
139. Pato MT, Pigott TA, Hill JL, et al. Controlled comparison of buspirone and clomipramine in obsessive-compulsive disorder. Am J Psychiatry. 1991 Jan;148(1):127-9.[Abstract]
140. Menkes DB. Buspirone augmentation of sertraline. Br J Psychiatry. 1995 Jun;166(6):823-4.[Abstract]
141. Kushner MG, Kim SW, Donahue C, et al. D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry. 2007 Oct 15;62(8):835-8.[Abstract]
142. Storch EA, Merlo LJ, Bengtson M, et al. D-cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2007 Jul;22(4):230-7.[Abstract]
143. Storch EA, Wilhelm S, Sprich S, et al. Efficacy of augmentation of cognitive behavior therapy with weight-adjusted d-cycloserine vs placebo in pediatric obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry. 2016 Aug 1;73(8):779-88.[Abstract][Full Text]
144. Andersson E, Hedman E, Enander J, et al. D-cycloserine vs placebo as adjunct to cognitive behavioral therapy for obsessive-compulsive disorder and interaction with antidepressants: a randomized clinical trial. JAMA Psychiatry. 2015 Jul;72(7):659-67.[Abstract]
145. Sayyah M, Boostani H, Pakseresht S, et al. Efficacy of aqueous extract of Echium amoenum in treatment of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Nov 13;33(8):1513-6.[Abstract]
146. Gerentes M, Pelissolo A, Rajagopal K, et al. Obsessive-compulsive disorder: autoimmunity and neuroinflammation. Curr Psychiatry Rep. 2019 Aug 1;21(8):78.[Abstract][Full Text]
147. Attwells S, Setiawan E, Wilson AA, et al. Inflammation in the neurocircuitry of obsessive-compulsive disorder. JAMA Psychiatry. 2017 Aug 1;74(8):833-840.[Abstract][Full Text]
148. Shalbafan M, Mohammadinejad P, Shariat SV, et al. Celecoxib as an adjuvant to fluvoxamine in moderate to severe obsessive-compulsive disorder: a double-blind, placebo-controlled, randomized trial. Pharmacopsychiatry. 2015 Jul;48(4-5):136-40.[Abstract][Full Text]
149. Shahini N, Talaei A, Shalbafan M, et al. Effects of celecoxib adjunct to selective serotonin reuptake inhibitors on obsessive-compulsive disorder. Basic Clin Neurosci. 2021 Jul-Aug;12(4):489-98.[Abstract][Full Text]
150. Westwell-Roper C, Best JR, Elbe D, et al. Celecoxib versus placebo as an adjunct to treatment-as-usual in children and youth with obsessive-compulsive disorder: protocol for a single-site randomised quadruple-blind phase II study. BMJ Open. 2022 Jan 31;12(1):e054296.[Abstract][Full Text]
151. Olthuis JV, Watt MC, Bailey K, et al. Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2016;3:CD011565.[Abstract][Full Text]
152. Cuijpers P, Marks IM, van Straten A, et al. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther. 2009;38(2):66-82.[Abstract]
153. Lovell K, Bower P, Gellatly J, et al. Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET). Health Technol Assess. 2017 Jun;21(37):1-132.[Abstract][Full Text]
154. Merlo LJ, Storch EA, Lehmkuhl HD, et al. Cognitive behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: a preliminary study. Cogn Behav Ther. 2010;39(1):24-7.[Abstract][Full Text]
155. Meyer E, Souza F, Heldt E, et al. A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping. Behav Cogn Psychother. 2010 May;38(3):319-36.[Abstract]
156. Meyer E, Shavitt RG, Leukefeld C, et al. Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial. Rev Bras Psiquiatr. 2010 Mar;32(1):20-9.[Abstract][Full Text]
157. Simpson HB, Zuckoff AM, Maher MJ, et al. Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder. Behav Res Ther. 2010 Oct;48(10):941-8.[Abstract]
158. Freeman J, Sapyta J, Garcia A, et al. Family-based treatment of early childhood obsessive-compulsive disorder: the Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr) - a randomized clinical trial. JAMA Psychiatry. 2014 Jun;71(6):689-98.[Abstract][Full Text]
159. Khodarahimi S. Satiation therapy and exposure response prevention in the treatment of obsessive compulsive disorder. J Contemp Psychotherapy. 2009;39:203-7.[Full Text]
160. Abedi MR, Vostanis P. Evaluation of quality of life therapy for parents of children with obsessive-compulsive disorders in Iran. Eur Child Adolesc Psychiatry. 2010 Jul;19(7):605-13.[Abstract]
161. Külz A, Barton B, Voderholzer U, et al. Third wave therapies of cognitive behavioral therapy for obsessive compulsive disorder: a reasonable add-on therapy for CBT? State of the art [Article in German]. Psychother Psychosom Med Psychol. 2016 Mar;66(3-4):106-11.[Abstract]
162. Bandelow B, Sher L, Bunevicius R, et al; WFSBP Task Force on Mental Disorders in Primary Care; WFSBP Task Force on Anxiety Disorders, OCD and PTSD. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract. 2012 Jun;16(2):77-84.[Abstract][Full Text]
163. Hollander E, Kwon JH, Stein DJ, et al. Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry. 1996;57:3-6.[Abstract]
164. Kamath P, Reddy YC, Kandavel T. Suicidal behavior in obsessive-compulsive disorder. J Clin Psychiatry. 2007;68:1741-1750.[Abstract]
165. Balci V, Sevincok L. Suicidal ideation in patients with obsessive-compulsive disorder. Psychiatry Res. 2010;175:104-108. [Abstract]
166. Sernyak MJ. Implementation of monitoring and management guidelines for second-generation antipsychotics. J Clin Psychiatry. 2007;68:14-18.[Abstract]
167. Serretti A, Porcelli S. Antidepressant induced weight gain. BMJ. 2018 May 23;361:k2151.[Abstract]