Highlights & Basics
- 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 (Y-BOCS) is useful in grading severity initially and following trials of therapy. The results obtained from the Y-BOCS should be complemented by assessment of the patient's impairment, level of family accommodation, and insight.
- Patients tend to seek treatment from three to four 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 (CBT), 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
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. Jul 2007 [internet publication].[Full Text]
American Psychiatric Association. Guideline watch (March 2013): practice guideline for the treatment of patients with obsessive-compulsive disorder. Mar 2013 [internet publication].[Full Text]
1. 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):S76-93.[Abstract][Full Text]
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
3. Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47:270-275.[Abstract]
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. Attwells S, Setiawan E, Wilson AA, et al. Inflammation in the neurocircuitry of obsessive-compulsive disorder. JAMA Psychiatry. 2017 Aug 1;74(8):833-40.[Abstract][Full Text]
26. 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]
27. 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]
28. 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]
29. 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]
30. 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]
31. Kar SK, Agrawal A, Silva-Dos-Santos A, et al. The efficacy of transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: an umbrella review of meta-analyses. CNS Spectr. 2024 Apr;29(2):109-18.[Abstract][Full Text]
32. Grassi G, Moradei C, Cecchelli C. Will transcranial magnetic stimulation improve the treatment of obsessive-compulsive disorder? A systematic review and meta-analysis of current targets and clinical evidence. Life (Basel). 2023 Jul 1;13(7):1494.[Abstract][Full Text]
33. Li K, Qian L, Zhang C, et al. Deep transcranial magnetic stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analysis of randomized-controlled trials. J Psychiatr Res. 2024 Dec;180:96-102.[Abstract]
34. Gregory ST, Goodman WK, Kay B, et al. Cost-effectiveness analysis of deep transcranial magnetic stimulation relative to evidence-based strategies for treatment-refractory obsessive-compulsive disorder. J Psychiatr Res. 2022 Feb;146:50-4.[Abstract]
35. Gerentes M, Pelissolo A, Rajagopal K, et al. Obsessive-compulsive disorder: autoimmunity and neuroinflammation. Curr Psychiatry Rep. 2019 Aug 1;21(8):78.[Abstract]
36. Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry. 2004;9:900-907.[Abstract]
37. Endres D, Pollak TA, Bechter K, et al. Immunological causes of obsessive-compulsive disorder: is it time for the concept of an "autoimmune OCD" subtype? Transl Psychiatry. 2022 Jan 10;12(1):5.[Abstract][Full Text]
38. 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]
39. 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]
40. 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]
41. 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]
42. 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.
43. 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]
44. Rapp AM, Bergman RL, Piacentini J, et al. Evidence-based assessment of obsessive-compulsive disorder. J Cent Nerv Syst Dis. 2016;8:13-29.[Abstract][Full Text]
45. Pampaloni I, Marriott S, Pessina E, et al. The global assessment of OCD. Compr Psychiatry. 2022 Oct;118:152342.[Abstract][Full Text]
46. Guy W, ed. ECDEU assessment manual for psychopharmacology. Rockville, MD: US Department of Health, Education, and Welfare; 1976.
47. 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]
48. 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]
49. 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]
50. Heyman I, Mataix-Cols D, Fineberg NA. Obsessive-compulsive disorder. BMJ. 2006 Aug 26;333(7565):424-9.[Abstract]
51. 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]
52. 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]
53. Pfohl B, Stangl DA, Zimmerman M. Structured Interview for DSM-II Personality Disorders (SIDP). Iowa City, Iowa: University of Iowa; 1982.
54. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.
55. 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]
56. American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Jul 2007 [internet publication].[Full Text]
57. Abudy A, Juven-Wetzler A, Zohar J. Pharmacological management of treatment-resistant obsessive-compulsive disorder. CNS Drugs. 2011 Jul;25(7):585-96.[Abstract]
58. Stanley MA, Turner SM. Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behav Ther. 1995;26(1):163-86.[Full Text]
59. 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]
60. 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]
61. 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]
62. 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]
63. American Psychiatric Association. Guideline watch (March 2013): practice guideline for the treatment of patients with obsessive-compulsive disorder. Mar 2013 [internet publication].[Full Text]
64. 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]
65. Reid JE, Laws KR, Drummond L, et al. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: a systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry. 2021 Apr;106:152223.[Abstract][Full Text]
66. 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]
67. 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]
68. 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]
69. 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]
70. 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]
71. 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]
72. 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]
73. 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]
74. Owen RT. Controlled-release fluvoxamine in obsessive-compulsive disorder and social phobia. Drugs Today (Barc). 2008 Dec;44(12):887-93.[Abstract]
75. 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]
76. 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]
77. 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]
78. 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]
79. 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]
80. 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]
81. 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]
82. Borue X, Sharma M, Hudak R. Biological treatments for obsessive-compulsive and related disorders. J. Obsessive Compuls. Relat. Disord. 2015 Jul 1;6:7-26.[Full Text]
83. 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]
84. 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]
85. 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]
86. 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]
87. Shusta SR. Successful treatment of refractory obsessive-compulsive disorder. Am J Psychother. 1999 Summer;53(3):377-91.[Abstract]
88. 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]
89. 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]
90. 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]
91. 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]
92. 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]
93. 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]
94. 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]
95. 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]
96. 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]
97. 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]
98. 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]
99. 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]
100. 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]
101. 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]
102. 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]
103. 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]
104. 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]
105. 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]
106. U.S. Food and Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Aug 2018 [internet publication].
107. 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]
108. Pallanti S, Marras A, Salerno L, et al. Better than treated as usual: transcranial magnetic stimulation augmentation in selective serotonin reuptake inhibitor-refractory obsessive-compulsive disorder, mini-review and pilot open-label trial. J Psychopharmacol. 2016 Jun;30(6):568-78.[Abstract][Full Text]
109. Kaster TS, Blumberger DM. Positioning rTMS within a sequential treatment algorithm of depression. Am J Psychiatry. 2024 Sep 1;181(9):781-3.[Full Text]
110. Donse L, Padberg F, Sack AT, et al. Simultaneous rTMS and psychotherapy in major depressive disorder: clinical outcomes and predictors from a large naturalistic study. Brain Stimul. 2018 Mar-Apr;11(2):337-45.[Abstract][Full Text]
111. 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]
112. Goodman WK, McDougle CJ, Price LH. Pharmacotherapy of obsessive-compulsive disorder. J Clin Psychiatry. 1992 Apr;(suppl 53):29-37.[Abstract]
113. 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]
114. 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]
115. 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]
116. 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]
117. 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]
118. 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]
119. 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]
120. 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]
121. 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]
122. 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]
123. 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]
124. 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]
125. 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]
126. 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]
127. 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]
128. Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003 Apr;14(2):225-35.[Abstract]
129. 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]
130. 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]
131. 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]
132. 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]
133. Mallet L, Mesnage V, Houeto JL, et al. Compulsions, Parkinson's disease, and stimulation. Lancet. 2002 Oct 26;360(9342):1302-4.[Abstract]
134. 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]
135. 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]
136. 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]
137. 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]
138. 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]
139. 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]
140. 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]
141. 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]
142. 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]
143. 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]
144. 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]
145. 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]
146. Hollander E, Dell'Osso B. Topiramate plus paroxetine in treatment-resistant obsessive-compulsive disorder. Int Clin Psychopharmacol. 2006 May;21(3):189-91.[Abstract]
147. 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]
148. 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]
149. 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]
150. 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]
151. 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]
152. Menkes DB. Buspirone augmentation of sertraline. Br J Psychiatry. 1995 Jun;166(6):823-4.[Abstract]
153. 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]
154. 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]
155. 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]
156. Farrell LJ, Waters AM, Tiralongo E, et al. Efficacy of D-cycloserine augmented brief intensive cognitive-behavioural therapy for paediatric obsessive-compulsive disorder: a randomised clinical trial. Depress Anxiety. 2022 Jun;39(6):461-73.[Abstract][Full Text]
157. Kvale G, Hansen B, Hagen K, et al. Effect of D-cycloserine on the effect of concentrated exposure and response prevention in difficult-to-treat obsessive-compulsive disorder: a randomized clinical trial. JAMA Netw Open. 2020 Aug 3;3(8):e2013249.[Abstract][Full Text]
158. 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]
159. 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]
160. 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]
161. 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]
162. 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]
163. 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]
164. 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]
165. 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]
166. Salazar de Pablo G, Pascual-Sánchez A, Panchal U, et al. Efficacy of remotely-delivered cognitive behavioural therapy for obsessive-compulsive disorder: an updated meta-analysis of randomised controlled trials. J Affect Disord. 2023 Feb 1;322:289-99.[Abstract][Full Text]
167. 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]
168. 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]
169. 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]
170. 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]
171. 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]
172. Aardema F, Bouchard S, Koszycki D, et al. Evaluation of inference-based cognitive-behavioral therapy for obsessive-compulsive disorder: a multicenter randomized controlled trial with three treatment modalities. Psychother Psychosom. 2022;91(5):348-59.[Abstract][Full Text]
173. Khodarahimi S. Satiation therapy and exposure response prevention in the treatment of obsessive compulsive disorder. J Contemp Psychotherapy. 2009;39:203-7.[Full Text]
174. 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]
175. 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]
176. Claus N, Miegel F, Jelinek L, et al. Perfectionism as possible predictor for treatment success in mindfulness-based cognitive therapy and metacognitive training as third-wave treatments for obsessive-compulsive disorder. Cogn Ther Res. 2023 Jun;47(3):439-53.[Full Text]
177. Philip J, Cherian V. Acceptance and commitment therapy in the treatment of obsessive-compulsive disorder: a systematic review. J Obsessive Compuls Relat Disord. 2021 Jan 1;28:100603.
178. Modarresi A, Chaibakhsh S, Koulaeinejad N, et al. A systematic review and meta-analysis: memantine augmentation in moderate to severe obsessive-compulsive disorder. Psychiatry Res. 2019 Dec;282:112602.[Abstract]
179. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - version 3. Part II: OCD and PTSD. World J Biol Psychiatry. 2023 Feb;24(2):118-34.[Abstract]
180. 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]
181. Kamath P, Reddy YC, Kandavel T. Suicidal behavior in obsessive-compulsive disorder. J Clin Psychiatry. 2007;68:1741-1750.[Abstract]
182. Balci V, Sevincok L. Suicidal ideation in patients with obsessive-compulsive disorder. Psychiatry Res. 2010;175:104-108. [Abstract]
183. Sernyak MJ. Implementation of monitoring and management guidelines for second-generation antipsychotics. J Clin Psychiatry. 2007;68:14-18.[Abstract]
184. Serretti A, Porcelli S. Antidepressant induced weight gain. BMJ. 2018 May 23;361:k2151.[Abstract]
